ABSTRACT
BACKGROUND: Prior studies have shown that Group Motivational Interviewing (GMI) for dually diagnosed patients holds promise for increasing treatment engagement. OBJECTIVES: The current study evaluated the impact of a novel GMI protocol that included tobacco-specific components (referred to as "Tobacco GMI or T-GMI") targeting enhanced engagement in smoking cessation treatment. METHODS: Thirty-seven primary alcohol and nicotine-dependent cigarette smoking homeless Veterans with co-morbid psychiatric conditions were recruited to receive four GMI sessions over 4 consecutive days. The first 16 participants received standard GMI, aimed at enhancing engagement in substance abuse treatment and for reducing substance use, while the remaining 21 participants received a modified "tobacco-specific" GMI protocol (T-GMI) that included additional content specific to cessation of tobacco use and enhancing smoking cessation treatment, in addition to the standard substance abuse content of GMI. RESULTS: Participants in T-GMI were more likely to attend tobacco cessation programming (p = .05), as well as to attend combined tobacco cessation programming with prescribed nicotine replacement therapy (p = .03), compared to those in standard GMI. Differences between treatment conditions with respect to alcohol and illicit drug use outcomes were not significant, although overall substance use declined over time in both groups. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Results suggest that inclusion of tobacco-specific components in the context of GMI for substance abuse may enhance treatment engagement for tobacco cessation behaviors among dually diagnosed nicotine dependent homeless patients, a highly vulnerable population for which interventional resources targeting engagement in smoking cessation treatment has historically been lacking. (Am J Addict 2016;25:533-541).
Subject(s)
Ill-Housed Persons/psychology , Motivational Interviewing/methods , Patient Compliance/psychology , Psychotherapy, Group/methods , Smoking Cessation/methods , Tobacco Use Disorder/therapy , Veterans Health , Adolescent , Adult , Aged , Combined Modality Therapy , Diagnosis, Dual (Psychiatry) , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Smoking Cessation/psychology , Tobacco Use Disorder/psychology , Treatment Outcome , United States , Veterans/psychology , Young AdultABSTRACT
BACKGROUND: Change talk (CT), or client speech in favor of change, is a hypothesized mechanism of action in motivational interviewing (MI) for substance use disorders. Although group-based treatment is the primary treatment modality for the majority of clients seeking substance use treatment, limited research has examined group motivational interviewing (GMI) among this population, and no study has examined CT within GMI. Therefore, in the current study we examined both standard CT (e.g., desire, ability, reason, need) and a novel phenomenon involving CT which we termed 'relatedness,' or the synergistic exchange of CT between and among group members. METHOD: Data were utilized from an ongoing randomized controlled trial (RCT) examining the effectiveness of GMI relative to a treatment control condition (TCC) among U.S. veteran outpatients with a primary alcohol use disorder at a Veterans Affairs hospital. A subsample of participants (n = 52) from the RCT were randomly assigned to receive GMI or TCC. The majority of participants in the subsample had co-existing psychiatric (88%) and dual diagnosis drug use disorders (38%). Two of four treatment sessions were coded by trained raters for CT and relatedness. RESULTS: Analyses demonstrated that CT and relatedness occurred with greater frequency in GMI compared to TCC, with effect sizes in the large range for each difference. Results held after controlling for number of group members in treatment sessions. CONCLUSIONS: Findings suggest that GMI is associated with more frequent CT and relatedness than TCC, consistent with the broader literature demonstrating the influence of MI on CT.
