School-based health center intervention improves body mass index in overweight and obese adolescents.

Adolescents Committed to Improvement of Nutrition and Physical Activity (ACTION) was undertaken to determine feasibility of a school-based health center (SBHC) weight management program. Two urban New Mexico SBHCs were randomized to deliver ACTION or standard care. ACTION consisted of eight visits using motivational interviewing to improve eating and physical activity behavior. An educational nutrition and physical activity DVD for students and a clinician toolkit were created for use as menu of options. Standard care consisted of one visit with the SBHC provider who prescribed recommendations for healthy weight. Sixty nondiabetic overweight/obese adolescents were enrolled. Measures included BMI percentile, waist circumference, insulin resistance by homeostasis model assessment (HOMA-IR), blood pressure, triglycerides, and HDL-C levels. Pre- to postchanges for participants were compared between groups. Fifty-one students (mean age 15 years, 62% female, 75% Hispanic) completed pre- and postmeasures. ACTION students (n = 28) had improvements in BMI percentile (P = 0.04) and waist circumference (P = 0.04) as compared with students receiving standard care (n = 23). No differences were found between the two groups in blood pressure, HOMA-IR, triglycerides, and HDL-C. The ACTION SBHC weight management program was feasible and demonstrated improved outcomes in BMI percentile and waist circumference.

Smoking cessation during substance abuse treatment: what you need to know.

Patients in substance abuse treatment frequently smoke cigarettes and often die of tobacco-related causes. Substance abuse treatment programs too often ignore tobacco use. Many patients have expressed interest in stopping smoking, although they may be ambivalent about smoking cessation during substance abuse treatment. This article provides a review of tobacco cessation literature and successful methods of intervention. Research supports two key findings: (a) smoking cessation during substance abuse treatment does not impair outcome of the presenting substance abuse problem and (b) smoking cessation may actually enhance outcome success. We will discuss how to incorporate smoking cessation.

A randomized trial of methods to help clinicians learn motivational interviewing.

The Evaluating Methods for Motivational Enhancement Education trial evaluated methods for learning motivational interviewing (MI). Licensed substance abuse professionals (N = 140) were randomized to 5 training conditions: (a) clinical workshop only; (b) workshop plus practice feedback; (c) workshop plus individual coaching sessions; (d) workshop, feedback, and coaching; or (e) a waiting list control group of self-guided training. Audiotaped practice samples were analyzed at baseline, posttraining, and 4, 8, and 12 months later. Relative to controls, the 4 trained groups showed larger gains in proficiency. Coaching and/or feedback also increased posttraining proficiency. After delayed training, the waiting list group showed modest gains in proficiency. Posttraining proficiency was generally well maintained throughout follow-up. Clinician self-reports of MI skillfulness were unrelated to proficiency levels in observed practice.

La terapia motivacional en el tratamiento del tabaquismo / Motivational therapy in the treatment of smoking

Este artículo explica de forma reducida los principios básicos de la terapia motivacional, uno de los abordajes terapéuticos para el tratamiento de las adicciones más novedoso de la última década y revisa los estudios existentes en la literatura respecto a su utilidad y eficacia. Curiosamente siendo el tabaquismo una de las patologías adictivas para las que primero se diseñó la terapia motivacional es la adicción para la que encontramos menos estudios controlados y en la que es más difícil demostrar su eficacia (AU)

This review article describes one of the newest approaches to drug dependence treatment the Motivational Interviewing Therapy and reviews the studies published in the literature about its utility and efficacy. To date few controlled clinical trials of Motivational Therapy for smoking have been published and little empirical evidence for its efficacy can be presented. Although all the studies show a positive tendency and a sure cost efficacy benefit (AU)

Client commitment language during motivational interviewing predicts drug use outcomes.

Client language from a motivational interview (MI) and drug use outcome were investigated. Interview videotapes of 84 drug abusers were coded for frequency and strength of utterances expressing commitment, desire, ability, need, readiness, and reasons to change or maintain their habit. Cluster analysis of proportion days abstinent (PDA) revealed 3 groups: high PDA at intake and follow-up (3, 6, 9, 12 months; maintainers); low intake PDA/high follow-up PDA (changers); and low intake PDA/low to moderate follow-up PDA (stragglers). Distinct group patterns emerged for commitment strength (CS) during MI. Clients dishonest in checklist self-report exhibited CS similar to stragglers. CS for client evaluation of a change plan predicted outcome PDA. CS was predicted by strength of desire, ability, need, and reasons, but more strongly predicted outcome PDA, suggesting CS is a pathway for their influence on behavior.

Motivational interviewing in drug abuse services: a randomized trial.

Motivational interviewing (MI) is a directive, client-centered brief intervention to elicit behavior change by helping clients explore and resolve ambivalence. In this clinical trial, 152 outpatients and 56 inpatients entering public agencies for treatment of drug problems were randomly assigned to receive or not receive a single session of manual-guided MI. Drug use was assessed by self-report, urine toxicology, and collateral reports from significant others at baseline, 3, 6, 9, and 12 months. Contrary to prior reports, MI showed no effect on drug use outcomes when added to inpatient or outpatient treatment, although both groups showed substantial increases in abstinence from illicit drugs and alcohol.

Magdalena Pilot Project: motivational outreach to substance abusing women street sex workers.

The Magdalena Pilot Project provided outreach to Albuquerque women sex workers who were also using illicit drugs, primarily cocaine and heroin. This initial uncontrolled trial evaluated the feasibility and potential impact of motivational interviewing (MI) on change in drug use and HIV risk behaviors. Twenty-seven women were enrolled and interviewed about their substance use, health risk behaviors, and plans for change, using the client-centered, directive method of MI. Four months later, 25 women (93%) were interviewed again to assess their drug use and health risk behaviors. Large reductions were reported in frequency (days) of drug use and sex work, with a corresponding increase in days of lawful employment. In identifying problems that most needed to be addressed in order to help them live healthier lives, the women prioritized (1) basic needs including decent housing, (2) mental health care, and (3) treatment for substance use disorders.