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Intervention Summary

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Motivational Enhancement Therapy

Motivational Enhancement Therapy (MET) is an adaptation of motivational interviewing (MI) that includes normative assessment feedback to clients that is presented and discussed in a nonconfrontational manner. Motivational interviewing is a goal-oriented, client-centered counseling style for facilitating behavior change by helping clients to resolve ambivalence across a range of problematic behaviors. MET uses an empathic and strategic approach in which the therapist provides feedback that is intended to strengthen and consolidate the client's commitment to change and promote a sense of self-efficacy. MET aims to elicit intrinsic motivation to change substance abuse and other behaviors by evoking the client's own motivation and commitment to change, responding in a way that minimizes defensiveness or resistance.

Descriptive Information

Areas of Interest Substance abuse treatment
Outcomes Review Date: September 2007
1: Substance use
2: Alcohol consumption
3: Drinking intensity
4: Marijuana use
5: Marijuana problems
Outcome Categories Alcohol
Drugs
Social functioning
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Inpatient
Residential
Outpatient
School
Geographic Locations Urban
Suburban
Implementation History Motivational Enhancement Therapy and its precursor, the Drinker's Check-Up, have been implemented in at least 200 sites since 1985. Thousands of participants have received the MET intervention described in this summary, which has been evaluated in approximately 30 research studies. Outside the United States, MET has been implemented in the Netherlands, New Zealand, Norway, and the United Kingdom.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations Applications of motivational interviewing are described in detail in "Motivational Interviewing: Helping People Change (3rd Ed.)" by W. R. Miller and S. Rollnick (2012). Adaptations have been tailored to address a variety of health issues, such as diet and physical activity change, HIV risk prevention, smoking cessation, and medication compliance.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: September 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Ball, S. A., Martino, S., Nich, C., Frankforter, T. L., van Horn, D., Crits-Christoph, P., et al. (2007). Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics. Journal of Consulting and Clinical Psychology, 75(4), 556-567.  Pub Med icon

Study 2

Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol, 58(1), 7-29.  Pub Med icon

Study 3

Miller, W. R., Benefield, G., & Tonigan, J. S. (1993). Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. Journal of Consulting and Clinical Psychology, 61(3), 455-461.  Pub Med icon

Study 4

Stephens, R. S., Roffman, R. A., & Curtin, L. (2000). Comparison of extended versus brief treatments for marijuana use. Journal of Consulting and Clinical Psychology, 68(5), 898-908.  Pub Med icon

Study 5

Borsari, B., & Carey, K. B. (2000). Effects of a brief motivational intervention with college student drinkers. Journal of Consulting and Clinical Psychology, 68(4), 728-733.  Pub Med icon

Study 6

Brown, J. M., & Miller, W. R. (1993). Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. Psychology of Addictive Behaviors, 7, 211-218.

Outcomes

Outcome 1: Substance use
Description of Measures Substance use was defined as the self-reported number of days per week that the client used substances (marijuana, cocaine, alcohol, methamphetamine, benzodiazepines, opioids, or other drugs) using the Substance Use Calendar (SUC). The SUC is an interview assessment completed by a research assistant at each contact with the client. The SUC is adapted from Timeline Followback (TLFB) interview methods.
Key Findings MET and the counseling as usual (CAU) therapy sessions (three 50-minute sessions in each condition) both resulted in reductions in substance use during the 4-week therapy phase (p < .001). MET participants, however, sustained these reductions in substance use for the subsequent 12 weeks of follow-up, whereas CAU participants increased their use to their original, pretreatment levels.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 2: Alcohol consumption
Description of Measures Alcohol consumption was defined as the self-reported number of alcoholic drinks consumed per week by the study participant. The Drinker Profile structured interview employed by the investigators expresses participants' average weekly consumption in standard ethanol content (SEC) units. One SEC is equivalent to 0.5 ounces of pure ethyl alcohol.
Key Findings In one study, compared with wait-list control group participants, MET participants reported substantially lower alcohol consumption 7 weeks after treatment. These treatment effect sizes were of medium magnitude (Cohen's d = 0.54).

In another study, motivational interviewing with feedback (MET) was associated with greater reductions in client-reported alcohol consumption compared with a standard treatment approach (p < .001). The average number of weekly drinks (in SEC units) for the clients in the MET group was reduced from 95 before treatment to 19 following 3 months of treatment. In contrast, for clients who received standard treatment, the number of weekly drinks consumed dropped from 85 to 61.
Studies Measuring Outcome Study 3, Study 5, Study 6
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 3: Drinking intensity
Description of Measures In one study, drinking intensity was defined as the number of drinks consumed per drinking day (DDD). The DDD measure was obtained through periodic interviews in which the client retrospectively examined his or her last month of drinking. These estimates of alcohol use were obtained by means of the Form 90 interview procedure that combines calendar memory cues within a Timeline Followback methodology. In other studies, weekly peak blood alcohol concentration (BAC) was used as the measure of drinking severity/intensity. Using the Drinker Profile structured interview, estimates of weekly peak BAC were derived by computer projection to estimate the client's regular levels of intoxication.
Key Findings Each of the studies reviewed clearly demonstrated that MET reduced the intensity of client drinking behavior over the course of outpatient treatment. Among three treatment interventions investigated as part of a large, National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded, randomized multisite evaluation of alcohol treatment (Project MATCH), MET substantially reduced heavy drinking across the 1-year posttreatment period. This study, however, revealed few differences in main drinking outcomes by the type of treatment intervention employed (i.e., MET compared with Cognitive Behavioral Coping Skills Therapy [CBT] and Twelve-Step Facilitation Therapy [TSF]). In Project MATCH, it was noted that MET produced equally effective drinking outcomes using only 4 sessions (over the course of 12 weeks) compared with the 12 sessions employed by the other 2 comparison treatments (CBT and TSF).

In another study that examined MET versus usual treatment in a residential alcohol treatment setting, weekly peak BAC decreased significantly (p < .001), and clients increased their participation in treatment; however, the positive changes in drinking intensity were not specific to the MET treatment group.
Studies Measuring Outcome Study 2, Study 3, Study 6
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 4: Marijuana use
Description of Measures Marijuana use was defined as the number of times the client used marijuana on a typical day of use in the past 90 days. Clients reported their use on a 4-point scale: 0 = not at all; 1 = once; 2 = 2-3 times; 3 = 4-5 times; 4 = 6 or more times per day.
Key Findings Compared with clients receiving delayed treatment (i.e., the control group), participants in the MET group (in this study referred to as individualized assessment and advice [IAI]) and the relapse prevention support group (RPSG) reported fewer days of use and number of times using marijuana per day. This finding was observed at the 1-, 4-, 7-, 13-, and 16-month follow-ups when compared with pretreatment levels (p < .001 for all five follow-up points). There were no significant differences in outcomes between the RPSG and the MET groups at any follow-up point.
Studies Measuring Outcome Study 4
Study Designs Experimental
Quality of Research Rating 2.6 (0.0-4.0 scale)
Outcome 5: Marijuana problems
Description of Measures Marijuana problems were measured with a 19-item list of negative psychological, social, occupational, and legal consequences of use. The list was adapted from other drug use severity indices in common use. Items on the list were rated on a 3-point scale ranging from 0 (no problem) to 2 (a serious problem).
Key Findings Compared with clients receiving delayed treatment (control group), participants in the MET group (in this study referred to as individualized assessment and advice [IAI]) and relapse prevention support group (RPSG) reported fewer problems related to marijuana at 1-, 4-, 7-, 13-, and 16-month follow-ups when compared with pretreatment levels (p < .001 for all five follow-up points). There were no significant differences in outcomes between the RPSG and the MET groups at any follow-up point.
Studies Measuring Outcome Study 4
Study Designs Experimental
Quality of Research Rating 2.7 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
63% Female
37% Male
75% White
12% Black or African American
10% Hispanic or Latino
3% Race/ethnicity unspecified
Study 2 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
72% Male
28% Female
80% White
12% Hispanic or Latino
6% Black or African American
2% Race/ethnicity unspecified
Study 3 26-55 (Adult) 57.1% Male
42.9% Female
Data not reported/available
Study 4 26-55 (Adult) 77% Male
23% Female
95% White
5% Race/ethnicity unspecified
Study 5 18-25 (Young adult) 55% Female
45% Male
90% White
10% Race/ethnicity unspecified
Study 6 26-55 (Adult) 75% Male
25% Female
42.9% Hispanic or Latino
39.3% White
10.7% American Indian or Alaska Native
7.1% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Substance use 4.0 4.0 3.5 2.5 3.0 4.0 3.5
2: Alcohol consumption 3.5 3.5 2.9 4.0 3.0 3.0 3.3
3: Drinking intensity 3.3 3.8 3.5 3.9 2.9 3.4 3.5
4: Marijuana use 3.0 2.5 2.0 1.5 3.0 3.5 2.6
5: Marijuana problems 3.0 3.0 2.0 1.5 3.0 3.5 2.7

Study Strengths

The studies were very rigorous. The majority used random assignment and attended closely to issues related to quality of measurement and fidelity of implementation.

Study Weaknesses

Several studies had small samples, which limited conclusions in some instances due to lack of statistical power.

Readiness for Dissemination
Review Date: September 2013

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Allison, J., Bes, R., & Rose, G. (2012). Motivational Interviewing Target Scheme (MITS 2.1), an instrument for practitioners, trainers, coaches and researchers: Explanation and guidance. Hilversum, Netherlands: MiCampus. Retrieved from http://www.motivationalinterviewing.org/sites/default/files/MITS_2.1.pdf

Hester, R. K., Squires, D. D., & Delaney, H. D. (2005). The drinker's check-up: 12-month outcomes of a controlled clinical trial of a stand-alone software program for problem drinkers. Journal of Substance Abuse Treatment, 28(2), 159-169.  Pub Med icon

Lane, C. (2002). Behavior Change Counseling Index (BECCI): Manual for coding behaviour change counseling. Cardiff, United Kingdom: University of Wales, College of Medicine.

Madson, M. B., & Campbell, T. C. (2006). Measures of fidelity in motivational enhancement: A systematic review. Journal of Substance Abuse Treatment, 31(1), 67-73.  Pub Med icon

Martin, T., Moyers, T. B., Houck, J., Christopher, P., & Miller, W. R. (2005). Motivational Interviewing Sequential Code for Observing Process Changes (MI-SCOPE) coder's manual. Albuquerque, NM: University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions. Retrieved from http://casaa.unm.edu/download/scope.pdf

Martino, S., Ball, S. A., Gallon, S. J., Hall, D., Garcia, M., Ceperich, S., …. Hausotter, W. (2006). Motivational interviewing assessment: Supervisory tools for enhancing proficiency. Salem, OR: Northwest Frontier Addiction Technology Transfer Center, Oregon Health and Science University.

Miller, W. R. (1995). Motivational Enhancement Therapy with drug abusers. Albuquerque, NM: University of New Mexico, Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions. Retrieved from http://casaa.unm.edu/download/METManual.pdf

Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1994). Motivational Enhancement Therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence (NIH Publication No. 94-3723). Rockville, MD: National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Retrieved from http://casaa.unm.edu/download/MET.pdf

Miller, W. R., Moyers, T. B., Ernst, D., & Amrhein, P. (2003). Manual for the Motivational Interviewing Skill Code (MISC) 2.0. Albuquerque, NM: University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions. Retrieved from http://www.motivationalinterviewing.org/sites/default/files/MISC2.pdf

Miller, W. R., Moyers, T. B., & Rollnick, S. (2013). Motivational interviewing: Helping people change [2-DVD set]. Carson City, NV: The Change Companies.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.

Moyers, T. B., Martin, T., Manuel, J. K., Miller, W. R., & Ernst, D. (2010, January 22). Revised Global Scales: Motivational Interviewing Treatment Integrity 3.1.1 (MITI 3.1.1). Albuquerque, NM: University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions. Retrieved from http://www.motivationalinterviewing.org/sites/default/files/MITI%203.1.pdf

Rosengren, D. B. (2009). Building motivational interviewing skills: A practitioner workbook. New York: Guilford Press.

Web sites:

  • Motivational Interviewing Network of Trainers (MINT) Web site, http://www.motivationalinterviewing.org
  • SAMHSA Addiction Technology Transfer Center Motivational Interviewing Web site, http://www.motivationalinterview.org
  • University of New Mexico, Center on Alcohol, Substance Abuse, and Addiction Assessment Instruments Web site, http://casaa.unm.edu/Instruments

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.8 3.3 3.5 3.5

Dissemination Strengths

Extensive, high-quality implementation materials are available to support the development of motivational interviewing skills, an integral component of this intervention. Three early MET implementation manuals are available with detailed descriptions of how the protocols are delivered, along with process forms and assessment instruments. A variety of training tools and resources are available, including the Motivational Interviewing Network of Trainers (MINT), although most of these are MI resources, not specific to MET. An assortment of MI assessment tools is available to support quality assurance.

Dissemination Weaknesses

While materials on MI continue to be updated and refined, the standard MET manuals have not been updated. Existing training, support, and quality assurance resources focus primarily on MI, with few specifically designed for MET.

Review Date: September 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Miller, W. R. (1995). Motivational Enhancement Therapy with drug abusers. Albuquerque, NM: University of New Mexico, Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions. Retrieved from http://casaa.unm.edu/download/METManual.pdf

Miller, W. R., Rollnick, S., & Moyers, T. B. (1998). Motivational interviewing professional training [DVD]. Albuquerque, NM: University of New Mexico.

Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1994). Motivational Enhancement Therapy: A clinical research guide for therapists treating individuals with alcohol abuse and dependence (NIH Publication No. 94-3723). Rockville, MD: National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Retrieved from http://casaa.unm.edu/manuals/met.pdf

Motivational Interviewing Web site, http://motivationalinterview.org

Northwest Frontier Addiction Technology Transfer Center. (2006). Motivational interviewing assessment: Supervisory tools for enhancing proficiency (MIA-STEP). Salem, OR: Oregon Health and Science University, Department of Public Health and Preventive Medicine. Retrieved from http://www.nfattc.org/publicationsNewsResources/publications.aspx

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
4.0 3.3 3.8 3.7

Dissemination Strengths

This program has multiple well-written and easy-to-follow manuals and instructional videos to support implementation. Many comprehensive training and support resources are readily available to interested implementers. The MIA-STEP manual provides training materials, teaching tools, a practitioner self-assessment protocol, rating guides, and forms to support clinical supervision and quality assurance.

Dissemination Weaknesses

It is unclear how an interested implementer identifies an MET-specific trainer from the Motivational Interviewing Network of Trainers (MINT) list other than contacting each one individually. Minimal guidance is provided to implementers for measuring posttreatment outcomes.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence Free No
Motivational Enhancement Therapy With Drug Abusers (manual) Free No
Building Motivational Interviewing Skills: A Practitioner Workbook $39.10 each No
Motivational Interviewing: Helping People Change (3rd ed.) (book) $51.00 each No
Motivational Interviewing: Helping People Change (2-DVD set) $180.00 each No
Talking With College Students About Alcohol: Motivational Strategies for Reducing Abuse (book) $35.70 each No
On- or off-site training Varies depending on trainer selected and site needs No
On-site or phone technical assistance, consultation, and coaching Varies depending on consultant selected and site needs No
Quality assurance instruments Free No
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Babor, T. F., & The Marijuana Treatment Project Research Group. (2004). Brief treatments for cannabis dependence: Findings from a randomized multisite trial. Journal of Consulting and Clinical Psychology, 72(3), 455-466.  Pub Med icon

Carroll, K. M., Easton, C. J., Nich, C., Hunkele, K. A., Neavins, T. M., Sinha, R., et al. (2006). The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence. Journal of Consulting and Clinical Psychology, 74(5), 955-966.  Pub Med icon

Peterson, P. L., Baer, J. S., Wells, E. A., Ginzler, J. A., & Garrett, S. B. (2006). Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents. Psychology of Addictive Behaviors, 20(3), 254-264.  Pub Med icon

Santa Ana, E. J., Wulfert, E., & Nietert, P. J. (2007). Efficacy of group motivational interviewing (GMI) for psychiatric inpatients with chemical dependence. Journal of Consulting and Clinical Psychology, 75(5), 816-822.  Pub Med icon

Tevyaw, T. O., Borsari, B., Colby, S. M., & Monti, P. M. (2007). Peer enhancement of a brief motivational intervention with mandated college students. Psychology of Addictive Behaviors, 21(1), 114-119.  Pub Med icon

Walker, D. D., Roffman, R. A., Stephens, R. S., Wakana, K., Berghuis, J., & Kim, W. (2006). Motivational enhancement therapy for adolescent marijuana users: A preliminary randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 628-632.  Pub Med icon

Contact Information

To learn more about implementation or research, contact:
William R. Miller, Ph.D.
wrmiller@unm.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):