Icmi discussant presentation trimmed

Editor's Notes

• #2: Helpful to compare MI trialsto another brief intervention for alcohol abuse (may be like MI in some important ways)Set of 5 randomized studies. Average intervention time, about 30 minutes. Average number of contacts, 2.In most cases, interventionists were highly trained (but not always, some computer)When done in person, strong emphasis on empathy (trust), eliciting (coming from client, deep content, client thinking about drinking)Effect sizes on risky drinking are similar to those of other brief interventions. The five studies above have reported average effect sizes of d=0.196 for drinks per drinking day (DDD) and an odds ratio of 2.24 for reporting a non-problematic AUDIT score (i.e., <8). Would it surprise you to know that these are 5 randomized trials of assessment reactivity? That is, in each case this was a randomized test of asking questions about drinking (but providing no formal intervention). But the rest of the story is true. Interventionists, for the most part highly trained. Emphasis on empathy, eliciting, depth of processing. Sound like another approach you know?
• #3: CTN 4, test of 3 session MET vs. TAU for increasing retention and reducing SA. 5 outpatient sites. At 16 weeks, an advantage for MET over TAU for alcohol users, but not drug users. Consulted original publications, estimated each MI/MET session at 60 minutes. Estimated assessment time conservatively from measures described (typically self report, urine, breath)MET and TAU each 3 sessions (chart assumes that TAU has no therapeutic value, and thus no time). Also ignoring the substantial assessment conducted by the CTP, and any group tx or self help groups attended.
• #4: CTN 5, test of standard intake vs. MI enhanced intake. 5 outpatient sites. MI produced better tx retention throughout 28 day tx, but no effects of MI at either followup. Consulted original publications, estimated MI/MET session at 60 minutes. Estimated assessment time conservatively from measures described (typically self report, urine, breath)Ignoring the substantial assessment conducted by the CTP, and any group tx or self help groups attended.
• #5: CTN 13, test of 3 session MET vs. TAU for increasing retention in SA program. 4 outpatient sites. At 4 weeks, decreased SA in both groups with no differences between groups. Trend towards effect of MI in minority participants. Consulted original publications, estimated each MI/MET session at 60 minutes. Estimated assessment time conservatively from measures described (typically self report, urine, breath)MET and TAU each 3 sessions (chart assumes that TAU has no therapeutic value, and thus no time). Also ignoring the substantial assessment conducted by the CTP, and any group tx or self help groups attended.
• #6: Just looking at difference between groups may obscure findings about when change occurs. In CTN 13, baseline occurred approx 1 week before first session, so if look at the timing of change, can see that most of the change happens during the point between the baseline assessment and randomization (this point) and not the “active” treatment phase. Pretx: dropping from an average of use on 30.5% of days during baseline to 16.7% of days during the pre-treatment phase. Much greater than change during the “active” phase. Note that cigarettes (not a target of the study) so serves as a control for reporting bias.