High-Quality Motivational Interviewing Skills In Brief Interventions for Drug Use In Primary Care Are Not Associated with Better Outcomes

Motivational interviewing (MI) is a strategy to address unhealthy drug use that is often employed as part of screening and brief intervention. However, the evidence for its efficacy in primary care is limited and even less is known about the association between the quality of MI skills and patient outcomes. A recent randomized controlled trial examined the efficacy of 2 types of brief interventions for unhealthy drug use among primary care patients identified through screening. One intervention was a brief intervention based on MI (BNI); the other a more intensive intervention that also used MI techniques (MOTIV). The original study found that these interventions did not have a significant effect on drug use at 6 weeks and 6 months. For this study, the researchers graded the quality of these interventions based on review of recordings and analyzed the association between the quality of the intervention and outcomes.

• There were 171 participants in this study; 69% were male and 63% reported marijuana as their main drug.
• On multivariable analyses, there was little evidence that ratings of the quality of MI skills for either intervention were associated with drug use at 6 weeks or 6 months.

Comments:

This study suggests that a brief intervention is insufficient to address unhealthy drug use in primary care, no matter how well it is delivered. For most individuals with substance use disorder, and perhaps even for those with risky use, the problem is probably better approached like other chronic conditions, with longitudinal care over an extended period of time. MI techniques may prove to be effective in this context.

Darius A. Rastegar, MD

Reference:

Palfai TP, Cheng DM, Bernstein JA, et al. Is the quality of brief motivational interventions for drug use in primary care associated with subsequent drug use? Addict Behav. 2016;56:8–14.