Motivational Interviewing, Second Edition by Miller William R

Author:Miller, William R. [Miller, William R.]
Language: eng
Format: mobi
ISBN: 9781606238233
Publisher: Guilford Press
Published: 2002-04-11T16:00:00+00:00

AMIs for Alcohol Problems: Discussion

There is cause for optimism regarding the value of AMIs in the treatment of alcohol problems. In general, AMIs have yielded noticeable effects in this domain with relatively small interventions (often no more than a session or two). Furthermore, the positive results of the AMI interventions are sometimes seen as soon 6 weeks posttreatment (e.g., Borsari & Carey, 2000; Miller et al., 1993) and are detectable in follow-ups of up to 4 years (Marlatt et al., 1998).

Moreover, most of these studies have been methodologically rigorous. Almost all of the studies (except Brown & Miller, 1993, and Heather et al., 1996) used true randomization as a means of equating groups of clients before treatment. The dependent measures were focused and precise, targeting pertinent areas of outcome (i.e., alcohol consumption) directly, while some studies also employed secondary outcome measures of auxiliary drinking behaviors and drinking-related consequences. In all of these studies except for Monti and colleagues (1999), Borsari and Carey (2000), and Gentilello and colleagues (1999), the main dependent variables were collateralized so that self-report drinking data could be corroborated, with collateral and self-report measures generally showing high correlations (e.g., correlations exceeding.90 in Brown & Miller, 1993). Furthermore, the majority of alcohol consumption measures used in the studies were derived from self-report questionnaires that have shown good reliability and validity in previous research (e.g., Form 90, Tonigan et al., 1997; AUI, Skinner & Allen, 1983), as well as consistency with laboratory-derived, biological consumption markers (e.g., O’Farrell & Maisto, 1987; Project MATCH, 1997b). Finally, with but one exception (Gentilello et al., 1999), there has been little subject attrition.

In addition to being a sound design aspect, the measurement of collaterals constitutes a key element of these AMI studies: If important others are noticing the client’s change in alcohol consumption, then this is likely to be a meaningful change. Moreover, clinical significance is bolstered by the frequent findings that reduction in consumption is associated with other key behavior changes like decreased hospital visits for alcohol-related trauma (Gentilello et al., 1999; Monti et al., 1999), reduced moving violations (Monti et al., 1999), less absence from work (Project MATCH, 1997b), and improved social functioning (Marlatt et al., 1998). These results show promise for AMIs as an intervention with broad-based effects that can precipitate widespread life changes beyond the target problem (Miller, Hedrick, & Taylor, 1983).

Taken together, these studies provide evidence for the clinical utility of AMIs with problem drinkers in a variety of settings—hospitals (Brown & Miller, 1993; Gentilello et al., 1999; Heather et al., 1996; Monti et al., 1999), outpatient clinics (Handmaker et al., 1999; Miller et al., 1993; Project MATCH, 1997b), and even college campuses (Borsari & Carey, 2000; Marlatt et al., 1998)—as well as with both men and women. While selection criteria have varied across studies, most have employed participants who were having serious life problems relating to their alcohol use.

One major shortcoming in most of these studies bears further scrutiny. While the dependent variables are clearly specified in almost

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