The Inclusion Exclusion Criteria Health And Social Care Essay

METHODOLOGY

Objectives

The aim of this dissertation is to systematically review the evidence of the effectiveness of MI with offenders who are on treatment order or on mandated treatment for substance abuse.

This section of the review will include how data was source to develop the research question and the selection of key words to be used in the search process. This will also include the process of identifying articles to be included in the review and also how suitable materials were selected to be included.

This process will be carried out in a systematic way by first scoping the available literature using data bases such as Google scholar, Cinahl and Medline to have a broad feel of the literature available on the subject area as suggested by (Holland and Rees 2010).

Levac et al 2010 stated that scoping exercise is a useful method of mapping a wide range of literature to envisage the available literature in the field of heath care to determine where there is a gap and also where new approaches may arise. Arksey and Omally (2005) while developing a frame work for scoping methodology also stated that scoping can be used to determine the value for undertaking a full systematic review. However, for the purpose of this systematic review the scoping exercise was mainly used to envisage the available literature and to determine the gap that exist in the use of motivational interviewing in the treatment of substance abuse clients. The differences between a scoping methodology and a systematic review is that authors in scoping do not necessarily assess the quality of studies used in their analysis while in systematic review it is a recommendation that for the findings to be validated and reliable the studies used for the review have to be assess for their methodological quality.

After the scoping exercise a search question was formulated relating to the treatment of those with substance abuse problem who are mandated to treatment either through treatment order in the community, in schools or prisons. Evans (2001) stated that search question serves as a guide for the systematic review. He explained that the question guide the author in the search strategy and in the selection and review of articles. Cherly et al (2011) also mentioned that the research question has to be précised and not to narrow. A narrow question may lead to limited number of articles and also small population number. However, on the other hand if a research question is too broad, this may lead to the search capturing too many studies and a larger population size which may fail to detect the most important studies. This may result to the author not getting the relationship between the population, the intervention and the outcome which is of interest as confirmed by (Margaliot and Chung 2007).

The PICO framework developed by (Sackett et al. 1997) was used in the development of the research question because it is useful when formulating a review question on the effectiveness of a clinical intervention.

P refers to the population of interest which in this review is patients with substance abuse problems that are on treatment order or mandated treatment. I refer to the intervention or exposure which is to be evaluated. Cherly et al (2011) stated that this may include a treatment or diagnostic test and for this systematic review the intervention or treatment is motivational interviewing. C refers to the comparison of exposure or intervention. Cherly et al (2011) argue that the comparison may or may not be included in the research question while O refers to the outcome expected and this could include a disease, complication or a measure health as explained by (Dans et al 2008).

As a recommendation for the dissertation for the Master of Art program, the research question needed to be related to nursing practice, an issue that has risen from practice or an area of interest. The area of interest arise from when I was on clinical placement and came across patients who had substance abuse problems and where mandated to treatment either because they had committed a criminal offence or were inpatient in a mental health ward. Dealing with such patients group was a challenge to health professionals who were responsible for their treatment.

Search strategy

A comprehensive literature search was carried out using nursing, psychological, social, medical, and educational databases, including PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PUBMED/ MEDLINE, SCIE, SCOPUS, ProQuest, European Monitoring Centre for Drugs and Drug Addiction, The National Criminal Justice Reference Service databases and ERIC to identify peer-reviewed publications that reported results of motivational interviewing for offenders undergoing treatment on substance abuse. Additionally, the reference sections of identified articles and systematic reviews (Smedslunde et al 2011, McMurran 2009) were examined to glean additional articles. Further, a bibliography listing publications concerning MI available on a website maintained by the Motivational Interviewing Network of Trainers (http://motivationalinterview. org/) was also examined.

To avoid potential publication bias and database bias the search strategy was carried out beyond the traditional nursing databases such as CINAHL and Ovid MEDLINE and Embase. This wider range of database was used for the search due to the limited materials available in the nursing database and also to ensure that all the available materials relating to the review was cover.

The PICO framework was adapted in formulating key words for the search strategy.

Cherly et al (2011) explained that using PICO along with the inclusion and exclusion criteria will assist the author in the formulation of key words to be used in the search strategy.

Using the right keywords is relevant to allocating all published articles available relating to the systematic review as stated by Timmins and McCabe (2005). They also stated that if any key word from the research question is missed out from the search exercise essential materials will be missed and this could affect the quality of the review.

Holland and Rees (2010) suggested that you can only stop searching when the same articles keep repeatedly coming up during each search which indicated that the search exercise is saturated. However, Rudenson and Newton (1992) highlighted that the aim of the search is to develop an argument rather than developing a library.

Searches were conducted using a Boolean strategy for subject terms, full keywords and subheadings from the research question which were developed using the PICO Framework (Sackett et al. 1997).

The keywords developed from the research questions are related to the content of the subject of interest. Relevant subject terms such as motivational interviewing, substance abuse and treatment order were used in order to focus the search to the area of interest.

These subject terms were also assigned as the major subject or major concept so as to limit the search only to documents relating to these subject terms. However doing this may eliminate available articles which can improve the quality of the review. To solve this problem the search exercise was expanded by first doing a general heading search using the subject term or key words and then exploded by selecting subheadings relating to the major subject term. By using different subheadings relating to the major subject term and combining the subheading increases the final result from the search.

After the search for the different subject terms and keywords Boolean connectors such as (AND/OR) were used to combined the search to produced search results that were used for the selection of research articles to be included in the study. The reason for using Boolean connectors was to modify the value of the Boolean results and also in order to connect the different expressions or subject terms together. The same search strategy was used in the other databases search exercises. An example of the search exercise using CINAHL database is shown in appendix 1.

Inclusion/Exclusion Criteria

The development of a clear inclusion and exclusion criteria are determined by the research question and the available resources which will also help to define and set boundaries for the review (Parahoo 2006). He also stated that the criteria must be justified and their implementation for the validity of the review must be recognised. The criteria could also affect the quality of the review if certain criteria are set which might lead to the possibility that significant materials are missed. Also the inclusion and exclusion criteria will determine the generalisation of the findings from the review as this will affect the identification and selection of evidence (Parahoo 2006).

The inclusion criteria for this review included intervention studies examining the effectiveness of treatments described as motivational interviewing as this is the main exposure or intervention to be reviewed. However other modified forms of MI which are based on Miller and Rollnick principles of MI were also included. The primarily intervention should be motivational interviewing (MI) or motivational enhancement therapy (MET) and should be offered in either as a standalone therapy, integrated with another therapy, or as a prelude to another therapy. Individual, face-to-face interventions were included as well as group interventions. Interventions not given in person (e.g. computer-delivered or telephone interventions) were excluded because this do not follow the principles and spirit of MI. Because most psychosocial interventions have many unspecific elements in common, and because terms like "motivational intervention" and "motivational interview" not necessarily refers to Miller’s specific program of MI, only studies that where based on Miller’s MI were included.

Studies where units (persons, therapists, institutions) on mandated treatment were allocated randomly or quasi-randomly to motivational interviewing were included. Only studies published in or after 1983 where Included which was the year that MI was introduced by miller and Rollnick.

There was no limitation on length of study and also included studies that recruited participants both in the community, prison, schools and inpatients which provided one or more sessions of MI to offenders were also included. The choice of including participants from the community, prison and schools is that these are the most common areas where mandated substance abuse treatments usually take place.

Only English-language, peer-reviewed articles that used quantitative methods or randomized control trials to assess effectiveness were included in the review.

There were no limitations on age or other participant characteristics. The term substance refers to drug and alcohol abuse excluding nicotine and medication. The reason for excluding medication and nicotine is that those on treatment order or mandated treatment are usually having offences relating to drug and alcohol abuse.

All studies that were eligible for inclusion were appraised for methodological quality using the Holland and Rees (2010) structured critical framework for quantitative research articles. Parahoo (2006) stated that the quality of a research article is determined from its methodology. Holland and Rees (2010) stated that their quantitative frame work is used to identify the strength and weaknesses of the research articles. The framework recommend that the philosophical assumptions of the author, their method of data collection and the technique in which they use to analysis data can be a useful tool in finding out the type of the research study whether it is a quantitative or qualitative study. They also stated that when appraising a research article for quality we should look at the research question and the objective whether these are stated clearly and also if the research design use was the most appropriate for the phenomenon under study. In the framework Holland and Rees (2010) also recommended that for a research article to be considered for good quality the method of data collection should be constructed for the purpose of the current study and should have a face, content or form of validity. They also stated that the author should provide the information on sampling method which involves how the participants were recruited for the study.

The most important component of using a framework is to evaluate the appropriateness of the study design in relation to the research question and also the methodological features of the research design (Parahoo 2006). Holland and Rees (2010) also highlighted that when critically appraising quantitative studies for systematic review the author should look at the validity and reliability of the studies by checking whether the correct tool was used for data collection in order to mentioned rigour. The result of the systematic review will also depend on the results of the articles used in the review which are also determined by the tools used in data collection as confirmed by (Hart 2011).

In the critical appraisal of the methodological quality of the articles included in this review emphasis will be placed mostly on the type of data collection for quantitative research which has to be as accurate as possible in the way in which it measures the variables highlighted in the aims of the studies. Since most of the studies are Randomised Control Trail (RCT) both the dependent and independent variables in the studies have to be defined and also measured using a reliable tool. It is only when this is done that the researcher can achieve validity. It will also be useful to check that the tool of data collection has either been used in a previous study to ensure that it can produce consistent and accurate results and if it is a tool designed by the author that it has been piloted to ensure that the measurements are consistent as also suggested by (Holland and Rees 2010).

The framework also recommended that factors such as the suitability of the statistical methods used and their interpretation and potential sources of errors and limitations of the studied should also be considered.

Holland and Rees (2010) also mentioned that for a research study to be considered as good quality, the author needs to state how many participants are the results based on and if questionnaires where used what was the response rate and the dropout rate. Parahoo (2006) confirmed that these are essential for a good research study as it is likely to have an impact on the results. The author should also state the inclusion and exclusion criteria for selecting participants and limits should be stated to whom the results may apply and also whether there was any bias in the selection of samples.

Cheryl et al (2011) also highlighted that when a critical analysis research articles the authors of the articles should indicate whether they sorted any ethical approval and also if their findings answer the aims of their research.

Chapter 3

Results

This section of the review will include the result of the search strategy and a description and summary of the reviewed articles. This will also include a critical analysis using the Holland and Rees (2010) frame work to assess the methodology and results of all the articles.

The initial electronic database search of the literature resulted in a total of ……… articles (Appendix 2). Of these, …….. were selected as potential studies based on their titles and abstracts.

After the complete article was read, however, only ………. of these actually fulfilled the initial criterion. Thirty papers were excluded after reading the complete article.

Detailed information regarding each included study is provided in Table 1. Many of the included studies examined the effect of MI on mandated clients with multiple restricted substances simultaneously. Of the included studies, 21.4% (n _3) included an outcome measure for readiness and motivation to change substance abuse, 35.7% (n _ 5) examined abstinence from substance abuse and 42.9% (n _ 6) included studies that examine outcome on substance abuse treatment engagement and retention.

Description of Studies

Out of all the14 studies included in the review three of the studies evaluated the effects of MI on offender’s readiness and motivation to change and are summarized in Table1.

Readiness and motivation to change

Austin et al. (2011) evaluated the effectiveness of an adaptation of motivational interviewing known as the Short Motivational Program (SMP). The study was a quasi-experiment ( which is a combination of a qualitative and quantitative study) to evaluate the effect of SMP in enhancing the motivation to change of high risk offenders with index offenses including substance abuse prior to release from two New Zealand prisons. The program consisted of 40 high risk offenders who consented to take part in the study and a final 14 participants who were assessed at 3-12months follow up. The process measure for the intervention SMP to assessed the degree to which it was administered as intended to underpin the principles and spirit of MI was carried out. To ensure fidelity of the study, therapist delivering the sessions provided two audio-tape records of their SMP sessions which were coded with MITI for evaluation (Moyers et al., 2010). This is in accordance with the recommendation set out in the selection of tools to be used in assessment in research study. Holland and Rees (2010) recommended that for a research study to be of high standard, assessment tools should be those that have been used and tested in similar studies. MITI is an instrument designed to measure the degree to which the therapist is interacting with the participants based on the principles of MI. This assessment tool has been used and evaluated and has proved to be effective in the assessment of therapist fidelity (Moyers et al., 2010). However the fidelity of the process measure could have been more convincing if methods such as the live observation of client could have been used as it involves the assessor sitting on clinician interactions and coding in real time. This has the benefit of high external validity or generalizability of coding, as there is no opportunity for the clinician to select clients or interactions with specific characteristics.

Though the actual sample size reduced from initial 38 to 12 participants they used The University of Rhode Island Change Assessment Questionnaire (URICA) (DiClemente &Hughes, 1990) which was adapted by Anstiss (2003) to form the Short Motivational Programme Adaptation (SMP URICA) to measure participant’s motivation to change pre- and post-SMP. URICA is a validated assessment tool for the evaluating client’s level of motivation to change in substance abuse population.

They found out that the participants’ motivation to change significantly increased from pre- to post-SMP and a follow-up group showed this change was maintained 3-12 months after the treatment intervention. However though there was a positive treatment effect on the sample there was no control variable and the sample size was too small. Wood and Ross-Kerr (2006) highlighted that the in quantitative research the larger the sample size the closer the results will fit the study population. This might have an impact on the results and the reliability or validity of the findings since it was a quasi-experiment and also on the implementation of the findings to a larger population.

Another study by D’Amico et al. (2010) examined how adolescent who had committed drug and alcohol offences for the first time responded to a motivational interviewing (MI) group intervention. D’Amico et al. (2010) developed and tested a six-session curriculum called Free Talk and solicited feedback from different teens after each session. The group sessions were recorded and transcribed. Feedback was categorized using the Motivational Interviewing Treatment Integrity scale (MITI 3.0). The result from the feedback indicated high levels of evocation, collaboration, autonomy/support, and empathy among the teens. The current study highlights that utilizing group MI can be an acceptable approach for at-risk youth. The sample size used for the study was large enough to produced results that are near fit to the study but however, the outcome evaluation measure that was used to assess the participant’s feedback on the intervention was the MITI 3.0 was not the right assessment tool as MITI is used for process evaluation and not for evaluating treatment outcome. Using the right assessment tool is essential for the reliability of a study as this has a great impact on the findings. More reliable outcome evaluation tools such as the Timeline Follow-Back which recreates drinking or drug use patterns day by day which can be more reliable and can also give additional information about patterns of use (Hettema et al. 2008).

Easton et al (2000) studied the motivation to change substance use among offenders of domestic violence who were referred for mandated anger management classes from the court. They evaluated the effectiveness of motivational enhancement intervention (MEI) on offender’s readiness to change substance use. The participants for the study were recruited from two anger management groups. The two groups were randomly selected as the treatment group to receive MEI and the other to act as the control group. The control group was offered standard anger management classes only. A sample size of forty one male with age range of 18-64 were selected for the study and the selection was carried out using a self- reported version of the Schedules for Clinical Assessment of Neuropsychiatry (SCAN) . This self-reported assessment tool is based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders 4th ed used to assess substance related disorders.

The validity of any research study relating to substance misuse depend directly on the population used in the study which intend depend on the selection of the participants.

To determine whether an individual has symptoms of substance abuse or dependence will depend on the assessment tool used. Samet at al (2007) recommended that diagnostic interviews are the best procedure for accomplishing that. They recommended Structured Clinical Interview for DSM Disorders (SCID) which is a clinical interview that assesses a range of mental health disorders and contained a substance use disorders section which covers dependence and abuse for seven classes of substances. Interviewer lead assessment tools are the best in determining whether the symptoms of dependence or abuse have ever been present during the participants’ lifetime or during the last month and age when the first symptoms appeared. If dependence is current, the interviewer rates the current severity as mild, moderate, or severe.

The used of self-reported tools such as SCAN used in this study has the tendency of not accurately selecting the best participant for the study as they relying solely on the subject's judgment as to the presence or absence of abuse or dependence (Eaton et al 2000). They also highlighted that the potential for self-report assessment tools are only greatest when the results are not strictly dependent on the threshold for the presence or absence of the specific diagnosis. However in this study the results dependent solely on the present of substance abuse or dependence which might have had a great impact on the findings of the study.

They reported no significant difference between the groups in substance abuse and dependence from pre to post intervention. They used the brief motivation to change survey which was adopted from the Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES) developed by (Miller and Tonigan 1996). The used of an adapted tool needs to be tested first for its reliability and vigour in a preliminary study before been used in the main study. They report this was done, however they stated the preliminary study was carried out to show the relationship between treatment engagement and retention and not client’s motivation to change substance abuse which was the focus of the study. This might have impacted the results of their findings in addition to the fact that the final number of participants that were assessed post intervention had reduced from 41 to 9.

Table1. Evaluating Readiness and motivation to change

Author

Targeted population

Aim

Intervention

Sample size

Outcome measure

Length of follow-up

Austin et al. (2011)

New Zealand offenders in prison who are with high risk substance abuse

To enhance motivation to change high risk offender substance abuse

Five sessions of Short motivational program.

38

Motivation to change

12 months

D’Amico et al. (2010)

first-time alcohol or other drug (AOD) Teen offenders

To evaluate the effect of MI on youth offenders based on evocation and collaboration during sessions.

Group MI

101

Increased levels of evocation and collaboration

6 sessions

Easton et al. 2000

Mandated substance misuse rated domestic violence offenders

To assess substance use, violence, and motivation to change substance use behaviors.

Motivational Enhancement Intervention

41

Readiness to change substance use

Five of the studies aimed to improve motivation and confidence to abstain from substance use as shown in the summary in table 2. In a randomized trial carried with 92 offenders with driving while impaired, Brown et al. (2010) assigned 30 minutes of Brief Motivational Interviewing (BMI) with a control group of (DWI) who received only control information advice. Outcome measures were evaluated in terms of percentage of risky drinking days in the previous 6 months which were derived from the Timeline Followback evaluation framework, biomarkers of alcohol abuse through blood test and alcohol abuse related behaviour measured using the MMPI-Mac scale. They also use the Readiness to Change Questionnaire to evaluate participant outcome. Brown et al. (2010) found out that there was a significant reduction in risky drinking with both interventions at 6-12 months follow up, however BMI produced a significant and more important longer lasting reduction in risky drinking as compared to the control group. Their findings were based on self-report data which they reported was consistent with the finding they had from the biomarker of alcohol abuse and the score from the MMPI-Mac scale.

Stein et al. (2006) reported on an evaluation of whether MI compared with an attention control condition known as Relaxation Training (RT) enhances substance abuse treatment engagement in incarcerated youth offenders. They randomly assigned 139 youth offender with substance abuse problem to individual sessions of MI or RT for 90 minutes at baseline and 60 minutes at booster. The MI intervention was modified to be meaningful to the specific youth receiving the intervention. They also reported that the intervention consisted of four components namely, establishing rapport, assessing motivation for change, motivational enhancement, and establishing goals for change. The aim of the modification was to be person centred while at the same time maintaining the nonauthoritarian and nonjudgmental elements essential to MI. After the evaluation they found out that MI can be useful in enhancing treatment engagement in youth offenders during incarceration. They also found out that MI appears to affected engagement largely by decreasing negative engagement in treatment. However they did not find any statistical significant difference in positive treatment engagement in youths who received MI but the effect size was in the expected direction.

Another study carried out by Stein et al. (2011) to evaluate the impact MI on reducing risky behaviours on depressed mood incarcerated adolescent. 189 incarcerated adolescents were randomly assigned to receive MI as treatment intervention and the control group received Relaxation Training (RT) as a treatment. The outcome was assessed using the Risks and Consequences Questionnaire (RCQ) which measures problems associated with alcohol and marijuana use (missing school, relationship difficulty, etc.). The assessment was carried at baseline which covers 12 months pre-incarceration and at 3 months after release which was 90 days post-incarceration. Their results at 3 months follow-up assessment show a significant main effect of (p ≤ .007) for treatment group on risks and consequences for marijuana (RCQ-M), with participants in the MI intervention showing fewer problems on the RCQ-M than participants in the RT condition. Adolescent who received MI indicated fewer problems on the RCQA, as compared to RT participants.

Stein et al .(2010) carried out a study to test out the hypothesis that among hazardously drinking offenders who are women returning to the community, a brief alcohol intervention will result in less alcohol use at follow-up relative to standard of care.

Women offender with hazardous drinking habits were randomized to either an assessment-only condition or to two brief motivationally focused sessions, the first delivered during incarceration, the second 1 month later after community re-entry and the third at three months after released depending on whether the women were released or had a prolonged prison stay. The intervention was delivered individually in sessions lasting between 30-45 minutes. The women who were assigned to the control condition completed baseline, 1-, 3- and 6-month assessment visits only.

The women offenders were assessed on 90 days prior to their incarceration using the time-line follow-back (TLFB) method, The Short-Index of Problems (SIP) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) were also used to determine their drinking habits. At 3 and 6 months following the intervention they were reassessed and found out that there was a statistically significant on abstinent at 3 month while at 6 months there was not significant difference.

The choice of using three different assessment tools for the selection and evaluation of treatment outcome may introduce bias and impact on the validity and reliability of the study.

Woodall et al. (2007) also examined the effectiveness of MI on incarcerated first time offenders with DWI offenders who are primarily American Indian. They randomly assigned 305 participants who were in for the normal 28days of incarceration treatment program with MI. The 28 days treatment program consist of an alcohol abuse, and dependence component, a health and nutrition component, a psychological effects of alcohol abuse component, a drinking and driving awareness component, a stress management component, a goal-setting component in which clients devise an action plan for their immediate future, a family issues and alcohol component, a domestic violence component, an HIV/AIDS prevention component, and a work release program for clients who are employed. As part of their study they adapted the MI spirit and principles in the delivery of the treatment program.

Out of the 305 participants, 177 were assigned to the intervention and 128 as control to no treatment just incarceration. They used the Diagnostic Interview Schedule (DIS) to assess the presence of alcohol dependence and found out that the participant that received the intervention which consisted of MI style of counselling reported greater reduction in alcohol consumption from baseline levels as compared to the offenders who did not receive the intervention.

Table2. Treatment outcome evaluating abstinence

Author

Targeted population

Aims

Intervention

Sample

Outcome measure

Length of follow-up

Outcome

Brown et al. 2010

Driving while impaired offenders

To reduce risky drinking

Brief MI

92

6-12 months

Declines in risky drinking

Stein et al 2011

Incarcerated Adolescent

To reduced risk associated with marijuana use

MI

189

4-12

months

MI significantly reduced risks associated with marijuana use

Stein 2010

Drinking incarcerated women

To test the hypothesis that among hazardously drinking incarcerated women who are returning to the community, a brief alcohol intervention will result in less alcohol use at follow-up relative to standard of care.

Brief motivationally focused sessions

245

3-6

Months

Intervention effects on abstinent was statistically significant at 3 months and at 6 months the effect was attenuated and no longer statistically significant.

Woodall et al 2007

Stein et al 2006

First-time driving while intoxicated (DWI) offenders

Incarcerated adolescents with alcohol and marijuana related driving offense

Evidence on the effectiveness of MI on incarceration and first-time driving while intoxicated offenders

To reduce alcohol and marijuana-related driving events

MI

MI

305

105

6,12 and 24 months after discharged

Reported greater reductions in alcohol consumption from baseline levels compared with participants who were only incarcerated.

Carrol et al. (2006) carried a study to compared two individually applied treatments – motivational enhancement therapy (MET) with cognitive behavioural skills training (CBT) and drug counselling (DC) – with and without contingency management (CM). The treatments interventions were manualized and delivered as individual weekly sessions over an 8-week period. In the treatment group with CM, participants received vouchers to the value of $25 for the first session, and then increased by $5 per session up to session 8, and vouchers to the value of $50 for the first clear urine sample rising by $5 for each subsequent clear sample. Participants were assessed at baseline, weekly during treatment, at the 8-week treatment termination point, and at follow-up through 6 months. The weekly assessments were carried out through drug urine analysis as well as self-report of substance use collected via the Timeline Followback Method.

At the end of the study they found out that attendance was best for MET/CBT plus CM, followed by MET/CBM only, then DC plus CM, and DC only. Those who were assigned to CM were abstinent for longer time than those not assigned to CM, but there was no differential effect of treatment type (i.e. MET/CBT or DC). Overall, results somewhat favoured MET/CBT plus CM over the other three interventions.

The study conducted by Engle et al. (2010) examined the influence of change talk in the form of commitment language and peer group responses during the delivery of motivational interview intervention on marijuana use 12 months after treatment. The group sessions discussions were audio recorded, transcribed, and coded using the Motivational Interviewing Treatment Integrity (MITI) scale (Moyers et al. 2004). The results indicated that the more positive and less negative the peer responses, the greater the reduction in marijuana use. In addition, group leader empathy was associated with more positive commitment language and peer responses to commitment language. Results from this study suggest that MI can be effective in a group setting, but the study is limited by a lack of a control group.

Another study by Schmiege et al. (2009) uses a single session of group motivational enhancement therapy (MET) to augment an intervention targeting risky sexual behaviour among youth with alcohol problems in detention centres. MET is an adaptation of MI which includes one or more client feedback sessions with a normative feedback presented and discussed in an explicitly non- confrontational manner (Miller, 2000). In this study, youths were randomized to an augmented intervention which include component of addressing risky alcohol use and its relation to sexual risk-taking behaviour. Youth were provided with feedback regarding their alcohol use and a discussion followed using MET procedures. Fidelity checks were conducted throughout the study to ensure that material was covered and that facilitators were using MET. Three-month outcome data revealed that youth who received the session with the MET component showed greater reductions in sexual risk behaviour compared to youth in a control group that only received the sexual risk reduction intervention.

Another study by Sinha et al. (2003), which aimed to evaluate treatment attendance improvement of probation-referred drug user’s (marijuana) by using MET in addition to CM element in the form of vouchers to the value of $25, $35, and $45 for attending sessions one, two, and three, respectively. The 37 participants who received MET and CM attended more sessions than those who received MET only. At 1 month follow up, they found out that both groups reported a reduction in drug use and also reported fewer problems, and had improved motivation for change.

The study by Mullins et al. (2004) looked at the impact of MI on treatment retention of women with substance abuse problems who were referred to substance abuse treatment by the children welfare services. They randomly assigned 71 such women who used drug during pregnancy to either a three sessions of MI or to watch two educational videos during home visits. The MI sessions were carried out at time of randomisation, one week after that and again two months after. Treatments retention group attendance and urine analysis were used to evaluate treatment outcome. They found out that there was no significant difference in the treatment outcome for both participants who received IM and the educational videos.

Begun et al. (2011) carried out a longitudinal repeated-study with women in jail who have alcohol and drug problems. They randomly assigned 790 women either to the jail in-reach intervention condition which was delivered in a motivational interviewing format or a ‘‘treatment as usual’’ (TAU) group, which involved no additional jail services, resources, or guidance being offered to the woman. Their aim was to evaluate whether women who receive the jail in-reach intervention were more likely to report a decrease in alcohol and other substance use, as well as alcohol and substance abuse-related problems. The selection of women was carried out using the Alcohol Use Disorder Identification Test (AUDIT-12) which is a modification of the standard AUDIT which screen only for quantity and frequency of alcohol use. The AUDIT is a ten question screening tool identifying symptoms of hazardous, harmful, and dependent drinking that can be self-administered or given orally while the AUDIT-12 is a 12-item rapid screening measure of quantity, frequency, harmful use, and dependence for alcohol and drug use based on the original Alcohol Use Disorders Identification Test (Campbell et al., 2001).

The author’s decision to use a modified but straight forward assessment tool which reliability and validity has already been tested by other researchers eliminate the need for proving it reliability and validity instead there was just the case of outlining what the tool was. However they failed to mention if there was a pilot study carried out prior to the main study to establish if the chosen tool is clear and unambiguous relating to the study and also to ensure that the proposed study has been conceptually well planned (Coughlan et al 2007). However there are other more extensive tools such as the Structured Clinical Interview for DSM Disorders (SCID) which is a clinical assessment tool for a range of mental health disorders. The substance use disorder domains in the SCID are dependence and abuse for seven classes of substances: alcohol, sedative-hypnotics-anxiolytics, Cannabis (marijuana), Stimulants, Opioids, Cocaine, and Hallucinogens/ PCP (Samet et al 2007).

The jail in-reach intervention was incorporated in to the Screening Brief Intervention (SBI) using a motivational interviewing style. Out of the 468 women who were randomised into the intervention only 276 actually received the intervention and 261 into the TAU group. At two months after released on evaluation they found out that there was a lower AUDIT score among women who were randomly assigned to the intervention. As lower score of AUDIT indicates that there is a reduction in the use of alcohol and other substances. A higher score of about 8 usually indicates hazardous drinking habits (Barbor et al 2001). They concluded that the greater improvement could not be attributed to greater treatment engagement because that difference was not significant.

LaChance et al. (2009) studied the effect of Group Motivational Enhancement Therapy (GMET) on 5 putative mediators of readiness to change, self-efficacy, perceived risk, norm estimated and positive drinking expectancies of college students who were mandated to a university alcohol diversion program. 206 students were randomly assigned to either the standard 2 sessions of 3 hours of care which focuses on alcohol concerns educational group program, a single three hours session of GMET or a single three hours alcohol information only program. Treatment outcome used to evaluate treatment effect was the problem drinking behaviour which was evaluated looking at the average amount consumed per drinking occasion, hazardous drinking symptoms, and alcohol-related consequences.

Participant were assessed 3 and 6 months after for the 5 mediators and they found out that the results supported their hypothesis that GMET was superior to the other two alcohol educational treatment programs. They found out that at 3 and 6 months follow up the participants assigned to GMET sessions demonstrated significantly lower problem drinking outcomes, in terms of hazardous drinking symptoms, alcohol-related problems, and average drinks per drinking day, compared with those in the standard alcohol educational program.

Feldstein and Ginsbury (2006)

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