Program Profile: Motivational Interviewing (MI) for Substance Abuse Issues of Juveniles in a State Facility

This is a person-centered counseling method designed to foster motivation for change in youth who abuse alcohol and marijuana. The program is rated Ineffective. Participants showed a statistically significant reduction in likelihood to exhibit negative treatment engagement and drive under the influence of alcohol, compared with control youth; however, there were no significant differences in other outcomes such as positive treatment engagement or driving under the influence of marijuana.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

Motivational Interviewing (MI) is a counseling method that uses collaborative, client-centered, and goal-oriented communication to foster behavioral change in the individual. MI aims to address the key problem of ambivalence toward behavioral change that exists within individuals and encourage an internalization of the desire for change in the client. MI addresses personal motivation through the exploration and identification of the individual’s own reasons and desires for change.

Target Population

MI has been applied to many different contexts but is particularly used in the treatment of substance users and the problems related to substance use (e.g., driving under the influence). MI has been used to counsel juveniles in multiple areas, including substance use, smoking, eating disorders, sexual risk taking, managing illness and disability, and behavioral problems. MI has also been used in multiple settings, including state juvenile correctional facilities. 

Program Components

While MI is adapted to each individual and the specific behavioral problems that individual presents, it is a collaborative effort between the therapist and the individual to identify and forge a path to behavioral change using the latter’s own motivations. MI has several core components that guide this process:

• Engaging to establish a rapport and listening reflectively to understand the ambivalence and issues that the individual is presenting
• Guiding the individual to strategically concentrate on certain aspects of his or her behavior
• Evoking in the individual his or her own motivations for change through selective questions, responses, and summaries
• Planning a behavioral change in the individual and solidifying the individual’s commitment

Program Theory

MI is developed to act on the ambivalence that exists within an individual contemplating a behavioral change. A traditional argument for change by a therapist can be met by the argument for continuation by the individual. MI seeks to foster, encourage, and elicit the desire and motivation for change that already exists within the individual to drive future behavioral changes. MI adopts a client-centric approach, building a program and motivation for change within the individual in collaboration and partnership with the therapist, while respecting the individual’s autonomy in decision-making (Stein et al. 2006a).

Study

Stein and colleagues (2006a) examined participants from a northeastern State juvenile facility where adolescents were identified immediately following adjudication. To be included, participants had to be between the ages of 14 and 19, have been sentenced to between 4 and 12 months, have presented regular (or binge) marijuana or alcohol use (monthly or in the month before the offense or in the month before incarceration), and consent to participate (from parents, guardians, or adult adolescents). This study was part of a larger treatment outcome study. The sample (n = 130) was 34.6 percent African American, 28.5 percent Hispanic, and 30.8 percent white. Ninety percent were male. The average age was 17.16 years, and on average they had been incarcerated 2.92 times before the current imprisonment. Sixty-two percent of the sample qualified for alcohol use disorder, while 89 percent qualified for marijuana use disorder in the previous year. The sample was then randomized into a treatment group, who were administered Motivational Interviewing (MI), and a comparison group who received Relaxation Therapy (RT). The purpose of the study was to examine the effects of MI on youth engagement with substance use treatment.

The MI was administered by research counselors delivering the four components of MI adapted as appropriate to each adolescent. The RT was delivered by research counselors instructing participants on relaxation and meditation techniques and providing general advice and information on reducing risky behavior and alcohol and marijuana use. Both interventions were 90 minutes at baseline and 60 minutes at booster. Assessment was made at baseline and then at 2 months postadjudication. In addition to these interventions, adolescents received the standard services offered by the facility.

Adolescents receive group and individual treatment on a variety of behavioral problems (drug use, sex offending, violence prevention, anger management, etc.). Drug programs at the facility concentrate on increasing the adolescents’ knowledge of the negative effects of drug use, including HIV risks, mental, dental, and psychological services also are available.

The measures used at baseline by the study were a record review, a background questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (or DSM–IV). At the 2-month follow-up, the average daily behavioral rating was used (adolescents’ behavior is rated with a possible 100 points to accumulate per week) and a treatment participation questionnaire (evaluating their engagement at baseline and at 2-month follow-up). The authors performed Analysis of Covariance (ANCOVA) for each dependent variable (negative treatment engagement, positive treatment engagement, and behavioral ratings). The authors did not conduct subgroup analyses.

Study

Stein and colleagues (2006b) conducted a 3-month follow up to their first study. Of the 130 youth who comprised the sample in the original study (Stein et al. 2006a), 105 participated in the follow-up study. The follow-up sample was 34.3 percent African American, 27.6 percent Hispanic, and 32.4 percent white. They were 89.5 percent male, and their average age was 17.06 years old. Sixty-one percent of the sample qualified for alcohol use disorder, while 89 percent qualified for marijuana use disorder in the previous year.

Participants were randomly assigned to either the MI group (n = 59) or to a RT comparison group (n = 46). Assessment was made at baseline and then at 3 months postrelease. The measures used at baseline by the study were a record review, a background questionnaire, and the Structured Clinical Interview for DSM–IV. At both points in time, the Center for Epidemiological Studies—Depression Scale and the Risky Behaviors Questionnaire were administered (concentrating on DUI and being a passenger with a driver under the influence—PUI).

The methods applied to the data were Analysis of Covariance (ANCOVA) for each dependent variable (number of DUI–marijuana, DUI–alcohol, PUI–marijuana and PUI–alcohol), using baseline measure as a covariate with the intervention condition (MI or RT) and depressive symptoms as independent variables. The authors conducted subgroup analyses on depressive symptoms in relation to substance-using behaviors.

Subgroup Analysis

Stein and colleagues (2006b) conducted subgroup analyses on depressive symptoms in relation to substance-using behaviors. Motivational interviewing (MI) participants with low-depressive symptoms reported a statistically significant reduction in passenger-under-the-influence (PUI) alcohol events, compared with the relaxation therapy (RT) group. However, there were no statistically significant differences between the groups for adolescents with high-depressive symptoms. Within the MI group, there was a statistically significant finding for those with high-depressive symptoms: their PUI–alcohol scores were lower than the scores of those with low-depressive symptoms. There were no statistically significant differences between the MI group and the RT group in PUI–marijuana scores. However, within the RT group, adolescents with high-depressive symptoms reported a statistically significant reduction in PUI–marijuana events, compared with adolescents with low-depressive symptoms.

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Motivational Interviewing for Substance Abuse

A client-centered, semidirective psychological treatment approach that concentrates on improving and strengthening individuals’ motivations to change. The practice is rated Effective. Individuals in the treatment groups significantly reduced their use of substances compared to those in the no-treatment control groups.

Evidence Ratings for Outcomes

Drugs & Substance Abuse - Multiple substances

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?