Beyond face-to-face individual counseling: A systematic review on alternative modes of motivational interviewing in substance abuse treatment and prevention

Highlights

• Telephone motivational interviewing (MI) is promising across addictive behaviors.

• Effectiveness of SMS-based MI and Internet-based MI in treating substance abuse remains inconclusive and unclear.

• Group MI's effectiveness for treating substance abuse is controversial.

• More studies are needed on alternative modes of MI for treating substance abuse.

Abstract

Objectives

This systematic review aimed to synthesize the evidence on the effectiveness of motivational interviewing (MI), delivered in modes other than face-to-face individual counseling, in preventing and treating substance abuse related behaviors.

Methods

Four databases (PubMed/MEDLINE, PsycINFO, ISI Web of Science and Cochrane Library) were searched for randomised clinical trials (RCTs) that evaluated the effectiveness of alternative modes of MI (other than face-to-face individual counseling) in preventing and treating substance abuse. Eligible studies were rated on methodological quality and their findings were qualitatively synthesized.

Results

A total of 25 articles (on 22 RCTs) were eligible for this review. Beyond face-to-face counseling, telephone was the most frequently used medium for delivering MI (11 studies), followed by Internet communication (4 studies) and short message service (SMS) (2 studies). Mail was incorporated as a supplement in one of the studies for telephone MI. In contrast to one-to-one individual counseling, group MI was adopted in 5 studies. The effectiveness of telephone MI in treating substance abuse was supported by all of the published RCTs we located. Internet-based MI was effective in preventing and treating alcoholism, but its outcome appeared to be inconsistent for smoking cessation and poor for abstinence from illicit drugs. SMS-based MI appeared to be useful for controlling tobacco and drinking. Group MI was attempted for quitting alcohol and drugs, with mixed findings on its outcomes.

Conclusions

Collectively, the studies reviewed indicate that telephone MI is a promising mode of intervention in treating and preventing substance abuse. The effectiveness of other alternative modes (SMS-based MI, Internet-based MI and group MI) remains inconclusive given the controversial findings and a limited number of studies. By synthesizing the currently available evidence, this systematic review suggested that telephone MI might be considered as an alternative to face-to-face MI for treating and preventing substance abuse. Further research is needed to investigate the effectiveness of SMS-based MI, Internet MI, group MI and other alternative modes. Studies with methodological rigor and incorporating MI fidelity measures have great potential to advance the understanding in this field.

Introduction

Substance use disorders, commonly known as substance abuse and substance dependence, are defined as “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems” (American Psychiatric Association, 2013). It was estimated by the United Nations that 162 million to 324 million people aged 15-64 years (3.5% to 7.0% of the global population) have used an illicit drug, whereas approximately 183,000 drug-related deaths were reported (United Nations Office on Drugs and Crime, 2014). Use of tobacco and alcoholism are other two common substance abuse problems. World Health Organization (WHO) indicated that more than 208 million people suffered from alcoholism (WHO, 2014). The harmful use of alcohol is considered as one of the top five risk factors for disease, disability and mortality (Lim et al., 2012, World Health Organization, 2011a). It causes around 3.3 million deaths per year, accounting for 5.9% of all deaths (WHO, 2014). It was also reported that 21% of the world's population aged 15 years and older smoked tobacco (WHO, 2015). Around 6 million deaths every year are the result of direct tobacco use or being exposed to second-hand smoke (WHO, 2011b). In general, substance abuse remains a serious problem worldwide and deserves further administrative, academic and public attention.

Motivational interviewing (MI) is a collaborative conversation style for strengthening a person's own motivation and commitment to change (Miller & Rollnick, 2013). It was initially introduced for treating substance abuse and was later expanded to changing many other health-related behaviors (Emmons and Rollnick, 2001, Miller, 1983, Resnicow et al., 2002). MI is typically done in one-to-one counseling through face-to-face sessions (Miller & Rollnick, 2009). Individual face-to-face MI has proven to be an effective method for helping people cut down or stop using drugs, alcohol and tobacco. A systematic review and meta-analysis showed that face-to-face MI had a stronger effect in treating substance abuse as compared with negative controls, although the difference was not significant when compared with treatment as usual or at long-term follow-ups (Smedslund et al., 2011).

Despite its encouraging effectiveness, face-to-face individual MI is considered labor-intensive, time-consuming and impractical under some circumstances (Carey, Scott-Sheldon, Elliott, Garey, & Carey, 2012). Other modes of MI have been explored as alternatives and are believed to have several theoretical advantages. Using telephone and Internet as alternative media of communication, access to hard-to-reach groups may be easier and it creates better privacy and less embarrassment in some cases (Bennett et al., 2008, Picciano et al., 2007, Roffman et al., 1997, Tate and Zabinski, 2004). In addition, Internet communication may be particularly relevant among younger generations since it has become an important channel that they interact with the world (Escoffery et al., 2005). In contrast to individual counseling, group MI has been introduced to engage more than one client suffering from the similar substance-related problems and is supposed to be potentially cost-effective and more efficient (Naar-King & Suarez, 2011). The assumptions on the potential of alternative modes of MI need to be tested in empirical studies. To the best of our knowledge, there is no published review on the effectiveness of alternative modes of MI. This review aims to systematically search for and synthesize the existing evidence collected through randomized controlled trials (RCT) on the effectiveness of alternative modes of MI in preventing and treating substance abuse.