Intervention Summary

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Motivational Enhancement Therapy

Motivational Enhancement Therapy (MET) is an adaptation of motivational interviewing (MI) that includes one or more client feedback sessions in which normative feedback is presented and discussed in an explicitly nonconfrontational manner. Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve their ambivalence and achieve lasting changes for a range of problematic behaviors. This intervention has been extensively tested in treatment evaluations of alcohol and other drug use/misuse. MET uses an empathic but directive approach in which the therapist provides feedback that is intended to strengthen and consolidate the client's commitment to change and promote a sense of self-efficacy. MET aims to elicit intrinsic motivation to change substance abuse by resolving client ambivalence, evoking self-motivational statements and commitment to change, and "rolling with resistance" (responding in a neutral way to the client's resistance to change rather than contradicting or correcting the client).

Descriptive Information

Areas of Interest	Substance abuse treatment
Outcomes	Review Date: September 2007 1: Substance use 2: Alcohol consumption 3: Drinking intensity 4: Marijuana use 5: Marijuana problems
Outcome Categories	Alcohol Drugs Social functioning
Ages	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	Inpatient Residential Outpatient School
Geographic Locations	Urban Suburban
Implementation History	Motivational Enhancement Therapy and its precursor, the Drinker's Check-Up, have been implemented in well over 200 sites since 1985. Thousands of participants have received the MET intervention described in this summary, which has been evaluated in approximately 30 separate research studies. Outside the United States, MET has been implemented in the Netherlands, New Zealand, Norway, and the United Kingdom.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	Specific applications and adaptations of motivational interviewing are described in detail in "Motivational Interviewing: Preparing People for Change (2nd Ed.)" by W. R. Miller and S. Rollnick (2002). Specific adaptations have been tailored to address a variety of health issues, such as diet and physical activity change, HIV risk prevention, smoking cessation, and medication compliance. The authors describe in detail how far motivational interviewing can be adapted "before its goals, skills, and spirit are diluted beyond recognition."
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Review Date: September 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 6

Brown, J. M., & Miller, W. R. (1993). Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. Psychology of Addictive Behaviors, 7, 211-218.

Outcomes

Outcome 1: Substance use
Description of Measures	Substance use was defined as the self-reported number of days per week that the client used substances (marijuana, cocaine, alcohol, methamphetamine, benzodiazepines, opioids, or other drugs) using the Substance Use Calendar (SUC). The SUC is an interview assessment completed by a research assistant at each contact with the client. The SUC is adapted from Timeline Followback (TLFB) interview methods.
Key Findings	MET and the counseling as usual (CAU) therapy sessions (three 50-minute sessions in each condition) both resulted in reductions in substance use during the 4-week therapy phase (p < .001). MET participants, however, sustained these reductions in substance use for the subsequent 12 weeks of follow-up, whereas CAU participants increased their use to their original, pretreatment levels.
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.5 (0.0-4.0 scale)

Outcome 2: Alcohol consumption
Description of Measures	Alcohol consumption was defined as the self-reported number of alcoholic drinks consumed per week by the study participant. The Drinker Profile structured interview employed by the investigators expresses participants' average weekly consumption in standard ethanol content (SEC) units. One SEC is equivalent to 0.5 ounces of pure ethyl alcohol.
Key Findings	In one study, compared with wait-list control group participants, MET participants reported substantially lower alcohol consumption 7 weeks after treatment. These treatment effect sizes were of medium magnitude (Cohen's d = 0.54). In another study, motivational interviewing with feedback (MET) was associated with greater reductions in client-reported alcohol consumption compared with a standard treatment approach (p < .001). The average number of weekly drinks (in SEC units) for the clients in the MET group was reduced from 95 before treatment to 19 following 3 months of treatment. In contrast, for clients who received standard treatment, the number of weekly drinks consumed dropped from 85 to 61.
Studies Measuring Outcome	Study 3, Study 5, Study 6
Study Designs	Experimental, Quasi-experimental
Quality of Research Rating	3.3 (0.0-4.0 scale)

Outcome 3: Drinking intensity
Description of Measures	In one study, drinking intensity was defined as the number of drinks consumed per drinking day (DDD). The DDD measure was obtained through periodic interviews in which the client retrospectively examined his or her last month of drinking. These estimates of alcohol use were obtained by means of the Form 90 interview procedure that combines calendar memory cues within a Timeline Followback methodology. In other studies, weekly peak blood alcohol concentration (BAC) was used as the measure of drinking severity/intensity. Using the Drinker Profile structured interview, estimates of weekly peak BAC were derived by computer projection to estimate the client's regular levels of intoxication.
Key Findings	Each of the studies reviewed clearly demonstrated that MET reduced the intensity of client drinking behavior over the course of outpatient treatment. Among three treatment interventions investigated as part of a large, National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded, randomized multisite evaluation of alcohol treatment (Project MATCH), MET substantially reduced heavy drinking across the 1-year posttreatment period. This study, however, revealed few differences in main drinking outcomes by the type of treatment intervention employed (i.e., MET compared with Cognitive Behavioral Coping Skills Therapy [CBT] and Twelve-Step Facilitation Therapy [TSF]). In Project MATCH, it was noted that MET produced equally effective drinking outcomes using only 4 sessions (over the course of 12 weeks) compared with the 12 sessions employed by the other 2 comparison treatments (CBT and TSF). In another study that examined MET versus usual treatment in a residential alcohol treatment setting, weekly peak BAC decreased significantly (p < .001), and clients increased their participation in treatment; however, the positive changes in drinking intensity were not specific to the MET treatment group.
Studies Measuring Outcome	Study 2, Study 3, Study 6
Study Designs	Experimental, Quasi-experimental
Quality of Research Rating	3.5 (0.0-4.0 scale)

Outcome 4: Marijuana use
Description of Measures	Marijuana use was defined as the number of times the client used marijuana on a typical day of use in the past 90 days. Clients reported their use on a 4-point scale: 0 = not at all; 1 = once; 2 = 2-3 times; 3 = 4-5 times; 4 = 6 or more times per day.
Key Findings	Compared with clients receiving delayed treatment (i.e., the control group), participants in the MET group (in this study referred to as individualized assessment and advice [IAI]) and the relapse prevention support group (RPSG) reported fewer days of use and number of times using marijuana per day. This finding was observed at the 1-, 4-, 7-, 13-, and 16-month follow-ups when compared with pretreatment levels (p < .001 for all five follow-up points). There were no significant differences in outcomes between the RPSG and the MET groups at any follow-up point.
Studies Measuring Outcome	Study 4
Study Designs	Experimental
Quality of Research Rating	2.6 (0.0-4.0 scale)

Outcome 5: Marijuana problems
Description of Measures	Marijuana problems were measured with a 19-item list of negative psychological, social, occupational, and legal consequences of use. The list was adapted from other drug use severity indices in common use. Items on the list were rated on a 3-point scale ranging from 0 (no problem) to 2 (a serious problem).
Key Findings	Compared with clients receiving delayed treatment (control group), participants in the MET group (in this study referred to as individualized assessment and advice [IAI]) and relapse prevention support group (RPSG) reported fewer problems related to marijuana at 1-, 4-, 7-, 13-, and 16-month follow-ups when compared with pretreatment levels (p < .001 for all five follow-up points). There were no significant differences in outcomes between the RPSG and the MET groups at any follow-up point.
Studies Measuring Outcome	Study 4
Study Designs	Experimental
Quality of Research Rating	2.7 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)	63% Female 37% Male	75% White 12% Black or African American 10% Hispanic or Latino 3% Race/ethnicity unspecified
Study 2	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)	72% Male 28% Female	80% White 12% Hispanic or Latino 6% Black or African American 2% Race/ethnicity unspecified
Study 3	26-55 (Adult)	57.1% Male 42.9% Female	Data not reported/available
Study 4	26-55 (Adult)	77% Male 23% Female	95% White 5% Race/ethnicity unspecified
Study 5	18-25 (Young adult)	55% Female 45% Male	90% White 10% Race/ethnicity unspecified
Study 6	26-55 (Adult)	75% Male 25% Female	42.9% Hispanic or Latino 39.3% White 10.7% American Indian or Alaska Native 7.1% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

1. Reliability of measures	4. Missing data and attrition
2. Validity of measures	5. Potential confounding variables
3. Intervention fidelity	6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Substance use	4.0	4.0	3.5	2.5	3.0	4.0	3.5
2: Alcohol consumption	3.5	3.5	2.9	4.0	3.0	3.0	3.3
3: Drinking intensity	3.3	3.8	3.5	3.9	2.9	3.4	3.5
4: Marijuana use	3.0	2.5	2.0	1.5	3.0	3.5	2.6
5: Marijuana problems	3.0	3.0	2.0	1.5	3.0	3.5	2.7

Study Strengths

The studies were very rigorous. The majority used random assignment and attended closely to issues related to quality of measurement and fidelity of implementation.

Study Weaknesses

Several studies had small samples, which limited conclusions in some instances due to lack of statistical power.

Readiness for Dissemination

Review Date: September 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Miller, W. R. (1995). Motivational Enhancement Therapy with drug abusers. Albuquerque, NM: University of New Mexico, Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions. Retrieved from http://casaa.unm.edu/download/METManual.pdf

Miller, W. R., Rollnick, S., & Moyers, T. B. (1998). Motivational interviewing professional training [DVD]. Albuquerque, NM: University of New Mexico.

Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1994). Motivational Enhancement Therapy: A clinical research guide for therapists treating individuals with alcohol abuse and dependence (NIH Publication No. 94-3723). Rockville, MD: National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Retrieved from http://casaa.unm.edu/manuals/met.pdf

Motivational Interviewing Web site, http://motivationalinterview.org

Northwest Frontier Addiction Technology Transfer Center. (2006). Motivational interviewing assessment: Supervisory tools for enhancing proficiency (MIA-STEP). Salem, OR: Oregon Health and Science University, Department of Public Health and Preventive Medicine. Retrieved from http://www.nfattc.org/publicationsNewsResources/publications.aspx

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
4.0	3.3	3.8	3.7

Dissemination Strengths

This program has multiple well-written and easy-to-follow manuals and instructional videos to support implementation. Many comprehensive training and support resources are readily available to interested implementers. The MIA-STEP manual provides training materials, teaching tools, a practitioner self-assessment protocol, rating guides, and forms to support clinical supervision and quality assurance.

Dissemination Weaknesses

It is unclear how an interested implementer identifies an MET-specific trainer from the Motivational Interviewing Network of Trainers (MINT) list other than contacting each one individually. Minimal guidance is provided to implementers for measuring posttreatment outcomes.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Program manuals	Free	Yes
On- or off-site training	Varies depending on trainer selected and length, location, and nature of training	No
Technical assistance and consultation	Varies depending on selected consultant	No
Quality assurance instruments	Free	No