Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial
General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse.
To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients.
Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057).
Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital.
Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition).
Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse.
20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge’s g = 1.49) and 3.0% (Hedge’s g = 1.26) in the respective workshop only and apprenticeship conditions (p < 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions.
Providers’ ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances.
KEY WORDSbehavioral science consultation implementation research substance abuse
The authors wish to thank the medical providers at the medical hospital where the study was conducted. We also would like to thank Victor Morris, Will Cushing, Jose Salvana, and Scott Sussman for the work they have done in support of the project. Finally, we want to acknowledge our research staff (Rebecca Aldi, Monica Canning-Ball, Heather Howell, Jessica Katon, Ashley McCaherty, and Jonathan Ryan) for their efforts to implement this trial with integrity.
The National Institute on Drug Abuse funded the study (R01 DA034243). The content of this manuscript solely reflects the authors’ views and not those of the funding agency or the authors’ institutional affiliates.
Compliance with Ethical Standards
The Yale University Human Investigation Committee approved the study (ClinicalTrials.gov (NCT01825057). We screened interested providers and obtained written informed consent alongside baseline assessments. Research assistants (RAs) screened and obtained written informed consent from eligible and interested patients.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 2.Richmond RL, Bell AP, Rollnick S, Heather BBN. Screening for smokers in four Sydney teaching hospitals. J Cardiovasc Risk 1995;2:199–203.Google Scholar
- 12.Miller WR, Rollnick S. Motivational Interviewing: Helping People Change Third Edition. New York: Guilford Press; 2013.Google Scholar
- 21.Rogers E. Diffusion of Innovations (5th Ed). New York: Free Press; 2003.Google Scholar
- 30.Rodriguez-Paz JM, Kennedy M, Salas E, et al. Beyond “see one, do one, teach one”: toward a different training paradigm. Qual Saf Health Care 2009;18:63–8.Google Scholar
- 43.Urbaniak GC, Plous S. Research Randomizer (Version 4.0) [Computer software]. 2013. Retrieved on June 22, 2013, from http://www.randomizer.org/
- 46.Sheehan D, Lecrubier Y, Janavs J, Knapp E, Weiller E. Mini International Neuropsychiatric Interview (MINI). University of South Florida , Tampa; 1996.Google Scholar
- 47.Brown RL., Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. WMJ. 1995;94:135–40.Google Scholar
- 50.Miller WR, Moyers TB, Ernst D, Amrhein P: Manual for the Motivational Interviewing Skills Code (MISC) v. 2.1. 2008. http://casaa.unm.edu/download/misc.pdf. Accessed 26 June 2019.
- 63.Wurcel AG, Anderson JE, Chui KK, et al. Increasing infectious endocarditis admissions among young people who inject drugs. Open Forum Infect Dis 2016;3:ofw157.Google Scholar
- 68.Rollnick S, Miller W, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press, 2008.Google Scholar