Effects of a Pretreatment Brief Motivational Intervention on Treatment Engagement in CBT-based and Mindfulness-Based Relapse Prevention

Abstract

Treatment for substance use disorders has been shown to be effective for the individual and to reduce costs to society. The effectiveness of these approaches, however, is substantially hampered by poor treatment engagement. Pretreatment engagement strategies have not been widely tested using Randomized Clinical Trials methodology in an outpatient substance use treatment context. Additionally, recent years have seen a surge of development of mindfulness-based treatment programs based on mindfulness-based stress reduction (MBSR). One such program is mindfulness-based relapse prevention (MBRP) for addictive behaviors. Mindfulness-based programs often suggest the use of a pretreatment interview to enhance treatment engagement, but no research has been conducted to test the efficacy of such an intervention. Employing a 2 x 3 randomized intervention design, the current study sought to fill these gaps in the literature. A pretreatment brief motivational interview (BMI) was developed. A sample of 286 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment were randomized to receive or not receive the pretreatment BMI, as part of a larger randomized clinical trial comparing three aftercare relapse prevention programs in a community setting. Logistic, Poisson, and zero-inflated negative binomial regression analyses revealed that participants who received the pretreatment BMI were significantly more likely to attend the first aftercare session, and attended aftercare at a higher rate, compared to those who didn't receive the interview. Substance use outcomes following aftercare treatment did not differ between the groups, however. This study provides support for the utility of including a pretreatment BMI for increasing treatment entry and engagement for aftercare relapse prevention groups and mindfulness-based groups.