Department of Psychiatry and Behavioral Sciences, University of Washington, United States.
Department of Educational Psychology, University of Utah, United States.
J Subst Abuse Treat. 2018 Jan;84:30-41. doi: 10.1016/j.jsat.2017.10.011. Epub 2017 Oct 28.
Providers' adherence in the delivery of behavioral interventions for substance use disorders is not fixed, but instead can vary across sessions, providers, and intervention sites. This variability can substantially impact the quality of intervention that clients receive. However, there has been limited work to systematically evaluate the extent to which substance use intervention adherence varies from session-to-session, provider-to-provider, and site-to-site. The present study quantifies the extent to which adherence to Motivational Interviewing (MI) for alcohol and drug use varies across sessions, providers, and intervention sites and compares the extent of this variability across three common MI research contexts that evaluate MI efficacy, MI effectiveness, and MI training. Independent raters coded intervention adherence to MI from 1275 sessions delivered by 216 providers at 15 intervention sites. Multilevel models indicated that 57%-94% of the variance in MI adherence was attributable to variability between sessions (i.e., within providers), while smaller proportions of variance were attributable to variability between providers (3%-26%) and between intervention sites (0.1%-28%). MI adherence was typically lowest and most variable within contexts evaluating MI training (i.e., where MI was not protocol-guided and delivered by community treatment providers) and, conversely, adherence was typically highest and least variable in contexts evaluating MI efficacy and effectiveness (i.e., where MI was highly protocolized and delivered by trained therapists). These results suggest that MI adherence in efficacy and effectiveness trials may be substantially different from that obtained in community treatment settings, where adherence is likely to be far more heterogeneous.
提供者在提供物质使用障碍的行为干预方面的坚持并不是固定的，而是可以在各个疗程、提供者和干预地点之间发生变化。这种可变性会对客户接受的干预质量产生重大影响。然而，对于系统地评估物质使用干预的坚持程度在各个疗程、提供者和干预地点之间的变化程度，以及评估动机访谈（MI）疗效、MI 有效性和 MI 培训的三个常见 MI 研究背景下的变化程度，已经开展了有限的工作。本研究量化了 MI 对酒精和药物使用的坚持程度在各个疗程、提供者和干预地点之间的变化程度，并比较了这种可变性在评估 MI 疗效、MI 有效性和 MI 培训的三个常见 MI 研究背景下的变化程度。独立评估者从 15 个干预地点的 216 名提供者提供的 1275 个疗程中对 MI 坚持程度进行了编码。多层次模型表明，MI 坚持程度的 57%-94%归因于疗程之间（即提供者之间）的变异性，而提供者之间（3%-26%）和干预地点之间（0.1%-28%）的变异性较小。MI 坚持程度通常在评估 MI 培训的背景下最低且最具可变性（即 MI 没有协议指导且由社区治疗提供者提供），相反，在评估 MI 疗效和有效性的背景下，MI 坚持程度通常最高且最具可变性（即 MI 高度协议化且由经过培训的治疗师提供）。这些结果表明，在疗效和有效性试验中获得的 MI 坚持程度可能与社区治疗环境中获得的坚持程度有很大不同，在社区治疗环境中，坚持程度可能更加多样化。
