Department of Psychology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR.
United Christian Hospital, Kwun Tong, Kowloon, Hong Kong SAR.
J Clin Psychiatry. 2021 Dec 28;83(1):21r13916. doi: 10.4088/JCP.21r13916.
A wealth of evidence has supported the efficacy of motivational interviewing (MI) in reducing substance use as well as other addictive behaviors. In view of the common co-occurrence of substance use disorder among individuals with schizophrenia spectrum disorders, there has been increased attention to applying MI in psychological interventions for individuals with co-occurring psychosis and substance use disorder. This review aims to synthesize the evidence on the efficacy of MI interventions (either as a stand-alone intervention or in combination with other psychological interventions) in reducing substance use and psychotic symptoms. MEDLINE, PsycINFO, EMBASE, CENTRAL, and CINAHL were searched using keywords related to "psychosis," "substance addiction," and "motivational interviewing" to identify studies published in English from 1984 to May 2021. Of 1,134 articles identified in the literature, we selected 17 studies for review: 5 studies examined stand-alone MI ("MI-pure"), and 13 studies assessed MI as a major treatment component ("MI-mixed"). Demographics of participants, intervention characteristics, and outcome data were extracted by the first author and checked by the second author. Random-effects models were used for substance use and psychotic symptom outcomes. MI-pure interventions did not significantly reduce severity of substance use ( = 0.06, = .81) or psychotic symptoms ('s for 2 individual studies = 0.16, = .54; and 0.01, = .96). The effect of MI-mixed interventions on substance use decrease was statistically significant but small in size ( = 0.15, = .048), whereas the effect on psychotic symptom improvement was not significant ( = 0.11, = .22). With the caveat that only a small number of comparisons were available for the review on MI-pure interventions, the efficacy of MI in treating co-occurring psychosis and substance use disorder was heterogeneous and modest.
大量证据表明，动机访谈（MI）在减少物质使用以及其他成瘾行为方面是有效的。鉴于精神分裂症谱系障碍患者中物质使用障碍的共同发生，人们越来越关注将 MI 应用于同时存在精神病和物质使用障碍的个体的心理干预中。本综述旨在综合 MI 干预措施（单独使用或与其他心理干预措施联合使用）在减少物质使用和精神病症状方面的疗效证据。使用与“精神病”、“物质成瘾”和“动机访谈”相关的关键词，在 MEDLINE、PsycINFO、EMBASE、CENTRAL 和 CINAHL 中进行检索，以确定 1984 年至 2021 年 5 月发表的英文研究。在文献中确定了 1134 篇文章，我们选择了 17 项研究进行综述：5 项研究考察了单独的 MI（“MI-纯”），13 项研究评估了 MI 作为主要治疗成分（“MI-混合”）。第一作者提取参与者的人口统计学特征、干预特征和结果数据，第二作者进行核对。使用随机效应模型进行物质使用和精神病症状结果分析。MI-纯干预措施并未显著降低物质使用的严重程度（ = 0.06， = .81）或精神病症状（2 项研究的's 值分别为 0.16， = .54 和 0.01， = .96）。MI-混合干预措施对物质使用减少的效果在统计学上是显著的，但效果较小（ = 0.15， = .048），而对精神病症状改善的效果不显著（ = 0.11， = .22）。鉴于 MI-纯干预措施的综述中可用的比较数量较少，MI 治疗同时存在的精神病和物质使用障碍的疗效存在异质性和适度性。
