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Motivational Interviewing and Treatment Adherence among Psychiatric and Dually Diagnosed Patients

SWANSON, ARTHUR J. Ph.D.1; PANTALON, MICHAEL V. Ph.D.2; COHEN, KENNETH R. M.D.1

The Journal of Nervous & Mental Disease: October 1999 - Volume 187 - Issue 10 - p 630-635
Articles

The effect of motivational interviewing on outpatient treatment adherence among psychiatric and dually diagnosed inpatients was investigated. Subjects were 121 psychiatric inpatients, 93 (77%) of whom had concomitant substance abuse/dependence disorders, who were randomly assigned to: a) standard treatment (ST), including pharmacotherapy, individual and group psychotherapy, activities therapy, milieu treatment, and discharge planning; or b) ST plus motivational interviewing (ST+MI), which involved 15 minutes of feedback on the results of a motivational assessment early in the hospitalization, and a 1-hour motivational interview just before discharge. Interviewers utilized motivational techniques described in Miller and Rollnick (1991), such as reflective listening, discussion of treatment obstacles, and elicitation of motivational statements. Results indicated that the proportion of patients who attended their first outpatient appointment was significantly higher for the ST+MI group (47%) than for the ST group (21%; χ2 = 8.87, df = 1, p < .01) overall, and for dually diagnosed patients (42% for ST+MI vs. 16% for ST only; χ2 = 7.68, df = 1, p < .01). Therefore, brief motivational interventions show promise in improving outpatient treatment adherence among psychiatric and dually diagnosed patients.

1 Department of Psychiatry, St. Barnabas Hospital, Third Avenue & 183rd Street, Bronx, New York, 10457.

2 Department of Psychiatry, Yale University School of Medicine, CMHC/Substance Abuse Center, Room S209, 34 Park Street, New Haven, Connecticut 06519. Send reprint requests to Dr. Pantalon.

Preliminary results of this study were presented at the annual meeting of the Association for the Advancement of Behavior Therapy (November, 1997) in Miami, Florida.

The authors express their gratitude to Robert Basile, Jewel James, David Randall, and Jennifer Wilson for administering questionnaires, conducting motivational interviews, and collecting follow-up data; to Giselle Albuquerque, Wendy Bobadilla, Brian Klein, and Beatrice Martineau for their assistance in data management; to Drs. Richard Schottenfeld, Bruce Rounsaville, Marek Chawarski, Douglas Zeidonis, and Tony George for their helpful comments on an earlier draft of this manuscript; and to the staff and patients of St. Barnabas and Union Hospital's Department of Psychiatry who participated in this study.

© 1999 Lippincott Williams & Wilkins, Inc.