Europad2012 Presentation Rik Bes
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Europad2012 Presentation Rik Bes

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Addiction and Motivation; what works? ...

Addiction and Motivation; what works?
Presentation at the 2012 Europad conference in Barcelona.
Three main points:
- Evidence base for Motivational Interviewing
- Practitioner competency
- Implementation issues

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    Europad2012 Presentation Rik Bes Europad2012 Presentation Rik Bes Presentation Transcript

    • Addiction and Motivation: What Works?Rik BesCentre for Motivation and ChangeHilversum, the Netherlandswww.motivationalinterview.nlwww.motivationalinterviewing.org
    • Addiction and Motivation: What Works?• Motivational Interviewing; evidence base• Practitioner’s competency• Implementation in organizations
    • Addiction and Motivation: What Works?• Motivational Interviewing; evidence base• Practitioner’s competency• Implementation in organizations
    • MI Outcome Studies by Era
    • MI and evidence-based research Meta-analysis Hettema JM, et al. Annual Review of Clinical Psychology 2005;1:91–111 Hettema JM, et al. J of Cons Clin Psychol 2010;78(6):668–84
    • Mean combined effect size by problem area (N = 72 RCT’s) HIV risk 0.71 Drug abuse 0.51 Public health 0.51 Gambling 0.44 3 MonthsTreatment adherence 0.42 Alcohol 0.41 Diet / exercise 0.14 Smoking 0.04 HIV risk 0.53 Drug abuse 0.29 Public health 0.3 Gambling 0.29 Follow-upTreatment adherence 0.72 Alcohol 0.26 Diet / exercise 0.78 Smoking 0.14 0 0.2 0.4 0.6 0.8 1
    • Adoption Curve for InnovationsN umber of Adoptions Source: Everett M. Rogers Diffusion of Innovations
    • Number of MI Publications 550 500Number of Publications 450 400 350 300 250 200 150 100 50 0 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5 Years Source: www.motivationalinterviewing.org Publications double about every three years
    • Adoption Curve for MINumber of AdoptionsIf Rogers’ curve holds, approximately 30% of those who willultimately adopt MI have done so
    • So, after 30 years of research we have a treatment method that is:• Evidence-based >90 RCT’s• Relatively brief• Specifiable (but be careful with manuals)• Grounded in testable theory• With specifiable mechanisms of action• Generalizable across problem areas• Complementary to other treatment methods• Learnable by a broad range of providers• Verifiable – Is it being delivered properly?
    • Addiction and Motivation: What Works?• Motivational Interviewing; evidence base• Practitioner’s competency• Implementation in organizations
    • A continuum of styles Directing Guiding Following70605040302010 0 Informing Asking Reflective Listening
    • A working definition:• Motivational interviewing is a collaborative,• person-centered• structured form of guiding• to elicit and strengthen• intrinsic motivation for change
    • Eight Stages in Learning MI1. Getting the spirit of MI2. Using client-centered skills (OARS)3. Recognizing change talk4. Eliciting and reinforcing change talk5. Rolling with resistance6. Developing a change plan7. Consolidating client commitment8. Integrating MI with other intervention methodsMiller, W. R., & Moyers, T. B. (2006). Eight stages in learning motivational interviewing. Journal of Teaching in the Addictions
    • 10 things that MI is . . .1. A refined form of guiding2. in a conversation focused on change3. that evokes and strengthens personal motivation4. in a person-centered, autonomy-honoring way5. using specific methods in certain ways6. toward a particular change goal7. that is attuned to and guided by client speech8. and is relatively brief9. adaptable across people, cultures and problems10. and is specifiable and learnable
    • Where MI Clinicians Can Get Stuck1. Letting go of the expert role (righting reflex)2. Using complex reflections3. Missing opportunities for MI4. Giving insufficient direction5. Opposing resistance6. (Not) moving on to focusing and planning7. (Not) attending to commitment language
    • MITI (Motivational Interviewing Treatment Integrity)• Therapist behavior counts• Global markers – Empathy – Collaboration – Evocation – Autonomy – Direction/focus
    • Learning MI Some findings• Reading about MI doesn’t affect competency• 2-3 day workshops will raise awareness and interest; they won’t increase competency enough to score ‘competency’ on MITI• Advanced workshops help to get ‘un-stuck’• Continued coaching and observed practice lead – over time – to full competency
    • Addiction and Motivation: What Works?• Motivational Interviewing; evidence base• Practitioner’s competency• Implementation in organizations
    • Examples from MI implementation• Addiction services in the Netherlands (mid 90’s)• Various hospitals (2007 ->)• Criminal Justice systems (Netherlands, Sweden, UK) (2000 ->)• Health Care standards (f.i. diabetes care, smoking cessation)
    • Implementation challenges• MI is not ‘easy’ to do for a practitioner, neither for the organisation to implement• Need for longer term planning• Sustainability of competency: • Professional peer support • Intervision/supervision/coaching • Life-long-learning• More than what happens between patient and therapist
    • Some helpful resources• Monitoring and research• Tailor-made: • Teaching tools • Peer-support solutions• E-Learing and blended learning • Webinars • Online coaching
    • Addiction and Motivation: What Works?Rik BesCentre for Motivation and ChangeHilversum, the Netherlandswww.motivationalinterview.nlwww.motivationalinterviewing.org