Spreading the Word: Case Study of a Community-Wide Dissemination of Motivational Enhancement Therapy

Background and Purpose: Empirically supported substance abuse treatments are frequently unused, while the least supported approaches (e.g. confrontation, drug education) are most used (Miller, 1995). Motivational enhancement therapy (MET) is a strengths-based practice developed by Miller and Rollnick (2002) to address alcohol abuse. Several barriers exist in the adoption of MET by substance abuse counselors, including no significant reduction in counselor responses that were antithetical to MET, particularly by counselors who use the disease-concept approach. Studies focus on specific variables and therefore may be missing key factors toward improving rates of implementation. The purpose of this case study was to explore the barriers and facilitators influencing community-wide adoption and implementation of MET. Methods: A qualitative approach was used for this case study. Twenty practitioners and administrators who primarily treated substance-involved adolescents or post-incarcerated substance-involved offenders, representing the New Orleans metropolitan area, were interviewed. A semi-structured interview protocol was utilized. Interview questions focused on the participants' experiences and attitudes toward MET. Questions were structured to reflect Rogers' Innovation-Decision Process (Rogers, 2003). Content analysis was used to identify themes across interviews, thus analyzing the treatment community (case) as a whole. Results: The sample was primarily Caucasian (70%), female (70%), and between the ages of 27-66 (M = 46). Most participants had a Masters degree (70%), and 35% (7) admitted to being in recovery. Four themes related to barriers and facilitators to implementation were identified: spreading the word, MET and “fit,” flexibility, and reminders. First, participants acknowledged the help of the external change agent (a practice-improvement collaborative) in “spreading the word” about MET through training and ongoing discussions in the community. Second, participants emphasized the importance of MET and how it “fit” into one's current approach to counseling as well as the fit with the population being served. Participants also frequently noted the flexibility of MET as applied in various contexts and counseling modalities (family, group and individual). Lastly, participants emphasized the need for reminders to support further implementation and application of MET strategies. Conclusions and Implications: While the influence of counselor orientation on adoption is well documented; the current study finds that the counselor's style (confrontational vs. client-centered) influenced one's perception of MET rather than the clinician's belief in the disease-concept. Therefore, the counselor-related factors influencing adoption should be further explored. Additionally, training and education should address how, and perhaps when, MET fits into traditional, Twelve-Step approaches. Second, MET was not only used in group and family therapy sessions, but was frequently a mode of communication used by MET-trained paraprofessional staff in working with clients. This is an area where more research is needed to investigate effectiveness and implications of paraprofessionals using MET. Lastly, the need for ongoing training and supervision is vital and can be addressed through not only formal workshop sessions, but through discussion and role-play of MET skills in supervision or clinical staff meetings.