Schedule:
Saturday, January 14, 2012
Independence F - I (Grand Hyatt Washington)
* noted as presenting author
Background and Purpose: Treatments for alcohol use disorders (AUDs) can be effective, but the overwhelming majority of individuals with AUDs never seek help for their problems. Brief alcohol interventions such as SAMHSA's Screening, Brief Intervention, and Referral to Treatment (SBIRT) have been implemented in general medical settings, emergency rooms, and community clinics to provide services to non-treatment-seeking individuals. Brief interventions can reduce alcohol misuse among those with mild to moderate alcohol problems. However, among those with severe alcohol problems, the referral to treatment component of SBIRT is essential due to a need for the provision of intensive services from substance abuse specialists. Presently, no systematic evaluations exist regarding the use of interventions to increase treatment initiation among people with alcohol problems. The current study sought to evaluate the extent to which the literature supports the use of motivational interventions versus referral-only interventions for increasing alcohol treatment initiation. Methods: We conducted a systematic review of randomized controlled trials published since 1980. We included studies that examined the efficacy of motivational or referral-only interventions which assessed alcohol treatment initiation as an outcome among people who were not seeking help but had unhealthy alcohol use or alcohol use disorders. Abstracts were identified using a replicable database search of MEDLINE and PsychINFO, an email query of experts in the field, and hand searching. Of the 460 identified articles, 16 met inclusion criteria. Two authors independently rated the methodological quality and outcome attainment using methods published by Miller and Wilborne (2002). Results: Of the 15 controlled trials that met criteria for inclusion, eight assessed motivational interventions and seven assessed referral-only interventions. Only two motivational intervention studies and four referral-only studies found positive, significant effects on treatment initiation as compared to the control conditions. Across the six studies with significant outcomes, effects were observed at 3 and 6 months. Conclusions and implications: Several important conclusions can be drawn from this study. First, referral-only interventions appear efficacious in encouraging treatment initiation in non-treatment-seeking individuals. Thus, this review found support for the referral to treatment component of SBIRT programs. Second, only a fraction of studies supported the use of motivational interventions. However, the majority of the motivational interventions only assessed treatment initiation as a secondary outcome. As a result, important intervention design issues were not adequately handled (e.g. tests of statistical power were conducted for alcohol use but not treatment initiation outcomes, and intervention components were not explicitly linked to treatment initiation outcomes). Third, the referral-only interventions were older (1980's-1990's) and the comparison condition of treatment as usual included no guidance on how to intervene with alcohol problems. In contrast, the motivational interventions studies were more recent (2002 to 2009) and the treatment as usual conditions typically included referral. As a result, findings from the two sets of studies are not comparable. It remains unknown whether the incorporation of motivational enhancement methods would further increase alcohol treatment initiation. Head-to-head tests of motivational intervention versus referral-only interventions are warranted.
