The Efficacy of Motivational Enhancement Therapy for African American Substance Users
LaTrice Montgomery, M.A.
1University
Background:
The low retention rates among African Americans in
substance abuse treatment (Milligan et al., 2004)
combined with the limited number of treatments with
demonstrated efficacy for African American substance
users (Nagayama-Hall, 2001) are both public health
concerns. This study is designed to address these
concerns by determining the efficacy of Motivational
Enhancement Therapy (MET) for increasing retention
and reducing drug use among African Americans who
abuse substances (i.e., alcohol, cocaine, marijuana,
opioids, benzodiazepines, methamphetamines and other
drugs). MET is a client-centered approach grounded in
Motivational Interviewing (MI) that enhances intrinsic
motivation in the client to change their behaviors.
A recent meta-analysis revealed that MI yielded a
larger effect size for ethnic minority populations than
White populations (Hettema et al., 2005). Few studies
have focused exclusively on substance abusing African
Americans. Results from these studies are promising. For
example, Longshore and Grills (2000) examined the
efficacy of a culturally tailored version of MET for
African American substance users. They found that MET
was successful in reducing drug use among African
Americans. The current study is among the few to assess
the efficacy of a generic (i.e., not culturally tailored)
version of MET as compared to counseling as usual
(CAU) with an African American sample. The study was
a secondary analysis of a multi-site randomized clinical
trial of MET conducted by the National Institute of Drug
Abuse (NIDA) Clinical Trials Network (CTN) 0004.
1,
Kathleen Burlew, Ph.D.
of Cincinnati,
2Duke
1, Andrzej
S. Kosinski, Ph.D.
Clinical Research Institute,
Outcome Variables:
Urine screens: Probability of receiving at least
one positive urine screen during the four week active
phase
Self-report of drug use: Self-report of weekly
drug use for each of the 16 study weeks
2,
3University
& Alyssa Forcehimes, Ph.D.
of New Mexico
Results:
Hypothesis 1:
Self-Report of Drug Use (Linear Mixed Modeling):
Overall, African Americans in MET reported using more
drugs than those in CAU throughout the 16 study weeks (p <
0.001).
Retention: Number of days between the day of
enrollment and the last day that the participant
received services
Measures:
Urine Monitoring Result Form
Substance Use Calendar
Client Disposition-End of Trial Status Form
Demographic Form
Procedure:
Urine Screens (Logistic Regression):
Among alcohol users only, African Americans in MET were
less likely to have a positive urine screen than those in CAU
during the 4 week active phase (p = 0.05, OR = 0.28, 95% CI
0.08 – 1.01).
However, the probability of positive urines did not
significantly differ among African Americans in MET and
those in CAU overall during the 4 week active phase (p =
0.52).
Hypothesis 2:
Retention (Survival Analysis):
Among African American females, those in MET had better
retention than those in CAU during the initial 12 weeks (logrank p = 0.05 when considering the initial 12 weeks; log-rank p
= 0.09 when considering the entire 16 week period).
Individuals sought treatment and completed triage at CTP,
were invited to participate and provide informed consent
Hypotheses:
Hypothesis 1: African Americans in MET will use
fewer substances (i.e., self-report of drug use and urine
screens) than African Americans in CAU.
Hypothesis 2: African Americans in MET will have
higher retention rates than African Americans in CAU.
Completed brief assessment battery
Randomized: CAU or MET
3 individual sessions of CAU
(28 day window)
3 individual sessions of MET
(28 day window)
Follow-up assessments at 8 and 16 weeks
The efficacy of MET appeared to be more evident when
urine screens rather than self report were used to assess
substance use. Moreover, even the positive findings for urine
screens were limited to primary alcohol users. This finding
suggests that those primary alcohol users assigned to MET
were less likely than those assigned to CAU to use other
drugs during the 4 week active phase. The finding that MET
was associated with better retention for African American
females is promising. However, the fact that this finding was
evident for females but not males suggests that the benefits
of MET may vary for specific subgroups of African
Americans.
The pattern of findings was somewhat different for the
African American sample than the overall sample. This
suggests that outcomes should be analyzed separately for
African Americans.
Future studies should focus more on identifying the specific
subgroups of African Americans who may benefit from
MET.
Future studies should examine whether a culturally adapted
version of MET might yield better outcomes for African
Americans.
References:
Hettema, J., Steele, J., & Miller, W.R. (2005). Motivational
interviewing. Annual Review of Clinical Psychology,1,
91-111.
Longshore, D., & Grills, C. (2000). Motivating illegal drug
use recovery: Evidence for a culturally congruent
intervention. Journal of Black Psychology, 26(3), 288301.
Milligan, C., Celeste, O., Nich, C., & Carroll, K. (2004).
Ethnic differences in substance abuse treatment,
retention, compliance and outcome from two clinical
trials. Psychiatric Services, 55, 167-173.
Nagayama-Hall, G. (2001). Psychotherapy research with
ethnic minorities: Empirical, ethical, and conceptual
issues. Journal of Consulting and Clinical Psychology,
69, 502-510.
Acknowledgments:
Completed posttreatment assessment
Referred to ongoing CAU treatment at
CTPs
Discussion:
FUTURE STUDIES:
Participants:
194 African Americans seeking substance abuse
treatment at one of five community based treatment
programs (CTPs)
Used drugs 28 days prior to randomization
48 females, 146 males
Average age of 38
Primary drug choices: cocaine (N = 50) and alcohol
(N = 51)
3
However, the retention rates did not differ for African
American males in MET and CAU (p = .10).
The authors would like to thank Dr. Kathleen
Carroll and the rest of the NIDA CTN 0004
research team for sharing data for this project.