Outcomes and Challenges of Motivational Interviewing in Dual Diagnosis Treatment - a Systematic Review

Abstract

Background: Motivational Interviewing (MI) is a patient-centered counseling approach which aims to promote behavior change by enhancing patient motivation through the exploration and resolution of ambivalence. This type of psychotherapy, initially designed for the treatment of Substance Use Disorders, is now seen as an effective way to manage chronic physical and psychiatric diseases. Dual Diagnosis (DD) patients are a complex group of psychiatric patients who have a particularly low treatment engagement, so it was hypothesized that MI would be a valuable add-on therapy. This review summarizes the main findings of randomized controlled trials applying MI to patients' psychiatric condition and substance use. We aim to clarify previous inconsistent results regarding MI effectivity in this complex and challenging disorder. Methods: A systematic literature search of PubMed/MEDLINE, Web Of Science and Scopus was performed. The final selection for this systematic review comprised exclusively randomized controlled trials (RCTs) comparing MI alone or integrated in routine care to routine care. All patients included in the selected studies were over 16 years old. Studies' quality assessment was conducted with the Jadad Scale. Results: We found that intervention groups showed an improvement of functioning, psychiatric symptoms, medication compliance and substance use. However, this superiority of the intervention was not statistically significant. Number of relapses, total days in relapse and alcohol binge days showed a significant improvement in favor of the intervention (p=0.002, p=0.0063, and p=0.02, respectively). Conclusions: Most studies failed to detect significant results, although there was a clear improvement in most of these outcomes. The only significant superiority of MI was found related to relapse and alcohol abuse. This disparity may be due to the heterogeneity of the disorder, and/or to methodological limitations. Our findings emphasize the need to carry out more methodically sound RCTs with adaptable characteristics according to the specific pairing of psychiatric disease and substance of abuse.