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      A Randomized Controlled Trial of Brief Motivational Interviewing in Impaired Driving Recidivists: A 5-Year Follow-Up of Traffic Offenses and Crashes

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          Abstract

          Background

          In a previously published randomized controlled trial (Brown et al. Alcohol Clin Exp Res 2010; 34, 292–301), our research team showed that a 30-minute brief motivational interviewing (BMI) session was more effective in reducing percentages of risky drinking days in drunk driving recidivists than a control information–advice intervention at 12-month follow-up. In this sequel to the initial study, 2 main hypotheses were tested: (i) exposure to BMI increases the time to further arrests and crashes compared with exposure to the control intervention (CTL) and (ii) characteristics, such as age, moderate the benefit of BMI.

          Methods

          A sample of 180 community-recruited recidivists who had drinking problems participated in the study. Participants gave access to their provincial driving records at baseline and were followed up for a mean of 1,684.5 days (SD = 155.7) after randomization to a 30-minute BMI or CTL session. Measured outcomes were driving arrests followed by convictions including driving while impaired (DWI), speeding, or other moving violations as well as crashes. Age, readiness to change alcohol consumption, alcohol misuse severity, and number of previous DWI convictions were included as potential moderators of the effect of the interventions.

          Results

          For arrests, Cox proportional hazards modeling revealed no significant differences between the BMI and the CTL group. When analyses were adjusted to age tertile categories, a significant effect of BMI in the youngest age tertile (<43 years old) emerged. For crashes, no between-group differences were detected.

          Conclusions

          BMI was better at delaying DWI and other dangerous traffic violations in at-risk younger drivers compared with a CTL similar to that provided in many remedial programs. BMI may be useful as an opportunistic intervention for DWI recidivism prevention in settings such as DWI courts. Treatment effectiveness studies are needed to ascertain how the present findings generalize to the real-world conditions of mandated relicensing programs.

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          Most cited references48

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          In search of how people change. Applications to addictive behaviors.

          How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.
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            Toward a theory of motivational interviewing.

            The widely disseminated clinical method of motivational interviewing (MI) arose through a convergence of science and practice. Beyond a large base of clinical trials, advances have been made toward "looking under the hood" of MI to understand the underlying mechanisms by which it affects behavior change. Such specification of outcome-relevant aspects of practice is vital to theory development and can inform both treatment delivery and clinical training. An emergent theory of MI is proposed that emphasizes two specific active components: a relational component focused on empathy and the interpersonal spirit of MI, and a technical component involving the differential evocation and reinforcement of client change talk. A resulting causal chain model links therapist training, therapist and client responses during treatment sessions, and posttreatment outcomes.
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              Assessing competence in the use of motivational interviewing.

              This report presents reliability, validity and sensitivity indices for the Motivational Interviewing Treatment Integrity (MITI) scale. Factor analysis of MI treatment sessions coded with the Motivational Interviewing Skills Code (MISC) was used to derive 10 elements of MI practice, forming the MITI. Canonical correlation revealed that the MITI captured 59% of the variability in the MISC. Reliability estimates for the MITI were derived using three masked, independent coders. Intra-class coefficients ranged from .5 to .9 and were generally in the good to excellent range. Comparison of MITI scores before and after MI workshops indicate good sensitivity for detecting improvement in clinical practice as result of training. Implications for the use of this instrument in research and supervision are discussed.
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                Author and article information

                Journal
                Alcohol Clin Exp Res
                Alcohol. Clin. Exp. Res
                acer
                Alcoholism, Clinical and Experimental Research
                BlackWell Publishing Ltd (Oxford, UK )
                0145-6008
                1530-0277
                November 2013
                29 July 2013
                : 37
                : 11
                : 1979-1985
                Affiliations
                Faculty of Medicine and Health Sciences, University of Sherbrooke Longueuil, Quebec, Canada
                Charles LeMoyne Research Center Longueuil, Quebec, Canada
                Douglas Mental Health University Institute Montreal, Quebec, Canada
                Department of Psychiatry, McGill University Montreal, Quebec, Canada
                Department of Psychiatry, University of Montreal Montreal, Quebec, Canada
                Pavillion Foster Addiction Rehabilitation Centre St. Philippe de Laprairie, Quebec, Canada
                Author notes
                Reprint requests: Marie Claude Ouimet, PhD, Department of Health Community Sciences/Addiction Unit, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Charles-Le Moyne PL, suite 200, Longueuil, QC, Canada J4K 0A8; Tel.: 450-463-1835 ext. 61849; E-mail: Marie.Claude.Ouimet@ 123456USherbrooke.ca
                Article
                10.1111/acer.12180
                4352330
                23895363
                89432769-dc4f-45e3-8adb-613d6be49347
                Copyright © 2013 by the Research Society on Alcoholism

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 04 November 2012
                : 04 April 2013
                Categories
                Behavior, Treatment and Prevention

                Health & Social care
                driving while impaired,driving under the influence,infraction,accident,motivational interviewing,recidivism

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