The impact of motivational interviewing on initial treatment attendance for participants with dual disorders

Poor treatment attendance and high drop out rates are pervasive problems among clients with dual disorders. As a result, these clients are commonly described as having low motivation for treatment. Motivation is a dynamic state, or a state of readiness for change, that has been conceptualized as stages within the stages of change model (Prochaska & DiClemente, 1986). Clients with dual disorders are typically in the early stages of change for attending outpatient treatment, or have low motivation to attend, due to ambivalence regarding the benefits of treatment. Motivational interviewing is a client-centered, directive method for increasing motivation to change by exploring and resolving ambivalence (Miller & Rollnick, 2002). Initial findings from studies of motivational interviewing with participants with dual disorders have included increased rates of outpatient treatment attendance. Additional research is needed, however, as the majority of these studies have been limited by small to moderate sample sizes and some have lacked comparison groups. The present study aimed to use a motivational interviewing intervention to increase attendance at the first outpatient therapy appointment for participants with dual disorders enrolling in treatment. It was hypothesized that participants who received motivational interviewing would attend the first appointment at higher rates than individuals who were in a video control condition or a retrospective waiting list control condition. A total of 24 participants were assigned to the intervention conditions, and 35 individuals were selected for the retrospective control group. The small obtained sample limited the study to exploratory analyses, and the findings indicated no significant differences in attendance among the groups. The MI group did have a significantly greater increase in motivation after the intervention than the video group. Additionally, an order effect was found as the interviewer's empathy scores improved over time in the motivational interviewing intervention. Possible explanations for the change in motivation but the lack of a related attendance finding are discussed, including: the waiting list for treatment; the conceptualization and operationalization of motivation; intervention implementation; the small sample size and recruitment problems. Implications for research and practice are discussed, as well as limitations and directions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)