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New approach to addiction interventions targets motivation

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February 25, 2013



Assis­tant pro­fessor Christina Lee believes it's time to rethink health­care pro­fes­sionals' strate­gies for addic­tion inter­ven­tion. "The instinct is to give advice and rush to help," said Lee, of the Depart­ment of Coun­seling and Applied Edu­ca­tional Psy­chology in the Bouvé Col­lege of Health Sci­ences. "But what we've observed is that patients shut down."

Lee pointed to evi­dence showing that the more training a clin­i­cian has and the more severe his or her patient's con­di­tion, the greater the rush to give advice. But this tra­di­tional approach tends to have the oppo­site effect than desired.

Lee, who joined the fac­ulty in the fall, and her col­leagues are inves­ti­gating an alter­na­tive approach: moti­va­tional inter­viewing, which has shown great effi­cacy in addic­tion coun­seling and in other health areas. Instead of deliv­ering infor­ma­tion, clin­i­cians engage with patients in non­judg­mental con­ver­sa­tion, reflecting the state­ments made by the patients themselves.

By helping patients to hear their own moti­va­tions to change, moti­va­tional inter­viewing helps people reduce their haz­ardous behav­iors like exces­sive drinking, which Lee is par­tic­u­larly focused on. "The task is to help people to clarify what's good and what's not so good about their drinking and to begin to shift the weight toward wanting to change," she said.

While moti­va­tional inter­viewing requires clin­i­cians to be empa­thetic toward a patient, cul­tural and social con­texts are not directly addressed. But social stres­sors, such as poverty, lim­ited Eng­lish pro­fi­ciency, and discrimination—which are often related to processes of accul­tur­ating to the United States—are pre­dic­tive of haz­ardous drinking and alcohol-​​related prob­lems among racial and ethnic groups. Lee said.

Lee recently com­pleted a pilot study at Brown Uni­ver­sity that showed effi­cacy improved when clin­i­cians con­sid­ered a patient's spe­cific cul­tural and social con­text. Now, with funding from the National Insti­tute on Alcohol Abuse and Alco­holism of the National Insti­tutes of Health, she is teaming up with the South End Com­mu­nity Health Center in Boston and the Boston Public Health Com­mis­sion to launch a larger ver­sion of this first-​​of-​​its-​​kind ran­dom­ized clin­ical trial. The new study will target Boston's immi­grant Puerto Rican pop­u­la­tion, which is highly rep­re­sented at the SECHC.

"This inter­ven­tion is designed to cap­ture people who have more trouble adjusting to their lives in the U.S. and who may be using alcohol as an avoidant way of coping with social stres­sors," Lee explained.

She hopes the project will help address alcohol-​​related health dis­par­i­ties in Boston's Latino com­mu­nity by pro­viding early screening and brief inter­ven­tions to reduce haz­ardous drinking. The project, she said, will also pro­vide a better under­standing of how stres­sors related to immi­gra­tion and accul­tur­a­tion confer risk for increased haz­ardous drinking and other unsafe behaviors.