Brief Motivational Intervention (BMI) effectiveness for Opiate Use Disorders

Brief Motivational Intervention is effective in reducing opiate abuse in many populations, especially with patients with co-occurring conditions (co-morbidity) (Barrowclough et al., 2010). Opiate abuse and addiction is a growing problem in the United States and in the top 3 most abused categories of both illegal and prescription drugs worldwide. A great percent of the prison population in the United States are incarcerated directly or indirectly due to addiction and opiate addiction is one of the leading addiction problems within the prison population. BMI has been found very effective in working with inmates and ex-convicts and helping them overcome addiction and avoid re-incarceration (Forsberg et al., 2011). BMI’s can be used effectively to move someone through the stages of change and in the early stages of recovery, even while detoxing (Berman et al., 2010).

Opiate Abuse a Growing Problem

Opiate abuse is a significant and growing problem with both (Illegal) street drug and (Prescription) drug users. Opiate dependence is a huge economic burden as it raises healthcare cost, work absenteeism, social/welfare costs, crime, incarceration & death rates, and lowers productivity and quality of life (Doran, 2008). The United Nations in a recent report estimated that nearly 80 million people abuse Opium, Heroine, or opiate based substances worldwide (Doran, 2008). The World Health Organization (WHO) estimates the harm from opiate use at 11,200,000 disability-adjusted life-years (DALYs). Death rates due to HIV, overdose, and suicide are greatly increased by opiate use disorders (Doran, 2008).

It is estimated that 60% of all prison inmates are incarcerated for drug related crimes. This population of abusers are more resistant to change and yet their success in being rehabilitated and not returning to jail or prison may be directly correlated to their recovery from addiction. Opiate use disorder is one of the leading causes of drug related crime (Forsberg et al., 2011).

Brief Motivational Intervention (BMI)

Brief Motivational Intervention (BMI) is an evidence-based practice for treating Opiate use disorders. Motivational Interviewing or intervention is a interviewing or conversational style defined as a person-centered, humanistic, and collaborative method of guiding an opiate user to elicit and strengthen their motivation to change (Miller & Rollnick, 2009). Although many behavioral and pharmacological interventions have a high efficacy they come at a high economic cost and still involve lost opportunities or a decreased quality of life. BMI’s have similar effectiveness without such a high cost since they can be part of normal health and behavioral care and can motivate change to a level far deeper and better than most other intervention options (Doran, 2008).

In a recent study conducted in an urgent care clinic that regularly treated opiate and other addictions. They separated treated patients into groups that in group 1) Received Motivational Interviewing (a client-centered approach to counseling that helps clients overcome their ambivalence or lack of resolve for behavioral change through brief intervention sessions), and group 2) Those that received Motivational Enhancement Therapy (MET) that incorporated structured assessments and follow-up sessions for personal feedback regarding assessment findings. Both were done in a collaborative and supportive setting, where trained counselors elicited motivation to change from the client rather than through direction or persuasion. The heroin abusers using both methods of MI had results of 40.2% abstinence compared to 30.6% found in the more formal drug intervention programs that patients were being referred to before the study. The conclusion was that BMI may help patients achieve abstinence from heroin effectively at the point of medical service (Bernstein et al., 2009).

Early studies on using BMI back in the 90’s were inconclusive but did see marked increases in self-efficacy and increased motivation. Later studies begin to find marked higher effectiveness in specific population’s responses to MI and opiate use disorder with co-occurring conditions is one of those populations (Saunders et al., 1995).

Specific BMI Effectiveness

BMI works with various populations of addicts, helps support motivation while in detox and is very effective for patients with Dual Diagnosis/Co-occurring Conditions. In a study that explored using BMI during detox it was found to be a good fit where patients were not yet ready for other counseling models due to impaired cognition and lack of commitment to recovery. BMI’s not only fit into the short time periods the providers had face to face with patients but showed great effectiveness in moving patients through the stages of change and preparing and motivating them to seek out continued recovery resources (Berman et al., 2010).

In co-morbid situations where addiction was co-occurring with behavioral health issues, using Cognitive Behavioral Therapy (CBT) with BMI was found to be much more effective than CBT alone (Barrowclough et al., 2010). The efficacy of HARM reduction with dual-diagnosis cases, or addiction with co-occurring depression, anxiety, bi-polar disorder, and other disorders was greatly enhanced for addicts and their families using BMI (Laker, 2007).

The effectiveness of using BMI for the inmate population has been extensively tested in Sweden. The inmate population is very similar to that in the U.S. as far as percent of addiction related convictions, substance use in jail, and return to use after release from jail. The opiate use disorder problem is also almost identical percentage-wise. The study concluded that prison staff could be effectively and consistently trained to use BMI skills, that the use of BMI made a difference with improved trust and relations in between workers and inmates, and that BMI lowered opiate abuse in prison, after release, and lowered recidivism (Forsberg et al., 2011).

Strategies for Using BMI for Opiate Use Disorders

The most effective use of BMI with opiate use disorders is consistent use across the stages of readiness and using specific strategies for each population of opiate addiction,

BMI is most effective if used regularly by trained staff (Doran, 2008, Forsberg et al., 2011). Use by frontline staff during medical checkups, social services & behavioral health contacts, during detox, and even with controlled populations like prison inmates can greatly motivate opiate use disorder patients to be motivated to change (Doran, 2008, Forsberg et al., 2011, Bernstein, 2009, Berman et al., 2010).

Conclusion

Brief Motivational Intervention can be very effective in reducing opiate abuse in many populations. BMI’s is effective moving addicts through the stages of change, it helps while detoxing patients, in the early stages of recovery, with co-occurring conditions (co-morbidity), and even in working with inmates and ex-convicts and helping them overcome addiction and avoid re-incarceration (Barrowclough et al., 2010, Forsberg et al., 2011, Berman et al., 2010).

There is certainly enough evidence based findings to increase the use of BMI on its own in the medical and social service industry. It also appears that adding BMI and the person centered principles of MI would work together with and greatly enhance the effectiveness of all other forms of intervention, treatment, and counseling (Doran, 2008).

References

Barrowclough, C., Haddock, G., Wykes, T., Beardmore, R., Conrod, P., Craig, T., Tarrier, N. (2010). Integrated motivational interviewing and cognitive behavioral therapy for people with psychosis and comorbid substance misuse: randomized controlled trial. British Medical Journal, 341(7784), 1-12. doi:10.1136/bmj.c6325

Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77(1), 49-59.

Berman, A. H., Forsberg, L., Durbeej, N., Källmén, H., & Hermansson, U. (2010). Single-session motivational interviewing for drug detoxification inpatients: Effects on self-efficacy, stages of change and substance use. Substance Use & Misuse, 45, 384-402. doi:10.3109/10826080903452488

Doran, C. M. (2008). Economic evaluation of interventions to treat opiate dependence: A review of the evidence. Pharmacoeconomics, 26(5), 371-393. doi:10.2165/00019053-200826050-00003

Forsberg, L. G., Ernst, D., Sundqvist, K., & Farbring, C. A. (2011). Motivational interviewing delivered by existing prison staff: A randomized controlled study of effectiveness on substance use after release. Substance Use & Misuse, 46, 1477-1485. doi:10.3109/10826084.2011.591880

Laker, C. J. (2007). How reliable is the current evidence looking at the efficacy of harm reduction and motivational interviewing interventions in the treatment of patients with a dual diagnosis? Journal of Psychiatric and Mental Health Nursing, 14, 720-726. doi:10.1111/j.1365-2850.2007.01159.x

Saunders, B., Wilkinson, C., & Phillips, M. (1995). The impact of a brief motivational intervention with opiate users attending a methadone programme. Addiction, 90, 415-424. doi:10.1111/j.1360-0443.1995.tb03788.x

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