Student-Perceived Quality of Motivational Interviewing Training: A Factor-Analytic Study

Objective: This study developed and tested a student-report measure of motivational interviewing (MI) teaching quality called the Evaluation of Motivational Interviewing Teaching (EMIT) scale. Method: Social work students (N = 297) receiving course content on motivational interviewing completed the EMIT, and exploratory factor analysis investigated whether theory-based dimensions of teaching emerged as EMIT subscales, including: interactivity/skill building, MI content coverage, modeling MI during teaching, trainee autonomy violation, and encouraging ongoing training in MI. Results: Two subscales emerged representing MIconsistent (28 items, α = .92) and MI-inconsistent teaching practices (7 items, α = .73). Conclusions: Although more research is needed on the EMIT, this study supports the initial reliability of the instrument and can help social work educators evaluate MI teaching qualit

Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the Life Shift/Shift Gears study.

BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227

Implementing a harm reduction approach to substance use in an intimate partner violence agency: practice issues in an Irish setting.

There has been growing recognition of the co-occurrence of substance use and intimate partner violence (IPV) victimization in women's and men's lives, yet many IPV service providers have not developed an integrated response to these issues. Fewer still have implemented substance use services from a harm reduction approach. This article outlines the approach, policy changes, initial outcomes, and learning points for an IPV agency in Ireland, which implemented a harm reduction response to female IPV survivors who were also using substances problematically. Barriers and challenges for staff and management seeking to coordinate and integrate service delivery on the dual issues are also presented

Predictors of role legitimacy and role adequacy of social workers working with substance-using clients.

Role adequacy (feeling knowledgeable about one's work) and role legitimacy (believing that one has the right to address certain client issues) have long been key theoretical constructs regarding explanations why various helping professionals are reluctant to address drug misuse problems with clients. This study examines these concepts in a sample of social workers and social work students. Using regression analysis, it was determined that the social workers who had more clients with drug problems, had taken a course in drug work and had support for their role were more likely to feel legitimate in their work with drug-using clients. Training in drug use identification and intervention, being male, having more clients with drug problems and role support predicted role adequacy. Having a Master's degree, work setting and job function were not related to role adequacy or role legitimacy. Implications for social work education are discussed

Practice note: The Irish drug treatment court.

Although international countries seek to adopt the American drug court model, each country brings its own culture, philosophy of treatment, and drug use context that affects how each court is implemented. This article reviews the history and context of the Irish Drug Treatment Court. Differences from the American model are considered, such as an emphasis on harm reduction, provision of services predominantly to heroin users, the use of an adult education program as the main intervention, and a varying view of therapeutic jurisprudence. Process and outcome evaluation findings are presented, along with a final discussion related to drug court practice

Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients

Introduction: Visits to settings such as emergency departments (EDs) may present a “teachable moment” in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an ’opportunistic’ public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use. Methods: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT) on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use). Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient’s visit) using a short instrument, and then delivered a brief motivational intervention matched to the patient’s risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis. Results: Results of generalized linear mixed models showed modest reductions in all 6 drug- and alcohol-use outcomes. Men (versus women), those at relatively higher risk status (versus lower risk), and those with only one substance of misuse (versus both alcohol and illicit drug misuse) tended to show more positive change. Conclusion: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use. [West J Emerg Med. 2013;14(3):263–270.

Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department

Emergency department (ED) settings have gained interest as venues for illegal drug misuse prevention and intervention, with researchers and practitioners attempting to capitalize on the intersection of need and opportunity within these settings. This study of 686 adult patients visiting two EDs for various reasons who admitted drug use compared daily cannabis-only users, nondaily cannabis-only users, and other drug users on sociodemographic and drug-related severity outcomes. The three drug use groups did not differ on most sociodemographic factors or medical problem severity scores. Forty-five percent of the sample was identified as having a drug use problem. ED patients who used drugs other than cannabis were at particular risk for high drug use severity indicators and concomitant problems such as psychiatric problems and alcohol use severity. However, 19-29% of cannabis-only users were identified as having problematic drug use. Furthermore, daily cannabis-only users fared less well than nondaily cannabis users with regard to drug use severity indicators and self-efficacy for avoiding drug use. Results may assist emergency medicine providers and medical social workers in matching patients to appropriate intervention. For example, users of drugs other than cannabis (and perhaps heavy, daily cannabis-only users) may need referral to specialty services for further assessment. Enhancement of motivation and self-efficacy beliefs could be an important target of prevention and treatment for cannabis-only users screened in the ED