Rethinking Substance Abuse Treatment Strategies

    • July 23, 2009

William R. Miller, PhD
Distinguished Professor Emeritus of Psychology and Psychiatry
University of New Mexico
Albuquerque, N.M.

Programee background: In 1983, William R. Miller, PhD, introduced "motivational interviewing" into the field of substance abuse treatment. Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It has been widely incorporated into substance abuse treatment programs.

The award: In 2003, Miller received an Innovators Combating Substance Abuse award and used it to complete four projects that he had been contemplating but had not undertaken. The Robert Wood Johnson Foundation (RWJF) created the Innovators program to nurture and promote innovation in combating substance abuse. Between 2000 and 2003, some 20 senior researchers, practitioners and policy-makers received Innovators awards. See Program Results Report for more information on the program.

Projects and Findings: Miller reported the following to RWJF about the projects he completed with his award:

Spiritual Intervention in Recovery and Treatment (SPIRIT) Project. Miller evaluated the effect of spiritual direction in combination with in-patient substance abuse treatment. Spiritual direction is the process of accompanying people on a spiritual journey as they explore the spiritual side of being human. Researchers recruited 60 patients from a 21-day treatment program in Albuquerque, N.M., and randomly assigned them to receive 12 sessions of spiritual direction as part of treatment or treatment without spiritual direction.

  • Findings. Contrary to expectation, spiritual direction had no effect on post-treatment substance abuse. (See Miller WR, Forcehimes A, O'Leary M and Lanoue M. "Spiritual Direction in Addiction Treatment: Two Clinical Trials." Journal of Substance Abuse Treatment, 35, 434–442, 2008).

Practice-based Intervention for Substance Abuse (PISA) Project. Miller and colleagues placed a master's level behavioral specialist in a public family practice clinic operated by the University of New Mexico Hospitals. The specialist explored the feasibility of using a model for providing specialized substance abuse treatment in a primary care setting and refined the model.

  • Findings. An article in the International Journal of Integrated Care included the following conclusion from the Practice-based Intervention for Substance Abuse:

    "Addressing substance abuse problems in primary care is important. Behavioral health professionals with training in substance abuse can provide a range of services that are likely to enhance the quality and quantity of care available to patients. Although contextual factors needed to be addressed, integration of services was manageable and seemed acceptable to both providers and patients in this project."

Meta-Analytic Review of Motivational Interviewing Treatment Efficacy (MARMITE) Project. Miller assembled a comprehensive bibliography of publications on motivational interviewing.

  • Findings. An analysis of 74 studies regarding the efficacy of motivational interviewing concluded:

    "Even with maximally conservative procedures, we found a mean effect size of motivational interviewing in the small to medium range." Hettema J, Steele J and Miller WR. "Motivational Interviewing." Annual Review of Clinical Psychology, 1, 91–111, 2005.

Conference on Approaches for Combating the Troublesome Use of Substances (CACTUS) Project. Miller convened 16 scientists from different fields and asked them to temporarily set aside all current treatment systems and programs and use a scientific knowledge base to develop strategies for combating these problems.

  • Findings. After the think-tank conference, each invited participant wrote a paper summarizing addiction science in a specified area. Miller used the papers to form chapters of a book—Rethinking Substance Abuse: What the Science Shows and What We Should Do About It. Miller WR and Carroll KM (editors), New York: Guilford Press, 2006.