Center for Care Delivery and Outcomes Research
Motivational Interviewing in SUD IOP
A major challenge for delivering evidence-based treatment to patient’s with substance use disorders (SUD) is low treatment completion, which leads to persisting poor clinical outcomes and suboptimal utilization of cost-effective treatments. Intensive outpatient programs (IOP) for SUD are a flexible, cost-effective, and comprehensive approach to treatment, yielding positive outcomes in terms of reduced substance use, enhanced psychological well-being, improved social functioning, and sustained recovery. However, the research on IOP discontinuation is sparse, from the pre-COVID era when services were delivered in person, and limited by reliance on administrative data that may not clarify central reasons for attrition such as treatment motivation or satisfaction. Furthermore, the clinical recommendations based on these findings, specifically building on existing motivation and addressing individual needs, have yet to be implemented and evaluated. Group therapy is the primary treatment modality of IOP, which typically includes psychoeducation and skills sessions. Supplementing the IOP with an adjunctive individual session using MI may increase intrinsic motivation and, in turn, optimize treatment engagement and retention. The first two objectives of this study were to describe outcomes for Veterans enrolled in SUD IOP using electronic medical record data and better understand these outcomes by interviewing Veterans on their experience in SUD IOP. These data were used to inform the individual MI session protocol by identifying primary reasons for discontinuation or completion that may be targeted using MI. Next, the third objective was to develop and test the feasibility and acceptability of the adjunctive individual MI session for use in Veterans enrolled in the SUD IOP. We will iteratively recruited Veterans admitted to IOP to participate in the MI session and to provide feedback on modifications. Upon revision of the protocol based on these data, we recruited a second cohort of Veterans to participate in the revised MI session. The preliminary results are promising and further adaptions are needed to expand the intervention. This will include qualitative interviews with Veterans who were referred but did not initiate SUD IOP to inform the expanded MI intervention. A pilot randomized controlled trial will also be carried out to assess the feasibility and acceptability of the adapted intervention and research protocol.
