Significant Others in Substance Abusers’ Change Talk During Motivational Interviewing Sessions in the Finnish Probation Service

Open access

Abstract

AIMS – This article explores the meanings substance-abusing clients attach to family and friendships during motivational interviewing (MI) sessions in Probation Service. DATA – The analyses are based on videotaped and transcribed data consisting of 82 MI sessions. This database involves the first two counseling sessions of 41 client-counselor pairs. Sessions were videotaped in 12 Probation Service offices in Finland between 2007 and 2009. METHODS – The analysis relies on coding of client’s change talk utterances and qualitative semiotic framework. RESULTS – The meanings of the significant others were diverse from the point of view of the client’s motivation: family appeared as a support for change, an aspiration, a sufferer, or an obstacle to change; and friendship appeared as an obstacle to change, a surmounted obstacle, a cause to change, or a support to change. CONCLUSIONS - Significant others and their quality are important and diverse factors that promote or hinder change in substance abuser’ change talk. Thus, it is suggested that the meaning of significant others should not be overlooked in MI and other substance abuse treatment.

Abstract

AIMS – This article explores the meanings substance-abusing clients attach to family and friendships during motivational interviewing (MI) sessions in Probation Service. DATA – The analyses are based on videotaped and transcribed data consisting of 82 MI sessions. This database involves the first two counseling sessions of 41 client-counselor pairs. Sessions were videotaped in 12 Probation Service offices in Finland between 2007 and 2009. METHODS – The analysis relies on coding of client’s change talk utterances and qualitative semiotic framework. RESULTS – The meanings of the significant others were diverse from the point of view of the client’s motivation: family appeared as a support for change, an aspiration, a sufferer, or an obstacle to change; and friendship appeared as an obstacle to change, a surmounted obstacle, a cause to change, or a support to change. CONCLUSIONS - Significant others and their quality are important and diverse factors that promote or hinder change in substance abuser’ change talk. Thus, it is suggested that the meaning of significant others should not be overlooked in MI and other substance abuse treatment.

References

  • Amrhein, P. C. (2007). A training manual for coding client commitment language. New York: Therapeutic Language Laboratory, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, Division on Substance Abuse, Unit #120.

  • Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. (2003). Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology, 71(5), 862–878.

  • Apodaca, T. R., & Longabaugh, R. (2009). Mechanisms of change in motivational interviewing: A review and preliminary evaluation of the evidence. Addiction, 104(4), 705–715.

  • Apodaca, T. R., Magill, M., Longabaugh, R., Jackson, K. M., & Monti, P. M. (2013). Effect of a significant other on client change talk in motivational interviewing. Journal of Consulting and Clinical Psychology, 81(1), 35–46.

  • Ashton, M. (2005). Motivational arm twisting – contradiction in terms? Drug and Alcohol Findings, (14), 4–19.

  • Beattie, M. C. (2001). Meta-analysis of social relationships and post-treatment drinking outcomes: comparison of relationship structure, function and quality. Journal of Studies on Alcohol, 62(4), 518–527.

  • Beattie, M. C., & Longabaugh, R. (1997). Interpersonal factors and post-treatment drinking and subjective well-being. Addiction, 92(11), 1507–1521.

  • Beattie, M. C., & Longabaugh, R. (1999). General and alcohol-specific social support following treatment. Addictive Behaviors, 24(5), 593–606.

  • Bertholet, N., Faouzi, M., Gmel, G., Gaume, J., & Daeppen, J. B. (2010). Change talk sequence during brief motivational intervention, towards or away from drinking. Addiction, 105(12), 2106–2112.

  • Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting & Clinical Psychology, 71(5), 843–861.

  • Campbell, S. D., Adamson, S. J., & Carter, J. D. (2010). Client language during motivational enhancement therapy and alcohol use outcome. Behavioural and Cognitive Psychotherapy, 38(4), 399–415.

  • De Civita, M., Dobkin, P. L., & Robertson, E. (2000). A study of barriers to the engagement of significant others in adult addiction treatment. Journal of Substance Abuse Treatment, 19(2), 135–144.

  • Ellis, B., Bernichon, T., Yu, P., Roberts, T., & Herrell, J. M. (2004). Effect of social support on substance abuse relapse in a residential treatment setting for women. Evaluation and Program Planning, 27(2), 213–221.

  • Fals-Stewart, W., O’Farrell, T. J., & Hooley, J. M. (2001). Relapse among married or cohabiting substance-abusing patients: the role of perceived criticism. Behavior Therapy, 32(4), 787–801.

  • Farbring, C. Å., & Berge, P. (2006). BSF. Beteende – samtal – förändring. Fem semistrukturerade motiverande samtal. Programmanual. Version för kriminalvården. [Behaviour – Interviewing – Change. Program manual to the Swedish Prison and Probation Service.]. Beställningsnummer vid Kriminalvården HK: 4751 [Swedish Prison and Probation Service, Norrköping.].

  • Farbring, C. Å., & Johnson, W. (2008). Motivational interviewing in the correctional system. An attempt to implement motivational interviewing in criminal justice. In H. Arkowitz, H. A. Westra, W. R. Miller, & S. Rollnick (Eds.), Motivational Interviewing in the Treatment of Psychological Problems (pp. 304–323). New York: The Guilford Press.

  • Havassy, B. E., Hall, S. M., & Wasserman, D. A. (1991). Social support and relapse: Commonalities among alcoholics, opiate users, and cigarette smokers. Addictive Behaviors, 16(5), 235–246.

  • Hettema, J. E., Steele, J. M., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91–111.

  • Hunter-Reel, D., McCrady, B., & Hildebrandt, T. (2009). Emphasizing interpersonal factors: An extension of the Witkiewitz and Marlatt relapse model. Addiction, 104(8), 1281–1290.

  • Kaskutas, L. A., Bond, J., & Humpreys, K. (2002). Social networks as mediators of the effect of Alcoholics Anonymous. Addiction, 97(7), 891–900.

  • Liszka, J. J. (1996). A General Introduction to the Semiotic of Charles Sanders Peirce. Bloomington: Indiana University Press.

  • Longabaugh, R., Wirtz, P. W., Zywiak, W. H., & O’Malley, S. S. (2010). Network support as a prognostic indicator of drinking outcomes: The COMBINE study. Journal of Studies on Alcohol and Drugs, 71(6), 837–846.

  • Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137–160.

  • McCrady, B. S. (2004). To have but one true friend: Implications for practice of research on alcohol use disorders and social network. Psychology of Addictive Behaviors, 18(2), 113–121.

  • McCrady, B. S., Epstein, E. E., & Sell, R. D. (2003). Theoretical bases of family approaches to substance abuse treatment. In F. Rotgers, D. S. Keller, & J. Morgenstern (Eds.), Treatment of Substance Abusers: Theory and Technique (pp. 112–139). New York: Guilford Press.

  • McCrady, B. S., Hayaki, J., Epstein, E. E., & Hirsch, L. S. (2002). Testing hypothesized predictors of change in conjoint behavioral alcoholism treatment for men. Alcoholism: Clinical and Experimental Research, 26(4), 463–470.

  • McCrady, B. S., Zucker, R. A., Molina, B. S., Ammon, L., Ames G. M., & Longabaugh, R. (2006). Social environmental influences on the development and resolution of alcohol problems. Alcoholism: Clinical and Experimental Research, 30(4), 688–699.

  • Miller, W.R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11(2), 147–172.

  • Miller, W. R., Moyers, T. B., Ernst, D., & Amrhein, P. (2008). Manual for the motivational interviewing skill code (MISC). Version 2.1. Center on alcoholism, substance abuse, and addictions. The University of New Mexico. http://casaa. unm.edu/download/misc.pdf. Accessed 26 August 2009.

  • Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3nd ed.). New York: Guilford Press.

  • Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), 527–537.

  • Mohr, C. D., Averna, S., Kenny, D. A., & Del Boca, F. K. (2001). “Getting by (or getting high) with a little help from my friends”: An examination of adult alcoholics’ friendships. Journal of Studies on Alcohol, 62(5), 637–645.

  • Moyers, T. B., Martin, T., Christopher, P. J., Houck, J. M., Tonigan, J. S., & Amrhein, P. C. (2007). Client language as a mediator of motivational interviewing efficacy: Where is the evidence? Alcoholism: Clinical & Experimental Research, 31(s3), 40–47.

  • O’Farrell, T. J., Hooley, J., Fals-Stewart, W., & Cotter, H. L. (1998). Expressed emotion and relapse in alcoholic patients. Journal of Consulting and Clinical Psychology, 66(5), 744–752.

  • Peirce, C. S. (1965). In C. Hartshorne & P. Weiss (Eds.), Collected papers of Charles Sanders Peirce. Vols. 1–2. Cambridge, MA: The Belknap Press of Harvard University Press.

  • Project MATCH Research Group. (1998). Therapist effects in three treatments for alcohol problems. Psychotherapy Research, 8(4), 455–474.

  • Rhodes, T., & Coomber, R. (2010). Qualitative methods and theory in addiction research. In P. G. Miller, J. Strang, & P. M. Miller (Eds.), Addiction Research Methods (pp. 59–78). Oxford: Wiley-Blackwell.

  • Saarnio, P. (2002). Factors associated with dropping out from outpatient treatment of alcohol-other drug abuse. Alcoholism Treatment Quarterly, 20(2), 17–33.

  • Sarpavaara, H. (2010). Use of metaphors in motivational interviewing sessions in the probation service. Communication & Medicine, 7(2), 197–206.

  • Sarpavaara, H. (2013). A Peircean analysis of counselors’ interpretations and clients’ responses in motivational interviewing sessions. Social Semiotics, 23(1), 67–82.

  • Sarpavaara, H., & Koski-Jännes, A. (2013). Change as a journey – Clients’ metaphoric change talk as an outcome predictor in initial motivational sessions with probationers. Qualitative Research in Psychology, 10(1), 86–101.

  • Short, T. L. (2007). Peirce’s Theory of Signs. Cambribge: Cambridge University Press.

  • Stevens, S. J., Estrada, A. L., Glider, P. J., & McGrath, R. A. (1998). Ethnic and cultural differences in drug-using women who are in and out of treatment. Drugs & Society, 13(1-2), 81–95.

  • UKATT Research Team. (2005). Effectiveness of treatment for alcohol problems: Findings of the randomised UK alcohol treatment trial (UKATT). British Medical Journal, 331, 541.

  • Walker, D., Stephens, R., Rowland, J., & Roffman, R. (2011). The influence of client behavior during motivational interviewing on marijuana treatment outcome. Addictive Behaviors, 36(6), 669–673.

  • Zywiak, W. H., Longabaugh, R., & Wirtz, P. W. (2002). Decomposing the relationship between pretreatment social network characteristics and alcohol treatment outcome. Journal of Studies on Alcohol, 63(1), 114–121.

Amrhein, P. C. (2007). A training manual for coding client commitment language. New York: Therapeutic Language Laboratory, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, Division on Substance Abuse, Unit #120.

Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. (2003). Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology, 71(5), 862–878.

Apodaca, T. R., & Longabaugh, R. (2009). Mechanisms of change in motivational interviewing: A review and preliminary evaluation of the evidence. Addiction, 104(4), 705–715.

Apodaca, T. R., Magill, M., Longabaugh, R., Jackson, K. M., & Monti, P. M. (2013). Effect of a significant other on client change talk in motivational interviewing. Journal of Consulting and Clinical Psychology, 81(1), 35–46.

Ashton, M. (2005). Motivational arm twisting – contradiction in terms? Drug and Alcohol Findings, (14), 4–19.

Beattie, M. C. (2001). Meta-analysis of social relationships and post-treatment drinking outcomes: comparison of relationship structure, function and quality. Journal of Studies on Alcohol, 62(4), 518–527.

Beattie, M. C., & Longabaugh, R. (1997). Interpersonal factors and post-treatment drinking and subjective well-being. Addiction, 92(11), 1507–1521.

Beattie, M. C., & Longabaugh, R. (1999). General and alcohol-specific social support following treatment. Addictive Behaviors, 24(5), 593–606.

Bertholet, N., Faouzi, M., Gmel, G., Gaume, J., & Daeppen, J. B. (2010). Change talk sequence during brief motivational intervention, towards or away from drinking. Addiction, 105(12), 2106–2112.

Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting & Clinical Psychology, 71(5), 843–861.

Campbell, S. D., Adamson, S. J., & Carter, J. D. (2010). Client language during motivational enhancement therapy and alcohol use outcome. Behavioural and Cognitive Psychotherapy, 38(4), 399–415.

De Civita, M., Dobkin, P. L., & Robertson, E. (2000). A study of barriers to the engagement of significant others in adult addiction treatment. Journal of Substance Abuse Treatment, 19(2), 135–144.

Ellis, B., Bernichon, T., Yu, P., Roberts, T., & Herrell, J. M. (2004). Effect of social support on substance abuse relapse in a residential treatment setting for women. Evaluation and Program Planning, 27(2), 213–221.

Fals-Stewart, W., O’Farrell, T. J., & Hooley, J. M. (2001). Relapse among married or cohabiting substance-abusing patients: the role of perceived criticism. Behavior Therapy, 32(4), 787–801.

Farbring, C. Å., & Berge, P. (2006). BSF. Beteende – samtal – förändring. Fem semistrukturerade motiverande samtal. Programmanual. Version för kriminalvården. [Behaviour – Interviewing – Change. Program manual to the Swedish Prison and Probation Service.]. Beställningsnummer vid Kriminalvården HK: 4751 [Swedish Prison and Probation Service, Norrköping.].

Farbring, C. Å., & Johnson, W. (2008). Motivational interviewing in the correctional system. An attempt to implement motivational interviewing in criminal justice. In H. Arkowitz, H. A. Westra, W. R. Miller, & S. Rollnick (Eds.), Motivational Interviewing in the Treatment of Psychological Problems (pp. 304–323). New York: The Guilford Press.

Havassy, B. E., Hall, S. M., & Wasserman, D. A. (1991). Social support and relapse: Commonalities among alcoholics, opiate users, and cigarette smokers. Addictive Behaviors, 16(5), 235–246.

Hettema, J. E., Steele, J. M., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91–111.

Hunter-Reel, D., McCrady, B., & Hildebrandt, T. (2009). Emphasizing interpersonal factors: An extension of the Witkiewitz and Marlatt relapse model. Addiction, 104(8), 1281–1290.

Kaskutas, L. A., Bond, J., & Humpreys, K. (2002). Social networks as mediators of the effect of Alcoholics Anonymous. Addiction, 97(7), 891–900.

Liszka, J. J. (1996). A General Introduction to the Semiotic of Charles Sanders Peirce. Bloomington: Indiana University Press.

Longabaugh, R., Wirtz, P. W., Zywiak, W. H., & O’Malley, S. S. (2010). Network support as a prognostic indicator of drinking outcomes: The COMBINE study. Journal of Studies on Alcohol and Drugs, 71(6), 837–846.

Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137–160.

McCrady, B. S. (2004). To have but one true friend: Implications for practice of research on alcohol use disorders and social network. Psychology of Addictive Behaviors, 18(2), 113–121.

McCrady, B. S., Epstein, E. E., & Sell, R. D. (2003). Theoretical bases of family approaches to substance abuse treatment. In F. Rotgers, D. S. Keller, & J. Morgenstern (Eds.), Treatment of Substance Abusers: Theory and Technique (pp. 112–139). New York: Guilford Press.

McCrady, B. S., Hayaki, J., Epstein, E. E., & Hirsch, L. S. (2002). Testing hypothesized predictors of change in conjoint behavioral alcoholism treatment for men. Alcoholism: Clinical and Experimental Research, 26(4), 463–470.

McCrady, B. S., Zucker, R. A., Molina, B. S., Ammon, L., Ames G. M., & Longabaugh, R. (2006). Social environmental influences on the development and resolution of alcohol problems. Alcoholism: Clinical and Experimental Research, 30(4), 688–699.

Miller, W.R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11(2), 147–172.

Miller, W. R., Moyers, T. B., Ernst, D., & Amrhein, P. (2008). Manual for the motivational interviewing skill code (MISC). Version 2.1. Center on alcoholism, substance abuse, and addictions. The University of New Mexico. http://casaa. unm.edu/download/misc.pdf. Accessed 26 August 2009.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3nd ed.). New York: Guilford Press.

Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), 527–537.

Mohr, C. D., Averna, S., Kenny, D. A., & Del Boca, F. K. (2001). “Getting by (or getting high) with a little help from my friends”: An examination of adult alcoholics’ friendships. Journal of Studies on Alcohol, 62(5), 637–645.

Moyers, T. B., Martin, T., Christopher, P. J., Houck, J. M., Tonigan, J. S., & Amrhein, P. C. (2007). Client language as a mediator of motivational interviewing efficacy: Where is the evidence? Alcoholism: Clinical & Experimental Research, 31(s3), 40–47.

O’Farrell, T. J., Hooley, J., Fals-Stewart, W., & Cotter, H. L. (1998). Expressed emotion and relapse in alcoholic patients. Journal of Consulting and Clinical Psychology, 66(5), 744–752.

Peirce, C. S. (1965). In C. Hartshorne & P. Weiss (Eds.), Collected papers of Charles Sanders Peirce. Vols. 1–2. Cambridge, MA: The Belknap Press of Harvard University Press.

Project MATCH Research Group. (1998). Therapist effects in three treatments for alcohol problems. Psychotherapy Research, 8(4), 455–474.

Rhodes, T., & Coomber, R. (2010). Qualitative methods and theory in addiction research. In P. G. Miller, J. Strang, & P. M. Miller (Eds.), Addiction Research Methods (pp. 59–78). Oxford: Wiley-Blackwell.

Saarnio, P. (2002). Factors associated with dropping out from outpatient treatment of alcohol-other drug abuse. Alcoholism Treatment Quarterly, 20(2), 17–33.

Sarpavaara, H. (2010). Use of metaphors in motivational interviewing sessions in the probation service. Communication & Medicine, 7(2), 197–206.

Sarpavaara, H. (2013). A Peircean analysis of counselors’ interpretations and clients’ responses in motivational interviewing sessions. Social Semiotics, 23(1), 67–82.

Sarpavaara, H., & Koski-Jännes, A. (2013). Change as a journey – Clients’ metaphoric change talk as an outcome predictor in initial motivational sessions with probationers. Qualitative Research in Psychology, 10(1), 86–101.

Short, T. L. (2007). Peirce’s Theory of Signs. Cambribge: Cambridge University Press.

Stevens, S. J., Estrada, A. L., Glider, P. J., & McGrath, R. A. (1998). Ethnic and cultural differences in drug-using women who are in and out of treatment. Drugs & Society, 13(1-2), 81–95.

UKATT Research Team. (2005). Effectiveness of treatment for alcohol problems: Findings of the randomised UK alcohol treatment trial (UKATT). British Medical Journal, 331, 541.

Walker, D., Stephens, R., Rowland, J., & Roffman, R. (2011). The influence of client behavior during motivational interviewing on marijuana treatment outcome. Addictive Behaviors, 36(6), 669–673.

Zywiak, W. H., Longabaugh, R., & Wirtz, P. W. (2002). Decomposing the relationship between pretreatment social network characteristics and alcohol treatment outcome. Journal of Studies on Alcohol, 63(1), 114–121.

Nordic Studies on Alcohol and Drugs

The Journal of Nordic Centre for Welfare and Social Issues

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