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Motivational interviewing (MI) was developed by William Miller from his work with problem drinkers. Miller and Stephen Rollnick1 further expanded MI as a directive, client-centered style of counseling with the goal of eliciting behavior change by helping individuals explore and resolve ambivalence. Although initially used for substance abuse counseling, MI has been used and evaluated across many other areas of behavioral health and in the treatment and prevention of chronic diseases. MI appears to be an easily adaptable approach that can be used with different populations and settings, and it can be delivered by trained professionals who have acquired the clinical skills through practice, training, and supervision.2 MI is an evidence-based practice with resources such as manuals, tools, self-assessment and fidelity measures, and in-service training to help support its implementation within agencies.2 This report summarizes recent findings from systematic reviews assessing the efficacy of MI across a multitude of domains but primarily in the areas of substance abuse and mental health. Information is included here that may not appear in the NREPP program summary completed.
Search Strategy and Criteria
An extensive literature search was conducted to identify and summarize published systematic reviews that focus on the efficacy of MI-based interventions and include at least one or more behavioral outcomes for substance abuse and mental health. Systematic reviews comparing efficacy across multiple interventions were included if at least two interventions were MI-based interventions. The search was limited to systematic reviews published; reported in English; and retrieved from the online catalog of the U.S. Government’s National Library of Medicine, PubMed to ensure free access to abstracts and in some cases full-text articles. Systematic reviews reported in the context of guidelines, consensus statements, or studies were not the target of the search.
The strategy to conduct the search was as follows: (“motivational interview” OR “motivational interviews” OR “motivational interviewing”) AND (Meta-Analysis[pt] OR systematic[sb]) AND “English”[lang] AND "Humans"[MeSH Terms] AND [PDAT] : [PDAT].
Each part of the strategy is described below:
- Topics: Various keyword forms of “Motivational Interviewing” were used to focus the search. PubMed Medical Subject Headings (MeSH) were not available for this topic.
- Additional limits: Limits were used restricting the search to systematic reviews (with a separate designation for those containing meta-analyses) and articles published in English, focusing on humans.
The literature search yielded a total of 17 systematic reviews assessing the efficacy of MI-based interventions on substance abuse and mental health outcomes. Of the 17 systematic reviews, 5 included a meta-analysis (Reviews 2, 3, 9, 10, and 16). The average number of studies included in a systematic review was 33, with a range between 9 and 72 studies. Studies were conducted in the United States and internationally, and most were carried out in a variety of academic, community, clinical, or custodial settings. The population samples in most systematic reviews were diverse, with the exception of systematic reviews that aimed to assess the efficacy of MI with a specific population such as HIV patients (Reviews 10 and 11), adolescents (Reviews 9, 14, and 17), patients with co-occurring disorders (Reviews 4, 5, and 8), college students (Reviews 3 and 12), and pregnant women (Review 15).
The objective of most systematic reviews was to assess the efficacy of MI on reducing substance use; at least 13 of the 17 systematic reviews obtained from the search assessed 2 or more substance use outcomes. Other outcomes of interest were mental health status, treatment adherence, physiological measures, eating behaviors, physical activity levels, lifestyle change behaviors, neonatal outcomes, risky behaviors, and readiness to change (a central goal of the MI approach). Outcome measures assessing readiness to change were mostly associated with substance use outcomes, with the exception of one systematic review (Review 1), which evaluated the mechanisms of change and how clinician behaviors interacted with client behaviors to produce change.
The findings across all systematic reviews show that while MI is a recommended approach for behavior change, it is mostly supported in the areas of alcohol and drug use. There are inconsistent findings supporting the efficacy of MI over any other treatment. However, there is strong evidence suggesting the effects of MI are greater when coupled with another active intervention such as cognitive behavioral therapy (CBT). Overall, MI helps individuals reduce their use of drugs and alcohol and helps them stay in treatment and make lifestyle changes to improve their well-being. MI review literature should be carefully considered as it offers valuable suggestions for future research opportunities.