Effects of motivational interviewing fidelity on substance use treatment engagement in primary care

Objective: Primary care (PC) may be an opportune setting to engage patients with opioid and alcohol use disorders (OAUDs) in treatment. We examined whether motivational interviewing (MI) fidelity was associated with engagement in primary care-based OAUD treatment in an integrated behavioral health setting. Methods: We coded 42 first session therapy recordings and examined whether therapist MI global ratings and behavior counts were associated with patient engagement, defined as the patient receiving one shot of extended release injectable naltrexone or any combination of at least two additional behavioral therapy, sublingual buprenorphine/naloxone prescriptions, or OAUD-related medical visits within 30 days of their initial behavioral therapy visit. Results: Autonomy/support global ratings were higher in the non-engaged group (OR = 0.28, 95%CI: 0.09-0.93; p = 0.037). No other MI fidelity ratings were significantly associated with engagement. Conclusion: We did not find positive associations between MI fidelity and engagement in primary care based OAUD treatment. More research with larger samples is needed to examine how providing autonomy/support to patients who are not ready to change may affect engagement. Practice implications: Training providers to strategically use MI to reinforce change as opposed to the status quo is needed. This may be especially important in primary care where patients may not be specifically seeking help for their OAUDs. (C) 2018 Elsevier Inc. All rights reserved.