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Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT), and Twelve-Step Facilitation treatments (TSF)
Comparison of three evidence-based interventions in a subsample of Native American participants drawn from a larger clinical trial.
This article reported results for comparing three evidence-based treatments, motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), or Twelve-Step Facilitation (TSF), among Native Americans with alcohol use disorder (AUD) seeking outpatient or aftercare treatment. MET is a person-centered approach to treatment that focuses on improving an individual's motivation to change. CBT is a behavioral intervention which focuses on increasing an individual’s ability to cope with high-risk situations that lead to drinking. TSF is an engagement strategy designed to increase the likelihood of becoming actively involved in 12-step self-help groups such as AA. Twelve weeks of treatment were provided, but MET was provided only four times across the 12 weeks.
Outcomes
There was some advantage of MET on one clinical outcome when compared to the two other treatments.
Despite limited statistical power due to small sample sizes, MET resulted in significantly less drinking intensity at long-term follow-up (7-12 months after treatment) when compared to CBT and TSF. Some nonsignificant differences favoring MET for days abstinent and lower drinking intensity were reported at the end of treatment and long-term follow up.
Costs
Substantial expense associated with staffing.
Even assuming access to treatment infrastructure, substantial resources would be required to start up and maintain each of the three treatment modalities. These costs include extensive staff time (i.e., therapist and supervisors), obtaining treatment manuals, and training and supervision in treatment modalities.
Cultural Engagment
No cultural or Tribal contribution to the protocol.
There is no mention of cultural adaptation or Tribal input into the research or treatment protocol.
Participants
Adult; Native; Female, Male
Setting
Clinical/Healthcare, Urban
Delivery
Individual, Face-to-Face
A small subsample of Native Americans who received treatment in urban settings.
This study evaluated a small subsample of participants drawn from Project MATCH, a large multisite, randomized clinical trial. This report included 25 Native Americans, mean age 35.6 years old, 7 females and 18 males, who were randomized and evenly distributed to the three different treatment interventions. Participants were recruited at outpatient and aftercare sites in urban settings in the Southwest and Pacific Northwest.
Staffing Needs
Not Specified
Staffing credentials or background not specified.
This report does not discuss the staffing needs to implement the interventions. There is mention of therapists being experienced therapists who received extensive training and supervision, but background or credentials were not specified.
Research Design
Randomized controlled experimental design
Developmental stage of research
Early stage research conducted on a small subsample of a large clinical trial with some encouraging findings.
This is early stage research that suggests MET may be useful as a treatment intervention for Native Americans. Implementation of this research within a much larger sample is needed to fully examine the efficacy of all these treatment interventions and to understand their acceptability for Native communities.
Potential
This study suggests MET might be differentially more effective for Native American individuals receiving evidence-based outpatient and aftercare treatments.
Results suggest that evidence-based treatment interventions for alcohol use developed and used for the general US population can be helpful in reducing drinking among Native Americans. This study suggests that MET outperforms CBT and TSF as a treatment intervention among Native Americans. However, Native Americans did not differentially reject either CBT or TSF and had similar outcomes within these conditions as compared to non-Hispanic Whites. Future research with larger numbers of Native Americans should examine factors that explain treatment engagement and aim to culturally tailor treatment interventions for Native Americans.
References
Villanueva M, Tonigan JS, Miller WR. Response of Native American clients to three treatment methods for alcohol dependence. J Ethn Subst Abuse. 2007;6(2):41-48. https://pubmed.ncbi.nlm.nih.gov/18192203. https://doi.org/10.1300/j233v06n02_04.
Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity): Rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. Alcohol Clin Exp Research. 1993;17(6):1130-1145. https://pubmed.ncbi.nlm.nih.gov/8116822. https://doi.org/10.1111/j.1530-0277.1993.tb05219.x.
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