Relevant bibliographies by topics / Motivational Enhancement Therapy

Academic literature on the topic 'Motivational Enhancement Therapy'

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Published: 4 June 2021
Last updated: 19 February 2022

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Journal articles on the topic "Motivational Enhancement Therapy"

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Wu, Sarah S., Erin Schoenfelder, and Ray Chih-Jui Hsiao. "Cognitive Behavioral Therapy and Motivational Enhancement Therapy." Child and Adolescent Psychiatric Clinics of North America 25, no. 4 (October 2016): 629–43. http://dx.doi.org/10.1016/j.chc.2016.06.002.

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Lee, Kang-Sook. "Moderate drinking and motivational enhancement therapy." Journal of the Korean Medical Association 54, no. 10 (2011): 1047. http://dx.doi.org/10.5124/jkma.2011.54.10.1047.

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Ager, Richard, Stephanie Roahen-Harrison, Paul J. Toriello, Patricia Kissinger, Patricia Morse, Edward Morse, Linton Carney, and Janet Rice. "Predictors of Adopting Motivational Enhancement Therapy." Research on Social Work Practice 21, no. 1 (January 20, 2010): 65–76. http://dx.doi.org/10.1177/1049731509353170.

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Korte, Kristina J., and Norman B. Schmidt. "Motivational Enhancement Therapy Reduces Anxiety Sensitivity." Cognitive Therapy and Research 37, no. 6 (June 7, 2013): 1140–50. http://dx.doi.org/10.1007/s10608-013-9550-3.

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Stapleton, Connie. "Motivational Enhancement Therapy… Keeping Our Patients Motivated!" Surgery for Obesity and Related Diseases 11, no. 6 (November 2015): S152—S153. http://dx.doi.org/10.1016/j.soard.2015.08.238.

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Guydish, Joseph, Martha Jessup, Barbara Tajima, and Sarah Turcotte Manser. "Adoption of Motivational Interviewing and Motivational Enhancement Therapy Following Clinical Trials." Journal of Psychoactive Drugs 42, sup6 (September 2010): 215–26. http://dx.doi.org/10.1080/02791072.2010.10400545.

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Polcin, Douglas L., Gantt P. Galloway, James Palmer, and William Mains. "The Case for High-Dose Motivational Enhancement Therapy." Substance Use & Misuse 39, no. 2 (January 2004): 331–43. http://dx.doi.org/10.1081/ja-120028494.

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Helstrom, Amy, Kent Hutchison, and Angela Bryan. "Motivational enhancement therapy for high-risk adolescent smokers." Addictive Behaviors 32, no. 10 (October 2007): 2404–10. http://dx.doi.org/10.1016/j.addbeh.2007.02.009.

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Lee, Sang Kyu. "Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Alcohol Use Disorders." Journal of Korean Neuropsychiatric Association 58, no. 3 (2019): 173. http://dx.doi.org/10.4306/jknpa.2019.58.3.173.

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Fioravanti, Giulia, Francesco Rotella, Barbara Cresci, Laura Pala, Giulia De Vita, Edoardo Mannucci, and Carlo Maria Rotella. "Motivational enhancement therapy in obese patients: A promising application." Obesity Research & Clinical Practice 9, no. 5 (September 2015): 536–38. http://dx.doi.org/10.1016/j.orcp.2015.06.003.

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Dissertations / Theses on the topic "Motivational Enhancement Therapy"

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Britt, Eileen Frances. "Enhancing Diabetes Self-Management: Motivational Enhancement Therapy." Thesis, University of Canterbury. Psychology, 2008. http://hdl.handle.net/10092/1479.

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The effectiveness of Motivational Enhancement Therapy (MET), a brief four session form of Motivational Interviewing (MI), provided by diabetes health practitioners at a hospital-based clinic, in improving diabetes outcome and self-management of Type 1 and Type 2 diabetes was evaluated using quasi-experimental designs (i.e., non-random control group and multiple baseline designs). Study 1 evaluated if MET provided by Diabetes Nurse Educators (DNEs) was effective in improving diabetes outcome (i.e., blood glucose and lipids) and diabetes self-management, and compared its effectiveness to the current standard treatment which comprised Patient Education (PE). Study 2 evaluated if the results of Study 1 could be generalised to Dietitians providing the intervention. Study 3 evaluated the effects of MI training and post-training supervised practice on practitioner and patient behaviour. Specific hypotheses (Studies 1-2) were that MI would lead to improved diabetes outcome through improved diabetes self-management, and would be more effective than PE. Further, training in MI plus supervised practice was predicted to lead to Nurse Educators behaving in ways consistent with MI and as a result the participants would exhibit less resistance and increased change talk than participants receiving PE (Study 3). The results suggest that MET was well received by the participants, and contributed to improved diabetes outcome (e.g., lowered blood glucose) and diabetes self-management (e.g., self-monitoring of blood glucose and dietary compliance), and may have been more effective than PE, although high variability made conclusions uncertain. Evidence of generalisation across participants, intervention staff, and outcomes is provided. Additionally, evidence is provided that with two days training plus supervised practice the DNE were able to practice MET to at least a beginning level of competency in MI and that as a result the participants behaved in ways consistent with MI theory (i.e., showed less resistance and increased change talk).
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Feld, Rachel Penny. "Pretreatment motivational enhancement therapy for eating disorders, a pilot study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0004/MQ46110.pdf.

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Dean, Helen Yasmin. "Brief inpatient treatment for eating disorders: can Motivational Enhancement Therapy improve outcome?" University of Sydney, 2007. http://hdl.handle.net/2123/1608.

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Doctor of Clinical Psychology / Master of Science
Despite a number of different psychotherapeutic approaches having been examined for use with patients with eating disorders, there is still no established psychological treatment associated with acceptable levels of long-term recovery. These poor recovery rates are associated with the observation that eating disorder patients are often ambivalent, or even resistant, to treatment. As such, research has begun to explore the use of Motivational Enhancement Therapy (MET), a treatment approach that aims to engage ambivalent and change resistant patients in the treatment process, with these individuals. Poor motivation to recover is particularly prominent within the inpatient eating disorder setting. However, no previous study has examined the use of MET to foster willingness to engage in treatment with this group of patients. The objectives of the current study were twofold. Firstly, an examination of the effectiveness of an inpatient eating disorders unit affiliated was undertaken in order to further the research base upon which future inpatient interventions can be built and compared. The second objective was to develop and evaluate a brief MET group program for inpatient eating disorder sufferers. The goal of the intervention was to enhance patients’ motivation to more effectively utilise the inpatient program and to hence positively impact upon their psychological, physical and behavioural functioning. Forty-two consecutive inpatients meeting DSM-IV criteria for an eating disorder were recruited into the current study and sequentially allocated to groups. Twenty-three inpatients completed four MET groups in addition to routine hospital care. A control group of 19 participants in the standard hospital treatment program was also employed (TAU group). The inpatient unit was associated with significant improvements on a number of physical, behavioural and emotional outcome measures. Despite no significant differences between the MET and the TAU groups being found on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer-term motivation and engagement, and to promote treatment continuation. This study hopes to start a constructive debate on the role of MET in the inpatient eating disorders unit.
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Campbell, Samadhi Deva. "Process of Motivational Enhancement Therapy: Relationships between Therapist and Client Behaviours, and Alcohol Use Outcome." Thesis, University of Canterbury. Psychology, 2007. http://hdl.handle.net/10092/1414.

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Motivational Interviewing (MI) is an evidence-based, directive, client-centered therapy designed to develop discrepancy and resolve ambivalence by eliciting and reinforcing client Change Talk. However, the exact link between the process engaged in during MI and outcome is only starting to be uncovered. The present thesis has replicated and expanded on the current knowledge of the relationship between Therapist and Client Behaviours during a MI-based intervention (Motivational Enhancement Therapy; MET) and outcome, and has provided support for the emergent theory of the inner workings of MI. This was achieved by coding 106 audiotaped MET sessions primarily by the methods outlined in the Motivational Interviewing Skill Code Version 2.0. Data was drawn from 28 participants who received 3-4 sessions of MET within the context of a randomised controlled trial for mild-moderate alcohol dependence at the Community Alcohol and Drug Service of Christchurch. Therapist and Client Behaviours were analysed within sessions (categorised into Early, Mid, or End Intervals) and across sessions, and compared with whether the client had drank within national drinking guidelines during the 6-months after MET (Controlled Drinkers). In terms of Client Behaviours during MET it was found that Uncontrolled Drinkers (compared with Controlled Drinkers) uttered a significantly higher frequency of Sustain Talk, lower Ability Language strength (over all MET and during End Intervals), and lower Commitment Language strength (during Session 2 and 4, and change over MET). Giving Information was the only Therapist Behaviour where significant differences were observed over all MET, with a higher frequency given to the Uncontrolled Drinkers. However, during End Intervals within MET Sessions, Controlled Drinkers received a significantly higher frequency of Advise without Permission and a lower frequency of Emphasise Control statements. In most instances MI-Consistent Therapist Behaviours were associated with higher strength of Ability and Commitment Language, and a lower frequency of Sustain Talk. MI-Inconsistent Therapist Behaviour, Direct, was associated with lower Client Language strength. Limitations to these results include small sample, limited ability to make inferences about causality, coder biases, and uneven reliability. However, this exploratory study was unique in investigating the relationship between Therapist Behaviours and the strength of Client Language, and in examining these factors within and across multiple sessions, and has produced a number of potentially valuable findings that warrant further investigation.
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Montgomery, LaTrice. "Moderators of the Relation Between Motivational Enhancement Therapy and Outcomes for African Americans: Substance Use and Retention." Cincinnati, Ohio : University of Cincinnati, 2010. http://rave.ohiolink.edu/etdc/view.cgi?acc_num=ucin1268427023.

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Thesis (M.A.)--University of Cincinnati, 2010.
Advisor: Ann Kathleen Burlew. Title from electronic thesis title page (viewed Apr. 19, 2010). Includes abstract. Keywords: Motivational Enhancement Therapy; African Americans; Substance Use; Retention; Treatment; Community based treatment programs. Includes bibliographical references.
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Moore, Thomas. "THE EFFECT OF LEGAL STATUS ON RESPONSES TO BRIEF MOTIVATIONAL INTERVIEWING WITH SUBSTANCE USERS." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2806.

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The effectiveness of drug abuse treatment for clients coerced into care remains controversial. Some studies find clients with legal pressure do better than those without legal pressure, while others report the exact opposite. Opposing views are often fueled by the wide-ranging models that guide delivery of addiction treatment. The present study examined how participants with and without legal pressure to attend treatment responded to a motivational (MET) vs. traditional (TAU) form of addiction treatment. Additionally, the predictive value of the Readiness to Change (RTC) score, from the URICA, was assessed across days of substance use and treatment retention. Legal status was shown to have a significant effect on days of primary substance use per week and treatment retention, regardless of intervention condition. The RTC score was shown not to be predictive of days of primary substance use or treatment retention. Research and clinical implications and future directions are discussed.
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Montgomery, LaTrice M. A. "The Influence of Change Talk and Decisional Balance on Treatment Outcomes among African American Substance Users." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1335461947.

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"Motivational enhancement therapy: A case study of a community-wide implementation process." Tulane University, 2006.

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Empirically supported substance abuse treatments are often the least used, while the least supported approaches (e.g. confrontation, drug education) are most used (Miller, 1995). Additionally, key components of an evidence-based practice are often not delivered with sufficient intensity (Sloboda & Schildhaus, 2002). The purpose of this case study was to explore the barriers and facilitators influencing adoption and implementation of motivational enhancement therapy (MET) and the consequences of the community-wide effort to disseminate MET by a researcher-provider collaborative. The identified case for this study was the substance abuse treatment community in metropolitan New Orleans, Louisiana. Twenty individuals representing the metropolitan area were interviewed; ten practitioners and ten administrators. The twenty participants included individuals who primarily treated substance-involved adolescents or post-incarcerated substance-involved offenders, and those who were trained in MET as well as those who were not trained in MET. Seven themes emerged: spreading the word, MET and fit, flexibility, reminders, counselor enhancement, client engagement and retention, and changing old school Results support many known barriers and facilitators to implementing evidence-based practices, including the importance of the innovation's fit with the clinician's counseling orientation and the need for ongoing supervision and training. Several themes provided new insights into the implementation of MET. First, while the impact of counselor orientation on adoption is well documented; the current study finds that the counselor's style (confrontational or client-centered) influenced one's perception of MET rather than the clinician's belief in the disease-concept. This finding questions previous research indicating that counselors who adhere to the disease-concept of addiction are less likely to use MET-like techniques. Second, MET was not only used in group and family therapy sessions, but was frequently used as a mode of communication in the therapeutic milieu for paraprofessional staff. Lastly, participants revealed that the treatment community decreased reliance on 'old school' (confrontational) techniques through the dissemination of MET. Thus, the findings support the use of a community-wide approach to diffusion of evidence-based practices
acase@tulane.edu
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Britt, Eileen F. "Enhancing diabetes self-management : motivational enhancement therapy : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in the Department of Psychology University of Canterbury /." 2008. http://library.canterbury.ac.nz/etd/adt-NZCU20080314.124830.

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Buckner, Julia D. "A randomized pilot study of motivation enhancement therapy to increase utilization of cognitive-behavioral therapy for social anxiety." 2008. http://etd.lib.fsu.edu/theses/available/etd-07112008-144626/.

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Thesis (Ph. D.)--Florida State University, 2008.
Advisor: Norman Bradley Schmidt, Florida State University, College of Arts and Science, Dept. of Psychology. Title and description from dissertation home page (viewed September 12, 2008). Document formatted into pages; contains viii, 100 pages. Includes bibliographical references.
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Books on the topic "Motivational Enhancement Therapy"

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Motivational Enhancement Therapy for Problem & Pathological Gamblers. Palm Coast: Electronic & Database Publishing, Inc., 2008.

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Nolan, Robert P. Motivational enhancement therapy: Smoking cessation treatment manual. Ottawa, Ont: University of Ottawa, Dept. of Epidemiology and Community Medicine, Ottawa-Carleton Health Dept., 1998.

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Pretreatment motivational enhancement therapy for eating disorders: A pilot study. Ottawa: National Library of Canada, 1999.

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Sampl, Susan, and Ronald Kadden. Motivational Enhancement Therapy And Cognitive Behavioral Therapy for Adolescent Cannabis Users: 5 Sessions. Diane Pub Co, 2002.

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D, Webb Charles Ph, and Center for Substance Abuse Treatment (U.S.), eds. The motivational enhancement therapy and cognitive behavorial therapy supplement: 7 sessions of cognitive behavioral therapy for adolescent cannabis users. Rockville, MD: U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2003.

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Fields, Ann E. Motivational Enhancement Therapy For Problem & Pathological Gamblers: A Five Session Curriculum-Based Group Intervention. BookSurge Publishing, 2006.

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R, Miller William, and National Institute on Alcohol Abuse and Alcoholism (U.S.), eds. Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Rockville, Md. (6000 Executive Blvd., Rockville 20892-7003): U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.

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R, Miller William, and National Institute on Alcohol Abuse and Alcoholism (U.S.), eds. Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Rockville, Md. (6000 Executive Blvd., Rockville 20892-7003): U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.

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R, Miller William. Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence. Echo Point Books & Media, 2014.

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R, Miller William, and National Institute on Alcohol Abuse and Alcoholism (U.S.), eds. Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Rockville, Md. (6000 Executive Blvd., Rockville 20892-7003): U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.

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Book chapters on the topic "Motivational Enhancement Therapy"

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Wenzel, Amy. "Psychoeducation and motivational enhancement." In Strategic decision making in cognitive behavioral therapy., 63–82. Washington: American Psychological Association, 2013. http://dx.doi.org/10.1037/14188-004.

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O’Connor Christian, Shannon L., and Mark S. Aloia. "Motivational Enhancement Therapy." In Behavioral Treatments for Sleep Disorders, 169–81. Elsevier, 2011. http://dx.doi.org/10.1016/b978-0-12-381522-4.00018-3.

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Steketee, Gail, and Randy O. Frost. "Enhancing Motivation." In Treatment for Hoarding Disorder, 64–81. Oxford University Press, 2013. http://dx.doi.org/10.1093/med:psych/9780199334964.003.0005.

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Chapter 5 briefly discusses insight and motivation problems, and guides clinicians through the use of motivational enhancement methods with clients who experience and display ambivalence about working on their hoarding and acquiring problems. Clinicians begin with a detailed discussion of clients’ personal values and goals to provide a firm foundation. Following Miller and Rollnick’s work on motivational interviewing, basic assumptions of this approach are described. The chapter describes a variety of specific strategies to help clients resolve ambivalence whenever this occurs during the therapy process.
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Ehrenreich-May, Jill, Sarah M. Kennedy, Jamie A. Sherman, Emily L. Bilek, Brian A. Buzzella, Shannon M. Bennett, and David H. Barlow. "Core Module 1: Building and Keeping Motivation." In Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents, 3–32. Oxford University Press, 2017. http://dx.doi.org/10.1093/med-psych/9780199340989.003.0001.

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Chapter 1 covers how the therapist should orient the adolescent and family to treatment concepts and structure (including the level of parent involvement). One of the early tasks is to identify the adolescent’s three top problems to be worked on throughout therapy. Motivational enhancement strategies (such as motivational interviewing, emotional avoidance, home learning assignment compliance) are introduced as the primary means of building both the adolescent’s and the parent’s motivation for change. This chapter links to the overall theory and case conceptualization model of the Unified Protocols.
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Interian, Alejandro, Ariana Prawda, Daniel B. Fishman, and William M. Buerger. "Motivational Enhancement Therapy for Increasing Antidepressant Medication Adherence and Decreasing Clinical Depression Among Adult Latinos." In Case Studies Within Psychotherapy Trials, 256–362. Oxford University Press, 2016. http://dx.doi.org/10.1093/med:psych/9780199344635.003.0009.

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Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research, combining the results from a randomized clinical trial (RCT), from case studies drawn from the RCT, and a synthesis of the two types of knowledge. Chapter 6 of the book applies this model to a study of the application of a three-session, individual, “motivational interviewing” therapy—specifically labeled “motivational enhancement therapy for antidepressants” (META). META was employed for treating disadvantaged, predominantly Spanish-speaking Latinos with depression. Finding META plus routine individual psychiatric therapy based in a community mental health center (CMHC) to be statistically and substantially superior to the CMHC-therapy-only condition, the authors then analyze and compare the positive-outcome case of Lupe, the mixed-outcome case of Ana, and the negative-outcome case of Maria, all drawn from the META condition.
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Taylor, Samantha M., and David L. Beckmann. "An adolescent with new-onset inattention." In Child and Adolescent Psychiatry, 221–28. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197577479.003.0028.

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Cannabis use disorder is defined as a pattern of use that includes at least two signs or symptoms of problematic use. Cannabis is the second most commonly used psychoactive substance by adolescents. Cannabis use is associated with significant impairments in multiple cognitive domains, although even one week of abstinence can result in improved cognitive functioning. Cannabis use, particularly of products containing high concentrations of tetrahydrocannabinol (THC), increases the likelihood of developing schizophrenia. N-acetylcysteine (NAC) may be helpful for decreasing cravings and the risk of relapse. The most effective therapy modalities for cannabis use disorder are motivational enhancement therapy, contingency management, cognitive behavioral therapy (CBT), and family-based therapy.
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Revolorio, Kaddy, and Jennifer L. Martin. "Hypnotic Medication Use." In Integrative Sleep Medicine, edited by Valerie Cacho and Esther Lum, 419–32. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190885403.003.0026.

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Hypnotic medications are widely prescribed for the treatment of insomnia, and, either due to patient preference or medical necessity, some patients must discontinue use of hypnotics after using these medications for long periods of time. Helping patients to discontinue use of hypnotics can be clinically challenging. Hypnotic taper interventions as well as hypnotic taper interventions combined with cognitive behavior therapy for insomnia (CBT-I) are generally useful in helping patients discontinue use without significant disruption to sleep. Interventions that include CBT-I seem to have greater long-term benefits as patients experience improvements in sleep that are long-lasting and are better able to abstain from hypnotic use in the future. Additional research to incorporate motivational enhancement strategies and better understand the optimal timing and structure of hypnotic medication tapering interventions with CBT-I are needed.
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van den Brink, Wim, and Falk Kiefer. "Alcohol use disorder." In New Oxford Textbook of Psychiatry, edited by John R. Geddes, Nancy C. Andreasen, and Guy M. Goodwin, 498–506. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198713005.003.0050.

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Alcohol is one of the most frequently used substances, and alcohol-related disorders are common, especially in western societies. While there is no safe lower drinking level, a clear dose–response relationship has been shown between alcohol intake and organ damage. Conceptualization and diagnostic classification of alcohol use disorders have changed over time, focusing most recently on aspects of craving, loss of control, and continued use despite negative consequences. Alcohol acts via various binding sites in the brain and via downstream effects, including glutamatergic, GABAergic, serotonergic, dopaminergic, opioid, and neuroendocrine pathways. For its long-lasting, habit-forming effects, sensitization within the mesolimbic–mesocortical system is crucial. Psychological treatments traditionally focus on motivational enhancement, cognitive behaviour therapy, and the community reinforcement approach. Pharmacological treatment approaches range from aversive and reward-inhibiting to anti-craving compounds and cognitive enhancers, which target opioid, glutamatergic, and monoamine receptors. Improvement of treatment effects can be achieved by polypharmacy and use of personalized medicine, based on clinical characteristics, biomarkers, and genetic indicators.
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Martires, Joanne S., Reuben Ram, and Jeanne Wallace. "Introduction to Sleep-Disordered Breathing and Treatment." In Integrative Sleep Medicine, edited by Valerie Cacho and Esther Lum, 509–28. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190885403.003.0031.

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Sleep-related breathing disorders encompass a wide range of problems that occur during sleep. The most common sleep-related breathing disorder is obstructive sleep apnea syndrome (OSAS). OSAS is increasingly prevalent, underdiagnosed and can lead to significant daytime sleepiness and disability. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS but lack of adherence to CPAP is rampant. Supportive care, education, and motivational enhancement programs do show promise in improving compliance. Alternatives to CPAP such as oral appliances, hypoglossal nerve stimulation, and myofunctional therapy have not been proved as efficacious but may provide some benefit. In the future, personalized treatment may be the best way to approach this condition. Central sleep apnea and hypoventilation are other forms of sleep-related breathing disorders. Treatment largely depends on the underlying condition but may require the use of advanced modes of noninvasive ventilation such as adaptive servo-ventilation, bilevel positive airway pressure, and volume-assured pressure support. Treatment of sleep-related breathing disorders is complex and includes seeking patient input, understanding barriers to treatment, and reevaluating patients after treatment is initiated. Successful treatment of sleep-disordered breathing can lead to improvements in daytime function, quality of life, and overall health.
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Lydall, Greg, and Kelly Clarke. "Substance Misuse Psychiatry." In Oxford Assess and Progress: Psychiatry. Oxford University Press, 2014. http://dx.doi.org/10.1093/oso/9780199665662.003.0021.

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Clinicians in all areas of medicine are likely to encounter people with substance misuse issues, so an understanding of the key issues is essen­tial. Human beings have used intoxicating substances, such as alcohol, nicotine, cannabis, and heroin, for millennia. Motivations might include experimentation, pleasure, social enhancement, or for physical or psy­chological pain management. Some people who use these legal and illegal substances experience problems related to their use, including loss of control, adverse consequences, withdrawals or cravings, damaged end organs, risky behaviour, and premature death. Substance misuse impacts not only on individual physical and mental health but also upon families and wider society by increased healthcare, criminal justice, social ser­vices, and unemployment costs. Drug and alcohol problems affect between 10% and 25% of the popu­lation each year, and up to 35% of people have ever used illicit drugs. Alcohol, an intoxicating sedative, is the most commonly used drug, with 25% of the UK population drinking above ‘low-risk’ limits. In England in 2010 there were an estimated 300 000 opiate, crack-cocaine, and inject­ing drug users, and only half were in treatment. Substance misuse is commonly associated with physical and mental health co-morbidity. The prevalence of co-existing mental health and substance use problems (termed ‘dual diagnosis’) may affect between 30% and 70% of those presenting to healthcare and social care settings. In general, four interrelationships in dual diagnosis are recognized: • substance use leading to social problems and psychological symptoms not amounting to a diagnosis • substance use leading to social dysfunction and secondary psychiatric and physical illness • substance use exacerbating an existing mental or physical health prob­lem and associated social functioning • primary psychiatric illness precipitating substance misuse which may also be associated with physical illness and affect social ability. Given the array of substance misuse problems, an individual treat­ment approach is essential and may involve psychological, pharmaco­logical, and social intervention. An empathic, non-judgemental clinical approach is essential to engage people with substance misuse problems. Motivational interviewing is an evidence-based talking therapy to help people in denial about their problems make changes for themselves and avoids imposing change prematurely.
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