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New approach to addiction interventions targets motivation

Assistant professor Christina Lee believes it’s time to rethink healthcare professionals’ strategies for addiction intervention. “The instinct is to give advice and rush to help,” said Lee, of the Department of Counseling and Applied Educational Psychology in the Bouvé College of Health Sciences. “But what we’ve observed is that patients shut down.”

Lee pointed to evidence showing that the more training a clinician has and the more severe his or her patient’s condition, the greater the rush to give advice. But this traditional approach tends to have the opposite effect than desired.

Lee, who joined the faculty in the fall, and her colleagues are investigating an alternative approach: motivational interviewing, which has shown great efficacy in addiction counseling and in other health areas. Instead of delivering information, clinicians engage with patients in nonjudgmental conversation, reflecting the statements made by the patients themselves.

By helping patients to hear their own motivations to change, motivational interviewing helps people reduce their hazardous behaviors like excessive drinking, which Lee is particularly focused on. “The task is to help people to clarify what’s good and what’s not so good about their drinking and to begin to shift the weight toward wanting to change,” she said.

While motivational interviewing requires clinicians to be empathetic toward a patient, cultural and social contexts are not directly addressed. But social stressors, such as poverty, limited English proficiency, and discrimination—which are often related to processes of acculturating to the United States—are predictive of hazardous drinking and alcohol-related problems among racial and ethnic groups. Lee said.

Lee recently completed a pilot study at Brown University that showed efficacy improved when clinicians considered a patient’s specific cultural and social context. Now, with funding from the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health, she is teaming up with the South End Community Health Center in Boston and the Boston Public Health Commission to launch a larger version of this first-of-its-kind randomized clinical trial. The new study will target Boston’s immigrant Puerto Rican population, which is highly represented at the SECHC.

“This intervention is designed to capture people who have more trouble adjusting to their lives in the U.S. and who may be using alcohol as an avoidant way of coping with social stressors,” Lee explained.

She hopes the project will help address alcohol-related health disparities in Boston’s Latino community by providing early screening and brief interventions to reduce hazardous drinking. The project, she said, will also provide a better understanding of how stressors related to immigration and acculturation confer risk for increased hazardous drinking and other unsafe behaviors.