The primary objective of this proposal is to use an automated motivational interviewing-based (MI-style) intervention to test the principle of Developing Discrepancy as a mediator of treatment entry. Developing Discrepancy will be operationalized as use of the Decisional Balance technique, and measured via the Decisional Balance Scale. This will be the first test of Developing Discrepancy via a Decisional Balance exercise as a mediator in indigent patients to facilitate entry into day treatment. The proposed study will meet all four essential criteria of mechanisms of change postulated by Kazdin and Nock (2003). The long term objective of this line of research is to use automated programs to study treatment processes and mechanisms, both in the community and in the lab. Automated programs are inexpensive to operate and relatively easy to modify to test different processes, while delivering treatment effectively and with almost total fidelity. This objective is relevant to the goals of NIH involving improved understanding of the active ingredients of therapy, allowing for more individualized treatment and stronger effects.
The specific aims of this study are: 1) to use an automated MI-style intervention program to test the mediating effect of a decisional balance exercise on treatment entry by presenting treatment both with and without the decisional balance exercise; and 2) to compare an automated MI-style brief intervention with a wait list control in enhancing treatment entry. The automated MI-style intervention will be used to improve the percent of veterans who enter an intensive day treatment program after a waiting period. The intervention is expected to improve treatment entry whether it contains the decisional balance exercise or not. Other aspects of the intervention are also expected to have an effect, but it will not be as strong as the intervention with decisional balance. The intervention is delivered by telephone, which makes sense in a population that has few resources and may be widely dispersed while waiting for treatment. Measures of Decisional Balance and two other hypothesized mediators, readiness to change and self- efficacy, will be collected at the initial clinical evaluation for treatment, and at the time of treatment entry (whether or nor the participant enters treatment). The relationship of Decisional Balance to the intervention and to the outcome will be analyzed. A path model will be used to evaluate Decisional Balance as a mediator, and to rule out readiness to change and self-efficacy as explanatory variables if Decisional Balance is shown to mediate treatment entry. This study will use a computerized intervention to improve rates of treatment entry into a substance abuse treatment program for veterans. It will also evaluate the importance of working with the pros and cons of alcohol use to help people decide to enter treatment for alcohol problems. This information will be important in developing methods to encourage people to get treatment and to strengthen the effect of the treatments we have now. ? ? ?
