Psychology ETDs

Publication Date

Summer 6-1-2019



Objective: The SMART ED study was a randomized, controlled trial of 3 brief interventions in ER settings targeting high-risk substance use. Findings in the main study indicated that there was no difference in outcomes for groups receiving minimal, rather than more extensive, behavioral interventions. This secondary analysis investigated the quality of (MI) sessions in the SMART ED study to examine the hypothesis that better quality of MI would be associated with improved client outcomes.

Method: The Motivational Interviewing Treatment Integrity Code (MITI 3.0) was used to evaluate 388 sessions, yielding indicators of MI Quality including Overall Spirit (MI Spirit), Reflection to Question (R:Q), Percent Open Questions (%OQ), MI Adherent (MIA) and MI Non-Adherent (MINA) behaviors. These quality indicators were used to predict client outcomes, measured as self-reported days of primary drug use, days with any drug use, and days of heavy drinking.

Results: Fewer than half (49%) of sessions met minimal criteria for MI quality using the MITI 3.0. Only 7% of sessions met the criteria for advanced MI practice. None of these indicators were associated with substance use outcomes.

Conclusions: These findings raise the possibility that negative trials of MI may be accounted for by poor adherence to the method, rather than lack of efficacy. Recommendations for quality monitoring and standards for future studies using behavioral treatments are discussed.

Degree Name


Level of Degree


Department Name


First Committee Member (Chair)

Theresa Moyers, Ph.D.

Second Committee Member

Jon Houck, Ph.D.

Third Committee Member

Kamilla Venner, Ph.D.

Fourth Committee Member

Tom Chavez, Ph.D.




Motivational Interviewing, Substance Use, Fidelity, Treatment Fidelity, Emergency Room

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Included in

Psychology Commons