Volitional control, self-regulation, and motivational interviewing in veterans with alcohol problems

This study sought to clarify the role of volitional control in changing addictive behaviors by examining how a key cognitive subcomponent of self-regulation, set shifting, mediates benefit from substance abuse treatment. Set shifting has been defined as the capacity to alter cognitive strategies appropriately in response to changing environmental contingencies. Thus, more specifically, this experiment examined the impact of set shifting upon ability to benefit from motivational interviewing (MI) for the treatment of alcohol problems. Earlier conceptual writings addressing MI have proposed that the intervention operates by resolving the ambivalence that derives from the discrepancy between behavior and values, a dissonance which is thought to trigger a shift from automatic processing of information to effortful control of behavior. To test this proposition as well as the larger question of volitional control, it was hypothesized that executive set shifting ability (ability to shift from automatic to controlled processing) would be linked to benefit from MI in terms of posttreatment drinking and associated consequences to drinking. Forty-seven veterans enrolled in substance abuse treatment at the New Mexico Veterans Affairs Health Care System were randomly assigned to receive either a single session of MI plus treatment-as-usual (TAU), or TAU alone. TAU included a treatment preparatory program, intensive outpatient day treatment, dual diagnosis treatment (posttraumatic stress disorder and substance abuse), relapse prevention, and/or sobriety maintenance. Participants who received MI (n=32) and controls who did not (n=15) were assessed approximately two months following consent on consequences to drinking in the preceding two months, lifetime head injury severity, executive functioning (Wisconsin Card Sorting Test), and drinking frequency and intensity (Form-90). Pretreatment drinking levels were estimated by reconstructive Form-90 techniques. Contrary to prediction, the results showed that those veterans with the most executive impairment benefited the most from the motivational interview, relative to controls and to experimental subjects with less executive impairment, in terms of lower levels of posttreatment drinking and fewer posttreatment consequences to drinking. This study's results augment current research on matching alcohol interventions to the cognitive abilities of individuals, and highlight that alcohol-related cognitive impairment is not an obstacle to benefiting from MI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)