MES is a computer-based brief intervention with the goal of facilitating self-change, treatment engagement, and/or motivation to change via a single intervention session.
This program consists of 3 components: 1) feedback regarding self-reported drug use, negative consequences of use, and readiness to change, 2) pros and cons of drug use and related changes, and 3) a summary and query regarding the participant’s interest in change, along with an optional goal-setting piece as it relates to drug use.
Motivational Interviewing (MI)
Motivation to change
Frequency of illicit drug use
Young Adult (18-30)
Methadone maintenance program
Outpatient substance abuse program
Primary care clinic
Summary : In phase 1 (formative feasibility and acceptability), postpartum women exposed to the assessment section of MES reported acceptability via interview and quantitative survey.Quantitative and qualitative responses were positive; no differences between groups in quantitative ratings of ease of use, interest, content comprehension.
In phase 2 (intervention-associated fluctuations in state motivation), motivation was higher after each of the three intervention components than at baseline. Intervention appears to be associated with significant increases in state motivation regarding drug use.
In phase 3 (pilot clinical trial), a randomized controlled study with 1-month follow-up phone interview, 22 participants (73% retention) provided follow-up data; no significant difference in retention rate between conditions; no significant differences in results between groups.
Take Away: Overall, women rated the MES as highly acceptable and easy to use. Results suggest that further research in this area is warranted.
Summary: In this randomized controlled trial, 107 postpartum women (approached in their private hospital rooms) were randomly assigned to the 20-minute, single-session CBI (n=55) or control group (n=52). All participants also received two non-tailored mailings (e.g. easy-to-read brochures on topics of maternal health at 4- and 9-weeks) and voucher-based reinforcement of attendance at the initial intake/treatment session. Assessments were conducted at baseline and 4-month follow-up, and focused on alcohol and drug use and readiness to change.
Despite significant attrition at follow-up, results did not differ when data were analyzed using treatment completers only or the last-observation-carried-forward-approach. Compared to the control participants, those in the CBI group significantly reduced their cocaine, opiate and/or amphetamine use at follow-up. However, there were no significant differences between groups for cannabis or alcohol.
Take Away: There is tentative support for the efficacy of this brief intervention to reduce illicit drug use (other than cannabis use) among postpartum women.
A randomized Phase I trial of a brief computer-delivered intervention for alcohol use during pregnancy.
Summary: This randomized controlled trial examined the acceptability and preliminary effectiveness of a computerized screening and brief intervention (e-SBI) program for risky drinking in pregnant women. Participants were fifty women attending a prenatal clinic who endorsed risky drinking during pregnancy. After being screened for alcohol use, participants were assigned to either the computerized intervention, or to answer questions about television show preference. The e-SBI included information on fetal alcohol spectrum disorders (FASD) and used motivational interviewing techniques to reduce alcohol use. Women receiving the intervention found the program acceptable and easy to use.
Alcohol use and postpartum outcomes were measured one month after the intervention. The infants born to participants that received the computerized intervention were significantly heavier than infants born to participants in the control condition. No differences were found in gestational age or head circumference. All participants had equivalent decreases in reported drinking from the initial screening session to the one month follow-up. Overall, 72% of participants were currently drinking at the screening session, while only 10% of participants were drinking at follow-up. The percent of participants drinking did not differ by group.
Take Away: Participants found the computerized brief intervention acceptable and easy to use. Further research is necessary to determine whether the program is effective in reducing alcohol use during pregnancy or improving birth outcomes for infants.
Computer-delivered screening and brief intervention (e-SBI) for postpartum drug use: A randomized trial
Summary: A replication of the Ondersma, 2007 study was conducted with 143 women hospitalized after childbirth. All participants had used drugs in the month prior to their pregnancy. Before release from the hospital, participants were randomly assigned to receive the electronic screening and brief intervention (e-SBI) or the control condition, which consisted of questions on television and music preference. Participants were assessed for substance use at 3 and 6 months after randomization. At 3 months, 26.4% of the e-SBI group and 9.9% of the control group reported abstinence in the week prior to the assessment. No difference was detected in past week abstinence rates 6 months after randomization. At 6 months, 80.9% of participants provided hair toxicology samples. Participants from the e-SBI group were less likely to testing positive for drugs. However, there was no difference in self-reported consequence outcomes by group at 3- and 6-month follow-up.
Take Away: Results suggest that the e-SBI program is associated with decreased postpartum drug use 3 months after childbirth. As no differences in self-reported drug use were found at the 6 month follow-up, the effects of this e-SBI appear to lack long-term durability.
A randomized trial of computer-delivered brief intervention and low-intensity contingency management for smoking during pregnancy.
Summary: The effectiveness of a brief computerized intervention, a reduced contingency management program, and a control condition were compared for decreasing smoking in pregnant women. Using a factorial randomized controlled design, participants were assigned to one or four conditions: e-SBI, CM, control only, or e-SBI+CM. The e-SBI condition consisted of one motivational session to promote abstinence from smoking. The CM program allowed participants to voluntarily submit urine sample to test for cotinine and rewarded participants for cigarette free samples. Participants in the control condition answered questions about their musical preferences. All participants were assessed at baseline and 10 weeks after randomization. At 10 weeks, participants receiving the e-SBI program had fewer positive urine samples than the control group, but no differences in past week abstinence rates from cigarettes were found, based on carbon monoxide (CO) testing. Additionally, no significant differences in smoking were detected between the CM and control conditions. The addition of CM to e-SBI did not improve outcomes. While 24.5% of e-SBI only participants were abstinent for one week prior to the assessment, only 8.9% of e-SBI+CM participants were abstinent.
Take Away: A brief computerized intervention is more effective in decreasing smoking during pregnancy than a reduced contingency management program. Further research on this e-SBI for smoking cessation is necessary.
Summary: In this randomized controlled trial, the Motivational Enhancement System (MES) computerized brief intervention (e-SBI) was compared to an in-person brief intervention (IBI). The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to screen adult patients in a primary care clinic. Patients with moderate substance abuse risk scores (n=360) were randomized to either e-SBI or IBI. Patients endorsing high risk substance use were excluded from the study and referred to substance abuse treatment. The e-SBI program consisted of one computerized session in the clinic, while participants getting IBI had one in-person session with a Master’s level behavioral health counselor. Both interventions used brief intervention and motivational interviewing techniques to explore drug and alcohol use. Participants were then assessed 3 months after completing either intervention. Hair samples were also obtained to test for drug use. Both groups showed decreased ASSIST global scores from baseline to follow-up, but the percent of positive hair samples did not decrease over time. There were no significant differences between groups in the ASSIST global score or in the prevalence of positive hair samples at the 3-month follow-up. The e-SBI group had greater average decreases in the ASSIST cannabis and cocaine use scores, compared to the IBI group. No differences in average alcohol, opioid, sedative, or amphetamine scores were detected.
Take Away: Although neither intervention resulted in decreased positive drug samples, the e-SBI and the IBI were both effective in decreasing ASSIST score severity.