Motivational Enhancement Therapy and Substance Use Disorders
There is an extensive body of literature on the efficacy of motivational enhancement therapy for treating a range of substance use disorders.
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Activity
Please use the links provided above to review two or more of the abstracts of the studies in each category to start to familiarize yourself with this body of literature.
Motivational Enhancement Therapy and Psychedelic-Assisted Therapy
We are promoting the use of motivational enhancement therapy in combination with psychedelic-assisted therapy for the treatment of substance use disorders because:
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It is a brief intervention that can be meaningfully incorporated into Preparation and Integration Sessions within the psychedelic-assisted therapy model.
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As previously discussed, there is a significant evidence base on the application and efficacy of motivational enhancement therapy in the treatment of a range of substance use disorders.
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There is a small evidence base emerging on the utility of motivational enhancement therapy used in combination with psilocybin- and ketamine-assisted therapy for the treatment of substance use disorders, two of which are highlighted below (Bogenschutz et al., 2015; Bogenschutz et al., 2022; Dakwar et al 2020; Azhari et al 2021)
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Dakwar et al., 2020
Dakwar et al. (2020) investigated the effects of ketamine combined with movement enhancement therapy on drinking outcomes in patients with alcohol use disorder. Participants were randomly divided into two groups, one being given ketamine (n = 17) and the other an active control dose of midazolam (n = 23); both groups also underwent movement enhancement therapy. Throughout the five-week treatment, movement enhancement therapy sessions were provided once weekly, apart from on week two; during this week, the ketamine dose was given, with an additional movement enhancement therapy session included 24 hours after the administration of the ketamine.
Dakwar et al., 2020
Participants in the ketamine group had greater odds of abstaining from heavy alcohol use, were more successful in maintaining abstinence, and were less likely to relapse over the 21 days after infusion than the control group. Data was collected again for 19 participants six months later; six of the eight from the ketamine group reported continued abstinence compared to only three of eleven from the control group.
Azhari et al., 2021
Azhari et al. (2021) investigated the efficacy of ketamine combined with both movement enhancement therapy and mindfulness-based relapse prevention (MBRP) in the treatment of cannabis use disorder. In this study, 8 participants received 1-2 doses of ketamine along with a 6-week therapeutic protocol of movement enhancement therapy and mindfulness-based relapse prevention.
Azhari et al., 2021
This study showed that the integration of ketamine with movement enhancement therapy and mindfulness-based relapse prevention was feasible and significantly decreased cannabis use after the ketamine administration week, and also drastically increased the participants' self-confidence in their ability to remain abstinent, even in stressful situations. Although no conclusions regarding efficacy could be inferred as a result of the study design, these results suggest that the integration of ketamine and psychotherapy may also be an appropriate strategy to address cannabis use disorder.
Synergies
Further to this, Elias Dakwar and his colleagues have identified a number of synergies between ketamine and motivational enhancement therapy, most of which also likely apply to other psychedelic medicines.-
Ketamine has already been shown to reduce cravings and to act through psychological mechanisms on motivation to quit as well as other vulnerabilities in addictions, perhaps through shifts in perspective (Dakwar et al., 2014).
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The use of a psychotherapeutic framework aimed at enhancing motivation may take advantage of perspective shifts induced by ketamine, potentially deepening commitment and strengthening motivation for change (Dakwar et al 2020).
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This mirrors previous work in the psychedelics field using psilocybin and LSD, wherein psychoactive effects were meant to facilitate a re-evaluation of existential meaning and personal values, while also restructuring commitments and behaviours (Dakwar et al 2020).
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Sessions are scheduled to take advantage of the window of time after ketamine administration during which neuroplasticity is heightened, as this is a potent period for the initiation and reinforcement of new behaviour.
References
Adamson, S. J., & Sellman, J. D. (2008). Five-year outcomes of alcohol-dependent persons treated with motivational enhancement. Journal of studies on alcohol and drugs, 69(4), 589–593.
Andersen, K., Behrendt, S., Bilberg, R., Bogenschutz, M. P., Braun, B., Buehringer, G., Ekstrøm, C. T., Mejldal, A., Petersen, A. H., & Nielsen, A. S. (2020). Evaluation of adding the community reinforcement approach to motivational enhancement therapy for adults aged 60 years and older with DSM-5 alcohol use disorder: a randomized controlled trial. Addiction (Abingdon, England), 115(1), 69–81.
Azhari, N., Hu, H., O'Malley, K. Y., Blocker, M. E., Levin, F. R., & Dakwar, E. (2021). Ketamine-facilitated behavioral treatment for cannabis use disorder: A proof of concept study. The American journal of drug and alcohol abuse, 47(1), 92–97.
Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A., Wilcox, C. E., Barbosa, P. C., & Strassman, R. J. (2015). Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. Journal of psychopharmacology (Oxford, England), 29(3), 289–299.
Bogenschutz, M. P., Ross, S., Bhatt, S., Baron, T., Forcehimes, A. A., Laska, E., Mennenga, S. E., O'Donnell, K., Owens, L. T., Podrebarac, S., Rotrosen, J., Tonigan, J. S., & Worth, L. (2022). Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA psychiatry, 79(10), 953–962.
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