When Can Brief Motivational Interviewing Backfire?

The criminal justice system has widely adopted brief motivational interviewing to curtail substance use, despite mixed results among offenders and a lack of benefit in primary care populations (NEJM JW Psychiatry Sep 2014 and JAMA 2014; 312:492). To assess whether psychopathic personality traits influence the value of this intervention, investigators randomized 105 jailed substance-abusing volunteers awaiting criminal trial (65% men; 52% nonwhite) to receive standard care alone (control) or standard care with four brief motivational interviewing sessions (provided within 3 months).

Participants were queried about substance use throughout the study and at 6 months after enrollment and underwent baseline psychiatric testing; a subset underwent…