Informal discussions in substance abuse treatment sessions with Spanish-speaking clients.

This ancillary investigation examined the extent to which bilingual counselors initiated informal discussions about topics unrelated to the treatment of their monolingual Spanish-speaking Hispanic clients in a National Drug Abuse Treatment Clinical Trials Network protocol examining the effectiveness of motivational enhancement therapy (MET), protocol CTN-0021. Session audiotapes were independently rated to assess counselor treatment fidelity and the incidence of information discussions. Eighty-three percent of the 23 counselors participating in the trial initiated informal discussions at least once in one or more of their sessions. Counselors delivering MET in the trial initiated informal discussion significantly less often than the counselors delivering standard treatment. Counselors delivering standard treatment were likely to talk informally the most when they were ethnically non-Latin. In addition, informal discussion was found to have significant inverse correlations with client motivation to reduce substance use and client retention in treatment.

Together with the results from the English version of this study (Martino et al, 2009, record 320), these findings suggest that a meaningful proportion of counselors initiate discourse during sessions that is unrelated to the issues for which their clients sought treatment and that such discourse may be experienced negatively by clients. As in the English MET trials, training and supervision of counselors in MET for use with Spanish-speaking clients may help reduce the occurrence of informal discussions and keep conversations focused on those topics most pertinent to retaining clients in treatment and enhancing their motivation to change their substance use.

Related protocols: CTN-0021