Motivational interviewing for substance use among adults in low- and middle-income countries: A systematic review.

Background: Harmful substance use (HSU) poses a significant global health challenge, impacting social, economic, and healthcare systems. Low- and middle-income countries (LMICs) are particularly burdened as a result of limited infrastructure for managing substance-related issues. While evidence-based brief interventions like motivational interviewing (MI) are widely used in high-income countries, research on their effectiveness in LMICs is limited. Aim: This systematic review aims to evaluate studies employing MI as part of interventions for adults with HSU in LMIC settings. Setting: This review focused on studies within low- and middle-income countries which include settings characterised by constrained mental health resources, high treatment gaps for substance use disorders (SUDs), and diverse service delivery contexts. Methods: Following Cochrane and PRISMA guidelines, we searched PubMed, EBSCOhost, Web of Science, Cochrane Library, clinicaltrials.gov and GSK Clinical Study Register for publications from 2010 to 2022. A narrative analysis was conducted, and the Joanna Briggs Institute Critical Appraisal Tools assessed study quality. Results: Out of 518 publications, 11 studies from five countries met our inclusion criteria. Most were randomised controlled trials, with some using qualitative or mixed methods. The interventions targeted alcohol, opioids, and other drugs. Different strategies were used, including MI-blended with other interventions (such as cognitive-behavioural therapy, behavioural activation, and imaginal desensitisation) or using MI-informed approaches. Conclusion: Overall, MI-informed interventions were shown to improve substance use outcomes in six of the 11 studies, with a significant reduction in substance use. However, further high-quality research with larger samples and rigorous designs is needed to strengthen the evidence base and address potential sources of bias. Contribution: Findings suggest that MI-informed approaches, as a brief intervention, can improve substance use outcomes in resource-constrained environments within LMICs.