Motivational interviewing for substance use reduction

Rosemarie Schwenker; Carla Emilia Dietrich; Selamawit Hirpa; Monika Nothacker; Geir Smedslund; Thomas Frese; Susanne Unverzagt

doi:10.1002/14651858.CD008063.pub3

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Figure 1

PRISMA flow chart

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Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 4

Funnel plot of comparison 1: MI versus no intervention, outcome: extent of substance use.

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Figure 5

Funnel plot of comparison 2: MI versus treatment as usual, outcome: extent of substance use.

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Figure 6

Funnel plot of comparison 3: MI versus assessment and feedback, outcome: extent of substance use.

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Figure 7

Funnel plot of comparison 4: MI versus other active intervention, outcome: extent of substance use.

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Analysis 1.1

Comparison 1: Motivational interviewing versus no intervention, Outcome 1: Extent of substance use

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Analysis 1.2

Comparison 1: Motivational interviewing versus no intervention, Outcome 2: Readiness to change

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Analysis 1.3

Comparison 1: Motivational interviewing versus no intervention, Outcome 3: Retention in treatment

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Analysis 2.1

Comparison 2: Motivational interviewing versus treatment as usual, Outcome 1: Extent of substance use

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Analysis 2.2

Comparison 2: Motivational interviewing versus treatment as usual, Outcome 2: Readiness to change

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Analysis 2.3

Comparison 2: Motivational interviewing versus treatment as usual, Outcome 3: Retention in treatment

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Analysis 3.1

Comparison 3: Motivational interviewing versus assessment and feedback, Outcome 1: Extent of substance use

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Analysis 4.1

Comparison 4: Motivational interviewing versus other active intervention, Outcome 1: Extent of substance use

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Analysis 4.2

Comparison 4: Motivational interviewing versus other active intervention, Outcome 2: Readiness to change

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Analysis 4.3

Comparison 4: Motivational interviewing versus other active intervention, Outcome 3: Retention in treatment

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Summary of findings 1. Motivational interviewing compared with no intervention for substance‐use reduction

Outcomes	*Illustrative comparative risks (95% CI)**	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
Motivational interviewing compared with no intervention for substance‐use reduction
Population: people with substance use (adults, young adults, adolescents) Settings: universities, colleges, clinics, army recruitment centres, Veterans' Affairs medical centres, student health centres Intervention: motivational interviewing or motivational enhancement therapy Comparison: no intervention
	Corresponding risk
	MI/MET versus no intervention
Extent of substance use post‐intervention	The extent of substance use in the MI groups was on average 0.48 SDs lower (0.07 to 0.89) than in the 'no intervention' control groups.	471 (6 studies)	⊕⊕⊝⊝ Low^a,b	SMD 0.48, 95% CI 0.07 to 0.89
Extent of substance use at short‐term follow‐up (1 to 4 months)	The extent of substance use in the MI groups was on average 0.20 SDs lower (0.12 to 0.28) than in the 'no intervention' control groups.	3351 (19 studies)	⊕⊝⊝⊝ Very low^c,d	SMD 0.20, 95% CI 0.12 to 0.28
Extent of substance use at medium‐term follow‐up (6 to 9 months)	The extent of substance use in the MI groups was on average 0.12 SDs lower (0.05 to 0.20) than in the 'no intervention' control groups.	3137 (16 studies)	⊕⊕⊝⊝ Low^b,d	SMD 0.12, 95% CI 0.05 to 0.20
Extent of substance use at long‐term follow‐up (12 to 15 months)	The extent of substance use in the MI groups was on average 0.12 SDs lower (‐0.00 higher to 0.25 lower) than in the' no intervention' control groups.	1525 (9 studies)	⊕⊝⊝⊝ Very low^c,e	SMD 0.12, 95% CI ‐0.00 to 0.25
Readiness to change (3‐ to 12‐month follow‐up)	The readiness to change in the MI groups was on average 0.05 SDs higher (‐0.11 lower to 0.22 higher) than in the 'no intervention' control groups.	1495 (5 studies)	⊕⊝⊝⊝ Very low^c,e	SMD 0.05, 95% CI ‐0.11 to 0.22
Retention in treatment (0‐ to 3‐month follow‐up)	The retention in the MI groups was on average 0.26 SDs higher (‐0.0 to 0.52) than in the 'no intervention' control groups.	427 (2 studies)	⊕⊝⊝⊝ Very low^a,c	SMD 0.26, 95% CI ‐0.0 to 0.52
The basis for the assumed risk* (i.e. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MI: motivational interviewing;MET: motivational enhancement therapy;SD: standard deviation; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
^aDowngraded 1 level due to inconsistency with moderate to substantial heterogeneity between treatment effects of studies ^bDowngraded 1 level due to serious study limitations, with unclear reporting of randomisation or other risk of bias in most studies, and low risk of attrition bias in studies whose total weight exceeded 50% in the meta‐analysis ^cDowngraded 2 levels due to very serious study limitations, with unclear reporting of randomisation or other risk of bias in most studies and high or unclear risk of attrition bias in studies whose total weight exceeded 50% in the meta‐analysis ^dDowngraded 1 level due to publication bias ^eDowngraded 1 level due to imprecision: the CI includes no to moderate effects and the total number of participants is lower than the optimal information size

Summary of findings 1. Motivational interviewing compared with no intervention for substance‐use reduction

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Summary of findings 2. Motivational interviewing compared with treatment as usual for substance‐use reduction

Outcomes	*Illustrative comparative risks (95% CI)**	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
Motivational interviewing compared with treatment as usual for substance‐use reduction
Population: people with substance use (adults, young adults, adolescents) Settings: community drug use clinics, emergency departments, detoxification hospitals, primary care clinics, urban trauma centres, outpatient addiction centres Intervention: motivational interviewing or motivational enhancement therapy Comparison: treatment as usual
	Corresponding risk
	MI/MET versus treatment as usual
Extent of substance use post‐intervention	The extent of substance use in the MI groups was on average 0.14 SDs higher (0.02 to 0.27) than in the control groups with treatment as usual.	976 (5 studies)	⊕⊝⊝⊝ Very low^a,b	SMD (0.14, 95% CI ‐0.27 to ‐0.02)
Extent of substance use at short‐term follow‐up (1 to 4 months)	The extent of substance use in the MI groups was on average 0.07 SDs lower (0.03 higher to 0.17 lower) than in the control groups with treatment as usual.	3066 (14 studies)	⊕⊕⊝⊝ Low^a,c	SMD (0.07, 95% CI ‐0.03 to 0.17)
Extent of substance use at medium‐term follow‐up (6 to 9 months)	The extent of substance use in the MI groups was on average 0.12 SDs lower (0.02 to 0.22) than in the control groups with treatment as usual.	1624 (9 studies)	⊕⊕⊝⊝ Low^b,d	SMD (0.12, 95% CI 0.02 to 0.22)
Extent of substance use at long‐term follow‐up (12 months)	The extent of substance use in the MI groups was on average 0.06 SDs lower (0.05 higher to 0.17 lower) than in the control groups with treatment as usual.	1449 (8 studies)	⊕⊕⊝⊝ Low^b,d	SMD (0.06, 95% CI ‐0.05 to 0.17)
Readiness to change (0‐ to 3‐month follow‐up)	Readiness to change in the MI groups was on average 0.06 SDs higher (0.27 lower to 0.39 higher) than in the control groups with treatment as usual.	150 (2 studies)	⊕⊝⊝⊝ Very low^a,b	SMD (0.06, 95% CI ‐0.27 to 0.39)
Retention in treatment (0‐ to 12‐month follow‐up)	Retention in treatment in the MI groups was on average 0.09 SDs lower (0.34 lower to 0.16 higher) than in the control groups with treatment as usual.	1295 (5 studies)	⊕⊝⊝⊝ Very low^a,e	SMD (‐0.09, 95% CI ‐0.34 to 0.16)
The basis for the assumed risk* (i.e. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MI: motivational interviewing; MET: motivational enhancement therapy;SD: standard deviation; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
^aDowngraded by 2 levels due to very serious study limitations, with unclear reporting of randomisation or other risk of bias in most studies and high or unclear risk of attrition bias in studies whose total weight exceeded 50% in the meta‐analysis ^bDowngraded by 1 level due to imprecision: the CI includes both a small negative and a small positive effect, the total number of participants is lower than the optimal information size to detect a small effect (SMD = 0.2) ^cNo downgrading due to imprecision; the number of participants exceeds the optimal information size (OIS) and the CI does not include any benefits or harms (SMD = 0.2) ^dDowngraded by 1 level due to serious study limitations, with unclear reporting of randomisation or other risk of bias in most studies, but low risk of attrition bias in studies whose total weight exceeded 50% in the meta‐analysis ^eDowngraded due to imprecision: the CI includes both a small negative and a small positive effect

Summary of findings 2. Motivational interviewing compared with treatment as usual for substance‐use reduction

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Summary of findings 3. Motivational interviewing compared with assessment and feedback for substance‐use reduction

Outcomes	*Illustrative comparative risks (95% CI)**	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
Motivational interviewing compared with assessment and feedback for substance‐use reduction
Population: people with substance use (adults, young adults, adolescents) Settings: paediatric emergency departments, prisons, colleges, Veterans Affairs' medical centres Intervention: motivational interviewing or motivational enhancement therapy Comparison: assessment and feedback
	Corresponding risk
	MI/MET versus assessment and feedback
Extent of substance use post‐intervention	None of the included studies measured this outcome.
Extent of substance use at short‐term follow‐up (1 to 4 months)	The extent of substance use in the MI groups was on average 0.09 SDs lower (0.23 lower to 0.05 higher) than in the control groups with assessment and feedback.	854 (7 studies)	⊕⊕⊝⊝ Low^a,b	SMD (0.09, 95% CI ‐0.05 to 0.23)
Extent of substance use at medium‐term follow‐up (6 months)	The extent of substance use in the MI groups was on average 0.24 SDs lower (0.08 to 0.40) than in the control groups with assessment and feedback.	688 (6 studies)	⊕⊕⊕⊝ Moderate^a,c	SMD (0.24, 95% CI 0.08 to 0.40)
Extent of substance use at long‐term follow‐up (12 to 15 months)	The extent of substance use in the MI groups was on average 0.24 SDslower (0.07 to 0.41) than in the control groups with assessment and feedback.	448 (3 studies)	⊕⊕⊕⊝ Moderate^a	SMD (0.24, 95% CI 0.07 to 0.41)
Readiness to change	None of the included studies measured this outcome.
Retention in treatment	None of the included studies measured this outcome.
The basis for the assumed risk* (i.e. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MI: motivational interviewing; MET: motivational enhancement therapy;SD: standard deviation; SMD: standardised mean difference
GRADE working group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
^aDowngraded by 1 level due to serious study limitations, with unclear reporting of randomisation or other risk of bias in most studies, but low risk of attrition bias in studies with whose total weight exceeded 50% in the meta‐analysis ^bDowngraded by 1 level due to imprecision: the total number of participants is lower than the optimal information size to detect a small effect (SMD = 0.2) ^cNot downgraded for very serious limitations (risk of attrition bias with loss to 6‐month follow‐up of 21% in Stein 2010)

Summary of findings 3. Motivational interviewing compared with assessment and feedback for substance‐use reduction

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Summary of findings 4. Motivational interviewing compared with other active intervention for substance‐use reduction

Outcomes	*Illustrative comparative risks (95% CI)**	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
Motivational interviewing compared with other active intervention for substance‐use reduction
Population: people with substance use (adults, young adults, adolescents) Settings: HIV primary care clinics, colleges, criminal justice system, inpatient detoxification clinics Intervention: motivational interviewing or motivational enhancement therapy Comparison: other active intervention (e.g. Alcohol and Cannabis Education, Health Education, Case Management)
	Corresponding risk
	MI/MET versus other active intervention
Extent of substance use post‐intervention	The extent of substance use in the MI groups was on average 0.07 SDs lower (0.29 lower to 0.15 higher) than in the control groups with another active intervention.	338 (3 studies)	⊕⊕⊝⊝ Low^a,b	SMD (0.07, 95% CI ‐0.15 to 0.29)
Extent of substance use at short‐term follow‐up (1 to 5 months)	The extent of substance use in the MI groups was on average 0.05 SDs lower (0.13 lower to 0.03 higher) than in the control groups with another active intervention.	2795 (18 studies)	⊕⊕⊝⊝ Low^c	SMD (0.05, 95% CI ‐0.03 to 0.13)
Extent of substance use at medium‐term follow‐up (6 to 11 months)	The extent of substance use in the MI groups was on average 0.08 SDs lower (0.17 lower to 0.01 higher) than in the control groups with another active intervention.	2352 (15 studies)	⊕⊕⊝⊝ Low^c,d	SMD (0.08, 95% CI ‐0.01 to 0.17)
Extent of substance use at long‐term follow‐up (12 to 24)	The extent of substance use in the MI groups was on average 0.03 SDs lower (0.13 lower to 0.07 higher) than in the control groups with another active intervention.	1908 (10 studies)	⊕⊕⊝⊝ Low^c,d	SMD (0.03, 95% CI ‐0.07 to 0.13)
Readiness to change (0‐ to 3‐month follow‐up)	Readiness to change in the MI groups was on average 0.15 SDs higher (0.00 lower to 0.30 higher) than in the control groups with another active intervention.	988 (5 studies)	⊕⊕⊝⊝ Low^a,b	SMD (0.15, 95% CI ‐0.00 to 0.30)
Retention in treatment (0‐ to 12‐ month follow‐up)	Retention in the MI groups was on average 0.04 SDs lower (0.23 lower to 0.14 higher) than in the control groups with another active intervention.	1945 (12 studies)	⊕⊕⊕⊝ Moderate^a	SMD (‐0.04, 95% CI ‐0.23 to 0.14)
The basis for the assumed risk* (i.e. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MI: motivational interviewing; MET: motivational enhancement therapy;SD: standard deviation; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
^aDowngraded by 1 level due to serious study limitations, with unclear reporting of randomisation or other risk of bias in most studies, but low risk of attrition bias in studies whose total weight exceeded 50% in the meta‐analysis ^bDowngraded by 1 level due to imprecision: the CI includes both negative and positive effects, and the total number of participants is lower than the optimal information size to detect a small effect (SMD = 0.2) ^cDowngraded by 2 levels due to very serious study limitations, with unclear reporting of randomisation or other risk of bias in most studies and high or unclear risk of attrition bias in studies whose total weight exceeded 50% in the meta‐analysis ^dNo downgrading due to imprecision; the number of participants exceeds the optimal information size (OIS) and the CI does not include any benefits or harms (SMD = 0.2)

Summary of findings 4. Motivational interviewing compared with other active intervention for substance‐use reduction

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Table 1. Motivational interviewing versus no intervention: specified characteristics for subgroup analysis

Study	Students	Age group	Substance	Number (length) of sessions	Intervention provider
Post‐intervention
Ball 2007a	No	Adults	Alcohol	3	Diverse
Connors 2002	No	Adults	Alcohol	1 (90 min)	Counsellors
Kelly 2000	No	Adults	Alcohol	6 (60 min)	Psychologists
Morgenstern 2017	No	Adults	Alcohol	4 (45‐60 min)	Therapists
Stein 2002	No	Adults	Alcohol	2 (60)	Other
Stotts 2006	No	Adults	Cocaine	2 (60 min)	Students
Short‐term follow‐up
Bell 2007	No	Adults	Alcohol and drugs	1 (20 min)	Diverse
Borsari 2012	Yes	Young adults	Alcohol	1 (60‐90 min)	Clinicians
Carey 2006	Yes	Young adults	Alcohol	1 (70 min)	Students
Carey 2011	Yes	Adolescents	Alcohol	1 (average 62, 30 to 148 min)	Psychology graduate students
Carroll 2006a	No	Adults	Alcohol and drugs	1 (60 min)	Counsellors
Feldstein 2007	No	Adolescents	Alcohol	1 (45 min)	PhD students
Gaume 2014	No	Young adults	Alcohol	1 (20‐30 min)	Physicians and psychologists
Kay‐Lambkin 2009	No	Adults	Alcohol and drugs	9 (60 min)	Psychologists
Kelly 2000	No	Adults	Alcohol	6 (60 min)	Psychologists
Marijuana Treatment Project 2004	No	Adults	Cannabis	2 (60 min)	NR
Martin 2008	No	Adolescents	Cannabis	2	NR
Mastroleo 2010	No	Young adults	Alcohol	1 (50 min)	Students
Morgenstern 2009	No	Adults	Drugs	4 (60 min)	Psychologists
Murphy 2010	Yes	Young adults	Alcohol	1 (50‐60 min)	Psychologists, therapists, social workers
Naar‐King 2006	No	Adolescents and young adults	Alcohol and drugs	4 (60 min)	Students
Peterson 2006	No	Adolescents	Alcohol and drugs	1 (30 min)	Counsellors
Schaus 2009	Yes	Young adults	Alcohol	2 (20 min)	Diverse
Wood 2007	Yes	Young adults	Alcohol	2 (52.5 min)	Students
Medium‐term follow‐up
Borsari 2012	Yes	Young adults	Alcohol	1 (60‐90 min)	Clinicians
Brown 2010	No	Adults	Alcohol	1 (30 min)	Students
Carey 2006	Yes	Young adults	Alcohol	1 (70 min)	Students
Connors 2002	No	Adults	Alcohol	1 (90 min)	Counsellors
Copeland 2001	No	Adults	Cannabis	6 (60 min)	Psychologists
Dermen 2011	Yes	Young adults	Alcohol	2 (30‐60 min)	Counsellors
Emmen 2005	No	Adults	Alcohol	2 (90 min)	Psychologists
Kay‐Lambkin 2009	No	Adults	Alcohol and drugs	9 (60 min)	Psychologists
Marsden 2006	No	Adolescents and young adults	Alcohol and drugs	1 (45 min)	Other
Morgenstern 2009	No	Adults	Drugs	4 (60 min)	Psychologists
Saitz 2013	No	Adults	Alcohol and drugs	2 (30‐45 and 20‐30 min)	Counsellors
Schaus 2009	Yes	Young adults	Alcohol	2 (20 min)	Diverse
Stein 2002	No	Adults	Alcohol	2 (60 min)	Other
Winters 2007	Yes	Adolescents	Alcohol and drugs	2 (60 min)	NR
Wood 2007	Yes	Young adults	Alcohol	2 (52.5 min)	Students
Long‐term follow‐up
Brown 2010	No	Adults	Alcohol	1 (30 min)	Students
Carey 2006	Yes	Young adults	Alcohol	1 (70 min)	Students
Connors 2002	No	Adults	Alcohol	1 (90 min)	Counsellors
Dermen 2011	Yes	Young adults	Alcohol	2 (30‐60 min)	Counsellors
Freyer‐ Adam 2008	No	Adults	Alcohol	1 (25 min)	Diverse
Kay‐Lambkin 2009	No	Adults	Alcohol and drugs	9 (60 min)	Psychologists
Morgenstern 2009	No	Adults	Drugs	4 (60 min)	Psychologists
Murphy 2012	No	Adolescents and young adults	Alcohol and marijuana	4 (60 min)	Psychologists or clinicians
Schaus 2009	Yes	Young adults	Alcohol	2 (20 min)	Diverse
min: minutes; NR: not reported

Table 1. Motivational interviewing versus no intervention: specified characteristics for subgroup analysis

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Table 2. Motivational interviewing versus treatment as usual: specified characteristics for subgroup analysis

Study	Students	Age group	Substance	Number (length) of sessions	Profession
Post‐intervention
Ball 2007b	No	Adults	Alcohol and drugs	3 (50 min)	Diverse
Carroll 2009	No	Adults	Alcohol and drugs	3	Other
Kavanagh 2004	No	Adults	Drugs	6‐9 (152 min)	NR
Marin‐Navarrete 2017	No	Adults	Alcohol and drugs	3	Clinic staff
Walker 2006	No	Adolescents and young adults	Cannabis	2 (60 min)	Diverse
Short‐term follow‐up
Ball 2007b	No	Adults	Alcohol and drugs	3 (50 min)	Diverse
Bazargan‐Hejazi 2005	No	Adults	Alcohol	1 (20 min)	Other
Berman 2010	No	Adults	Alcohol and drugs	1 (45‐120 min)	Clinicians
Caroll 2009	No	Adults	Alcohol and drugs	3	Other
D'Amico 2008	No	Adolescents	Cannabis	1 (15 min)	Other
D'Amico 2018	No	Adolescents	Alcohol and drugs	1 (45 min)	NR
Field 2020	No	Adults	Alcohol and drugs	1 (30‐45 min)	Clinicians
Kavanagh 2004	No	Adults	Drugs	6‐9 (152 min)	NR
Marin‐Navarrete 2017	No	Adults	Alcohol and drugs	3	Clinic staff
Mertens 2014	No	Young adults	Alcohol and drugs	1 (10 min)	Primary care nurse practitioners
Miller 2003	No	Adults	Alcohol and drugs	1 (120 min)	Diverse
Monti 2016	No	Adults	Alcohol	1 (60 min)	Doctoral‐ and master‐level interventionists
Walitzer 2009	No	Adults	Alcohol	12 (60 min)	NR
Winhusen 2007	No	Adults	Alcohol and drugs	3 (60 min)	Diverse
Medium‐term follow‐up
Brown 2015	No	Adolescents	Alcohol and drugs	2 (45 min)	Psychologists
D'Amico 2018	No	Adolescents	Alcohol and marijuana	1 (45 min)	NR
Field 2020	No	Adults	Alcohol and drugs	1 (30‐45 min)	Clinicians
Kavanagh 2004	No	Adults	Drugs	6‐9 (152 min)	NR
Maisto 2001	No	Adults	Alcohol	3 (45 min)	NR
Miller 2003	No	Adults	Alcohol and drugs	1 (120 min)	Diverse
Monti 2016	No	Adults	Alcohol	1 (60 min)	Research staff
Swogger 2016	No	Adults	Alcohol and drugs	2.5 (40 min)	Therapists
Walitzer 2009	No	Adults	Alcohol	12 (60 min)	NR
Long‐term follow‐up
Alderson 2020	No	Young adults	Alcohol and drugs	Up to 6 sessions (60 min)	Practitioners
D'Amico 2018	No	Adolescents	Alcohol and marijuana	1 (15‐20 min)	Facilitators with master and/or bachelor degree
Field 2020	No	Adults	Alcohol and drugs	1 (30‐45 min)	Clinicians
Kavanagh 2004	No	Adults	Drugs	6‐9 (152 min)	NR
Maisto 2001	No	Adults	Alcohol	3 (45 min)	NR
Miller 2003	No	Adults	Alcohol and drugs	1 (120 min)	Diverse
Saitz 2007	No	Adults	Alcohol	1 (30 min)	Diverse
Walitzer 2009	No	Adults	Alcohol	12 (60 min)	NR
min: minutes; NR: not reported

Table 2. Motivational interviewing versus treatment as usual: specified characteristics for subgroup analysis

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Table 3. Motivational interviewing versus assessment and feedback: specified characteristics for subgroup analysis

Study	Students	Age group	Substance	Number (length) of sessions	Profession
Short‐term follow‐up
Bernstein 2009	No	Adolescents and young adults	Marijuana	1 (25 min)	Other
Bien 1993	No	Adults	Alcohol	1 (60 min)	NR
McDevitt‐Murphy 2014	No	Adults	Alcohol	1 (60 min)	Clinician
Morgenstern 2012	No	Adults	Alcohol	4 (45‐60 min)	Therapists
Stein 2010	No	Adults	Alcohol	2 (30‐45 min)	Psychologist
Walters 2009	Yes	Young adults	Alcohol	1 (45 min)	Diverse
White 2006	Yes	Young adults	Alcohol and drugs	2	Counsellor
Medium‐term follow‐up
Bien 1993	No	Adults	Alcohol	1 (60 min)	NR
McDevitt‐Murphy 2014	No	Adults	Alcohol	1 (60 min)	Clinician
Sellman 2001	No	Adults	Alcohol	4	Diverse
Stein 2010	No	Adults	Alcohol	2 (30‐45 min)	Psychologist
Stephens 2007	No		Cannabis	2 (90 min)	Diverse
Walters 2009	Yes	Young adults	Alcohol	1 (45 min)	Diverse
Long‐term follow‐up
Bernstein 2009	No	Adolescents and young adults	Marijuana	1 (25 min)	Other
Stephens 2007	No	Adults	Marijuana	2 (90 min)	Diverse
White 2006	Yes	Young adults	Alcohol and drugs	2	Counsellor
min: minutes; NR: not reported

Table 3. Motivational interviewing versus assessment and feedback: specified characteristics for subgroup analysis

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Table 4. Motivational interviewing versus other active intervention: specified characteristics for subgroup analysis

Study	Students	Age group	Substance	Number (length) of sessions	Profession
Post‐intervention
Aharonovich 2017	No	Adults	Drugs	1 (25‐30 min) + 2 booster sessions (10‐15 min)	Bilingual counsellors
Anton 2005	No	Adults	Alcohol	4	NR
Kadden 2007	No	Adults	Marijuana	2 (60 min)	Diverse
Short‐term follow‐up
Barnett 2007	Yes	Young adults	Alcohol	1 + 1 booster session	Counsellors
Borsari 2005	Yes	Young adults	Alcohol	1 (60 min)	Psychologists
Carroll 2006b	No	Young adults	Marijuana	8	Other
Chanut 2007	No	Adults	Alcohol	1 (25 min)	NR
Colby 2018	No	Young adults	Alcohol	1 (60 min)	Clinical psychologist, social worker
De Gee 2014	No	Adolescents	Cannabis	2 (60‐90 min)	Prevention workers
Dieperink 2014	No	Adults	Alcohol and drugs	4 (30‐45 min)	Healthcare professionals
Kadden 2007	No	Adults	Marijuana	2 (60 min)	Diverse
Kahler 2004	No	Adults	Alcohol	1 (60 min)	NR
Mackiewicz Seghete 2022	No	Adolescents	Alcohol	2 (60 min)	Therapists
Martino 2006	No	Adults	Alcohol and drugs	2 (60 min)	Diverse
McCambridge 2008	No	Adolescents and young adults	Alcohol and cannabis	1	Students
Parsons 2014	No	Adults	Drugs	4 (60 min)	Therapists with PhD and/or master degree
Slesnick 2013	No	Adolescents	Alcohol and drugs	2 (60 min)	Therapists
Slesnick 2015	No	Adolescents and young adults	Alcohol and drugs	2 (60 min)	NR
Stein 2017	No	Young adults	Alcohol and drugs	5 (20‐30 min)	Diverse
UKATT 2005	No	Adults	Alcohol	3 (50 min)	Diverse
Walitzer 2009	No	Adults	Alcohol	12 (60 min)	NR
Wood 2007	Yes	Young adults	Alcohol	2 (52.5 min)	Students
Medium‐term follow‐up
Aharonovich 2017	No	Adults	Drugs	1 (25‐30 min)+2 booster sessions (10‐15 min)	Bilingual counsellors
Borsari 2005	Yes	Young adults	Alcohol	1 (60 min)	Psychologists
Chanut 2007	No	Adults	Alcohol	1 (25 min)	NR
De Wildt 2002	No	Adults	Alcohol	3 (20 min)	Diverse
Dieperink 2014	No	Adults	Alcohol and drugs	4 (30‐45 min)	Health‐care professionals
Feldstein Ewing 2021	No	Adolescents	Alcohol and cannabis	2 (60 min)	Therapists
Kadden 2007	No	Adults	Marijuana	2 (60 min)	Diverse
Kahler 2004	No	Adults	Alcohol	1 (60 min)	NR
Logan 2015	Yes	Young adults	Alcohol	1 (45‐60 min)	Psychology graduate students
Mackiewicz Seghete 2022	No	Adolescents	Alcohol	2 (60 min)	Therapists
Match 1993	No	Adults	Alcohol	4	Diverse
McCambrigde 2008	No	Adolescents and young adults	Alcohol and cannabis	1	Students
Parsons 2014	No	Adults	Drugs	4 (60 min)	Therapists
Slesnick 2013	No	Adolescents	Alcohol and drugs	2 (60 min)	Therapists
Slesnick 2015	No	Adolescents and young adults	Alcohol and drugs	2 (60 min)	NR
Stein 2017	No	Young adults	Alcohol and drugs	5 (20‐30 min)	Diverse
Walitzer 2009	No	Adults	Alcohol	12 (60 min)	NR
Wood 2007	Yes	Young adults	Alcohol	2 (52.5 min)	Students
Long‐term follow‐up
Aharonovich 2017	No	Adults	Drugs	1 (25‐30 min) + 2 booster sessions (10‐15 min)	Bilingual counsellors
Barnett 2007	Yes	Young adults	Alcohol	1 + 1 booster session	Counsellors
Kadden 2007	No	Adults	Marijuana	2 (60 min)	Diverse
Mackiewicz Seghete 2022	No	Adolescents	Alcohol	2 (60 min)	Therapists
Match 1993	No	Adults	Alcohol	4	Diverse
Parsons 2014	No	Adults	Drugs	4 (60 min)	Therapists
Slesnick 2013	No	Adolescents	Alcohol and drugs	2 (60 min)	Therapists
Slesnick 2013	No	Adolescents and young adults	Alcohol and drugs	4	NR
Stein 2017	No	Young adults	Alcohol and drugs	5 (20‐30 min)	Diverse
UKATT 2005	No	Adults	Alcohol	3 (50 min)	Diverse
Walitzer 2009	No	Adults	Alcohol	12 (60 min)	NR
min: minutes; NR: not reported

Table 4. Motivational interviewing versus other active intervention: specified characteristics for subgroup analysis

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Table 5. Motivational interviewing versus no intervention: extent of substance use as reported

Study	Outcome as reported in the study	Follow‐up (as reported in the study)	Results (MI vs. no intervention)
Post‐intervention
Ball 2007a	Drinks per drinking day Frequency of days drinking	Post	2.53 (SD 0.98) vs. 3.63 (SD 1.36) 0.68 (SD 0.3) vs. 0.68 (SD 0.28)
Connors 2002	Days abstinent Heavy drinking days	Post	28 (SD 3) vs. 19.9 (SD 10.17) 1 (SD 2.06) vs. 3.59 (SD 5.37)
Kelly 2000	Standard drinks per day	Post	2.42 (SD 1.44) vs. 5.55 (SD 3.25)
Morgenstern 2017	Heavy drinking days per week Sum of standard drinks per week	8 weeks	2.71 (SD 1.99) vs. 2.49 (SD 1.95) 24.8 (SD 18.9) vs. 23.3 (SD 17.3)
Stein 2002	Drinking days	1 month	11.1 (SD 10.9) vs. 11.4 (SD 10.6)
Stotts 2006	Cocaine positive	Post	56.3 vs. 84.6%
Short‐term follow‐up
Bell 2007	Drinks per day Drinks Substance use days Substance use per day	2 months	1.2 (SD 0.4) vs. 3.2 (SD 8.8) 84.1 (SD 159.5) vs. 182.6 (SD 499.8) 8.6 (SD 20.5) vs. 1.3 (SD 2.9) 0.1 (SD 0.2) vs. 0 (SD 0)
Borsari 2012	Heavy drinking days (in the past month)	3 months	6.47 (SD 4.99) vs. 7.31 (SD 5.43)
Carey 2006	Drinks per drinking day Drinks per week Heavy drinking frequency Peak BAC RAPI	1 month	4.8 (SD 3) vs. 5.3 (SD 2.3) 13.8 (SD 10.5) vs. 16.4 (SD 9.1) 5.1 (SD 4.7) vs. 6.2 (SD 4) 0.17 (SD 0.12) vs. 0.18 (SD 0.09) 6.2 (SD 5.7) vs. 8.5 (SD 6.7)
Carey 2011	Reductions in number of drinks per heaviest week	1 month	Females: ‐5.04 vs. ‐2.67 (95% CI ‐4.47 to ‐1.13) Males: ‐4.94 vs. 0.34 (95% CI ‐1.22 to 2.06)
Carroll 2006a	Days of use of primary substance	1 month 3 months	3.33 (SD 6.31) vs. 3.99 (SD 7.24) 6.85 (SD 12.65) vs. 8.05 (SD 12.24)
Dermen 2011	Drinking days (last 90 days) Drinks per drinking day (last 90 days)	3 months	27.5 (SD 12.9) vs. 29.2 (SD 18.9) 5.2 (SD 2.9) vs. 5.0 (SD 2.4)
Feldstein 2007	Binge episodes RAPI	2 months	0.77 (SD 1.06) vs. 1.27 (SD 9.96) 26.34 (SD 4.12) vs. 27.2 (SD 4.23)
Gaume 2014	Drinking composite score	3 months	MD ‐0.13 (95% CI ‐0.25 to ‐0.02)
Kay‐Lambkin 2009	Alcohol Cannabis Hazardous drug use	3 months	3.58 (SD 4.6) vs. 4.79 (SD 4.95) 8.9 (SD 11.25) vs. 7.24 (SD 7.77) 39.84 (SD 50.27) vs. 31.11 (SD 13.54)
Kelly 2000	Standard drinks per day	1 month	1.92 (SD 1.33) vs. 5.34 (SD 3.7)
Marijuana Treatment Project 2004	Abuse symptoms Dependence symptoms Joints per day Marijuana problems Percentage of days smoking Periods smoked per day	4 months	1.38 (SD 1.1) vs. 1.63 (SD 0.91) 3.7 (SD 2.26) vs. 4.36 (SD 1.92) 1.5 (SD 1.62) vs. 2.03 (SD 1.94) 8.35 (SD 4.06) vs. 7.77 (SD 3.9) 55.9 (SD 36.2) vs. 75.6 (SD 30.7) 1.35 (SD 0.89) vs. 1.95 (SD 1.05)
Martin 2008	Cannabis use Mean cones per week	3 months	54.3 (SD 36.1) vs. 54.5 (SD 31.6) 75.1 (SD 89.7) vs. 59.4 (SD 62.2)
Mastroelo 2010	Daily drinking questionnaire Heavy drinking Peak BAC	3 months	11.57 (SD 8.05) vs. 14.54 (SD 11.93) ‐1.07 (SD 3.08) vs. 0.05 (SD 3.59) 0.13 (SD 0.08) vs. 0.15 (SD 0.11)
Morgenstern 2009	Club drug use	3 months	Cohen's d 0.23 (SE 0.228)
Murphy 2010	Drinks per week (last month) Heavy drinking per month	1 month	9.43 (SD 11.84) vs. 14.99 (SD 11.34) 1.85 (SD 2.83) vs. 3.61 (SD 3.26)
Naar‐King 2006	Most number of times tried marijuana Most standard drinks one week	3 months	1.76 (SD 3.57) vs. 0.65 (SD 1.23) 2.01 (SD 2.5) vs. 3.96 (SD 7.73)
Peterson 2006	Days of marijuana use Days of marijuana use Other illicit drug use days Other illicit drug use days	1 month 3 months 1 month 3 months	13.61 (SD 11.33) vs. 14.81 (SD 12.8) 11.83 (SD 11.74) vs. 12.14 (SD 12.08) 7.86 (SD 10.32) vs. 7.99 (SD 10.43) 7.91 (SD 10.31) vs. 6.39 (SD 9.31)
Schaus 2009	Drinks per sitting Drinks per week Heavy drinking episodes Times drunk per week Peak BAC Peak no drinks per sitting Typical BAC	3 months	4.02 (SD 3.22) vs. 4.49 (SD 3.08) 7.33 (SD 8.44) vs.9.47 (SD 9.65) 4.55 (SD 6.24) vs. 5.37 (SD 6.53) 0.85 (SD 0.93) vs. 1.24 (SD 1.15) 0.11 (SD 0.09) vs. 0.14 (SD 0.09) 6.87 (SD 5.38) vs. 8.03 (SD 5.15) 0.05 (SD 0.05) vs. 0.07 (SD 0.05)
Wood 2007	Alcohol consumption past 30 days Alcohol consumption past 30 days	1 month 3 months	73.46 (SD 41.33) vs. 86.28 (SD 39.3) 75.86 (SD 47.06) vs. 84. 56 (SD 43.8)
Medium‐term follow‐up
Borsari 2012	Heavy drinking days (last month) Heavy drinking days (last month)	6 months 9 months	6.16 (SD 4.77) vs. 6.83 (SD 4.99) 6.61 (SD 5.02) vs. 6.89 (5.42)
Brown 2010	ALT AST GGT MMPI‐MAC MCV Risky drinking	6 months	37.16 (SD 38.81) vs. 36.81 (SD 37.76) 33.17 (SD 27.23) vs. 34.47 (SD 33.35) 54.05 (SD 94.59) vs. 68.34 (SD 111.3) 24.91 (SD 4.63) vs. 25.79 (SD 5.31) 93.95 (SD 7.05) vs. 92.88 (SD 5.74) 39.48 (SD 32.13) vs. 37.36 (SD 28.52)
Carey 2006	Drinks per drinking day Drinks per week Heavy drinking ‐ frequency Peak BAC RAPI	6 months	4.8 (SD 2.2) vs. 5.4 (SD 2.4) 17.6 (SD 13.1) vs. 17.4 (SD 10.06) 7 (SD 5.3) vs. 7.4 (SD 5.4) 0.18 (SD 0.11) vs. 0.2 (SD 0.11) 6.5 (SD 6.1) vs. 8.2 (SD 8)
Connors 2002	Days abstinent Heavy drinking days	6 months	22.9 (SD 7.78) vs. 18.84 (SD 11.97) 3.04 (SD 5.14) vs. 5.6 (9.06)
Copeland 2001	Cannabis dependence (SDS‐score) Daily cannabis use last month	8 months	MI (1CBT): 7.6 (SD 4.4) vs. MI (6CBT): 5.8 (SD 4.3) vs. 9.2 (SD: 3.2) MI (1CBT): 1.5 (SD 1.2) vs. MI (6CBT): 1.3 (SD 0.9) vs. 1.8 (SD 1)
Dermen 2011	Drinking days (last 90 days) Drinks per drinking day (last 90 days) Drinking days (last 90 days) Drinks per drinking day (last 90 days)	6 months 6 months 9 months 9 months	26.0 (SD 17.0) vs. 30.4 (SD 19.5) 4.2 (SD 2.0) vs. 5.0 (SD 2.1) 24.8 (SD 14.7) vs. 27.1 (SD 19.0) 4.3 (SD 2.0) vs. 5.3 (SD 2.4)
Emmen 2005	CDT Units per day (previous month)	6 months	2.52 (SD 1.04) vs. 2.35 (SD 0.77) 3.35 (SD 2.11) vs. 2.86 (SD 2.35)
Kay‐Lambkin 2009	Alcohol Cannabis Hazardous drug use	6 months	3.62 (SD 5.31) vs. 6.41 (SD 5.91) 7.1 (SD 9.51) vs. 8 (9.7) 27 (SD 22.8) vs. 38.78 (SD 17.14)
Marsden 2006	Alcohol number of days Cannabis number of days Cocaine number of days Crack number of days Ecstasy number of days	6 months	28.87 (SD 25.7) vs. 30.66 (SD 25.3) 52.01 (SD 36.5) vs. 57.24 (SD 36.3) 5.54 (SD 11.5) vs. 7.4 (SD 12.6) 4.67 (SD 5.1) vs. 5.73 (SD 15.8) 8.2 (SD 13.5) vs. 8.7 (SD 13.2)
Morgenstern 2009	Club drug use Club drug use	6 months 9 months	Cohen's d 0.37 (SE 0.230) Cohen's d 0.17 (SE 0.238)
Saitz 2013	Days > 1 time using main drug Days using main drugs Main drug use (ASSIST)	6 months	10.95 (SD 12.1) vs. 9.1 (SD 11.3) 14.15 (SD 12.4) vs. 13.8 (SD 12.1) 18.3 (SD 9.6) vs. 18.1 (SD 9.2)
Schaus 2009	Drinks per sitting Drinks per sitting Drinks per week Drinks per week Heavy drinking episode Heavy drinking episode Times drunk per week Times drunk per week Peak BAC Peak BAC Peak no drinks per sitting Peak no drinks per sitting Typical BAC Typical BAC	6 months 9 months 6 months 9 months 6 months 9 months 6 months 9 months 6 months 9 months 6 months 9 months 6 months 9 months	3.18 (SD 3.28) vs. 4.55 (SD 3.43) 3.98 (SD 3.89) vs. 4.00 (SD 2.89) 6.16 (SD 7.51) vs. 8.9 (SD 9.89) 6.12 (SD 7.18) vs. 7.47 (SD 8.57) 3.92 (SD 5.37) vs. 5.33 (SD 7.69) 3.94 (SD 5.57) vs. 4.79 (SD 7.47) 0.71 (SD 0.94) vs. 1.1 (SD 1.09) 0.93 (SD 1.33) vs. 1.33 (1.52) 0.1 (SD 0.09) vs. 0.14 (SD 0.11) 0.11 (SD 0.11) vs. 0.12 (SD 0.09) 6.52 (SD 5.27) vs. 7.98 (SD 5.32) 6.71 (SD 5.53) vs. 6.92 (SD 4.49) 0.05 (SD 0.05) vs. 0.07 (SD 0.07) 0.05 (SD 0.07) vs. 0.06 (SD 0.05)
Stein 2002	Drinking days > 50% reduction in cocaine use Abstinence Any reduction in cocaine use	6 months	7.6 (SD 10.3) vs. 9.1 (SD 11.0) 55.7 vs. 46.5% 33.0 vs. 25.7% 61.9 vs. 56.4%
Winters 2007	Alcohol use days Binge‐drinking days Illicit drug use days	6 months	4.5 (SD 0.9) vs. 5.7 (SD 1.1) 1.8 (SD 1) vs. 2.4 (SD 1.4) 11.9 (SD 5.2) vs. 13.4 (SD 5.4)
Wood 2007	Alcohol consumption past 30 days	6 months	72.99 (SD 53. 36) vs. 82.1 (SD 50.34)
Long‐term follow‐up
Brown 2010	ALT GGT MAC MCV Risky drinking	12 months	37.66 (SD 29.25) vs. 40.26 (SD 32.93) 59.926 (SD 81.03) vs. 63.26 (SD 85.84) 25.51 (SD 4.25) vs. 24.82 (SD 5.16) 93.62 (SD 6.44) vs. 93.46 (SD 5.57) 34.27 (SD 30.83) vs. 39.06 (SD 31.85)
Carey 2006	Drinks per drinking day Drinks per week Heavy drinking frequency Peak BAC RAPI	12 months	4.5 (SD 2.2) vs. 4.6 (SD 2.5) 15.6 (SD 10.8) vs. 15 (SD 10.5) 5.7 (SD 4.2) vs. 5.1 (SD 4) 0.16 (SD 0.1) vs. 0.17 (SD 0.1) 5.5 (SD 6.3) vs. 5.3 (SD 5.1)
Connors 2002	Days abstinent Heavy drinking days	12 months	22.41 (SD 9.26) vs. 19.81 (SD 11.18) 1.58 (SD 3.36) vs. 5.34 (SD 8.86)
Dermen 2011	Drinking days (last 90 days) Drinks per drinking days (last 90 days) Drinking days (last 90 days) Drinks per drinking day (last 90 days)	12 months	24.6 (SD 13.5) vs. 27.6 (SD 19.4) 4.4 (SD 2.1) vs. 5.0 (SD 2.7) 21.7 (SD 13.5) vs. 24.9 (SD 15.7) 4 (SD 2.1) vs. 5.1 (SD 2.9)
Freyer‐ Adam 2008	Alcohol per day Alcohol per week	12 months	42.1 (SD 56.22) vs. 46.32 (SD 59.33) 255.39 (SD 346.15) vs. 274.01 (SD 344.09)
Kay‐Lambkin 2009	Alcohol Cannabis Hazardous drug use	12 months	2.49 (SD 3.47) vs. 4.03 (SD 3.22) 5.72 (SD 6.22) vs. 8.61 (SD 10.16) 24.21 (SD 18.71) vs. 34.11 (SD 16.01)
Morgenstern 2009	Club drug use	12 months	Cohen's d 0.61 (SE 0.256)
Murphy 2012	Only alcohol use/past week Only alcohol use/past week (self‐reported) Only marijuana use/past week	15 months	28 vs. 41% 39.7% vs. 53.6%, Chi‐Square=2.81 25.9% vs. 23.2%, Chi‐Square=0.11
Schaus 2009	Drinks per sitting Drinks per week Heavy drinking episodes No. of times drunk per week Peak BAC Peak no drinks per sitting Typical BAC	12 months	3.96 (SD 3.01) vs. 4.04 (SD 3.02) 6.45 (SD 7.47) vs. 7.26 (SD 8.36) 4.34 (SD 5.91) vs. 4.37 (SD 6.06) 1.31 (SD 2.11) vs. 1.7 (SD 2.05) 0.11 (SD 0.09) vs. 0.11 (SD 0.09) 6.71 (SD 5.27) vs. 6.92 (SD 4.59) 0.06 (SD 0.05) vs. 0.06 (SD 0.05)
ALT: alanine aminotransferase; AST: aspartate aminotranferase; BAC: blood alcohol concentration; CDT: serum carbohydrate‐deficient transferrin; GGT: gammaglutamyl transferase; MCV: mean corpuscular red blood cell volume; MD: mean difference; MMPI‐MAC: MacAndrew Alcoholism Scale from the Minnesota Multiphasic Personality Inventory–2; RAPI: Rutgers Alcohol Problems Index; SD: standard deviation; SE: standard error

Table 5. Motivational interviewing versus no intervention: extent of substance use as reported

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Table 6. Motivational interviewing versus treatment as usual: extent of substance use as reported

Study	Outcome as reported in the study	Follow‐up as reported in the study	Results (MI vs. treatment as usual)
Post‐intervention
Ball 2007b	Days/week primary substance use	Post	0.67 (SD 1.67) vs. 0.37 (SD 1.21)
Carroll 2009	Percent days abstinent Percent positive urine specimens	1–4 weeks	94.7 (SD 12.1) vs. 92.2 (SD 17.8) 37.6 (SD 41.9) vs. 31.8 (SD 41.3)
Kavanagh 2004	Abstinent or improved	6 weeks	10/13 (76.9%) vs. 9/12 (75%)
Marín‐Navarrete 2017	Days of primary substance use	1–3 weeks	Cohen's d: ‐0.31 (‐0.68 to 0.05)
Walker 2006	Days of marijuana use	Post	31.05 (SD 23.28) vs. 32.76 (SD 20.61)
Short‐term follow‐up
Ball 2007b	Days/week primary substance use	16 weeks	0.79 (SD 1.76) vs. 0.57 (SD 1.46)
Bazargan‐Hejazi 2005	At risk /moderate (AUDIT 7‐18) High risk (AUDIT 19‐40) Participants who reduced their risk	3 months	11/88 (12.5%) vs. 5/97 (5.1%) 31/88 (35.2%) vs. 32/97 (33.0%) 42/88 (48%) vs. 37/97 (38%)
Berman 2010	Alcohol use (AUDIT) Drug use (DUDIT)	3 months	10.89 (SD 10.96) vs. 9.12 (SD 10.34) 25.57 (SD 11.93) vs. 23.75 (SD 10.68)
Carroll 2009	Percent days abstinent	5–16 weeks	94.4 (SD 13.9) vs. 92.5 (SD 18.3)
D'Amico 2008	Intentions to use alcohol Intentions to use marijuana Alcoholic drinks on days drinking Days +3 drinks Days last month drank alcohol Days last month used marijuana Times used marijuana on days used	3 months	2.5 (SD 1.18) vs. 3.1 (SD 0.83) 2.18 (SD 1.09) vs. 2.75 (SD 1.16) 3.14 (SD 1.87) vs. 3.6 (SD 1.84) 1.04 (SD 1.09) vs. 1.35 (SD 1.08) 1.72 (SD 1.51) vs. 1.95 (SD 1.6) 1.54 (SD 1.71) vs. 2.1 (SD 2.04) 1 (SD 0.92) vs. 1.45 (SD 0.99)
D'Amico 2018	Alcohol use Heavy alcohol Marijuana Intentions to use alcohol Intentions to use marijuana Alcoholic drinks on days drinking Days with more than three drinks Days last month drank alcohol Days last month used marijuana Times used marijuana on days used	3 months	5.18 (SD 5.59) vs. 5.64 (SD 5.84) 2.76 (SD 4.56) vs. 3.04 (SD 4.79) 6.38 (SD 8.05) vs. 5.95 (SD 7.58) 2.5 (SD 1.18) vs. 3.1 (SD 0.83) 2.18 (SD 1.09) vs. 2.75 (SD 1.16) 3.14 (SD 1.87) vs. 3.6 (SD 1.84) 1.04 (SD 1.09) vs. 1.35 (SD 1.08) 1.72 (SD 1.51) vs. 1.95 (SD 1.6) 1.54 (SD 1.71) vs. 2.1 (SD 2.04) 1 (SD 0.92) vs. 1.45 (SD 0.99)
Field 2020	Average drinks Maximum number of drinks	3 months	8.58 (SD 24.8) vs. 13.94 (SD 31.73) 8.29 (SD 22.11) vs. 7.86 (SD 14.12)
Kavanagh 2004	Abstinent or improved	3 months	10/13 (76.9%) vs. 7/12 (58.3%)
Marín‐Navarrete 2017	Days of primary substance use	5–16 weeks	Cohen's d: ‐0.04 (95%CI ‐0.37 to 0.32)
Mertens 2014	Alcohol use (ASSIST score) (past 3 months) Alcohol and drug use (ASSIST score) (past 3 months) Cannabis use (ASSIST Score (past 3 months)	3 months	8.0 vs. 9.1 (p=0.029) 13.7 vs. 15.1 (p= 0.081) 4.6 vs. 5.2 (p =0.112)
Miller 2003	Abstinence from illicit drugs	3 months	0.78 (SD 0.32) vs. 0.78 (SD 0.26)
Monti 2016	CDC excessive drinking (8/15 drinks per week for women/men), 30 days FDA Heavy drinking (4/5 drinks in one day for women/men) Number of heavy drinking days Average number of drinks per week	3 months	39 (SD 27.7) vs. 67 (SD 41.6) 100 (SD 70.9) vs. 125 (SD 77.6) 3.8 (SD 5.4) vs. 5.6 (6.4) 9.1 (SD 11.5) vs.16.5 (SD 28.1)
Walitzer 2009	Percent days abstinent Percent days heavy drinking	3 months	69.6 (SD 31.7) vs. 66.4 (SD 34.6) 9.4 (SD 18.6) vs. 16.4 (SD 31.3)
Winhusen 2007	Days of use	3 months	4.26 (SD 8.73) vs. 4.7 (SD 8.87)
Medium‐term follow‐up
Brown 2015	Number of days of alcohol use (across the first 6 months) Number of days of any substance use (across the first 6 months) Number of days of marihuana use (across the first 6 months)	6 months	MD ‐0.52 (95% CI ‐1.1 to 0.06) MD ‐0.58 (95% CI ‐1.16 to ‐0.01) MD ‐0.81 (95% CI ‐1.6 to ‐0.02)
D'Amico 2018	Alcohol use Heavy alcohol use Marijuana use	6 months	4.72 (SD 5.86) vs. 5.44 (SD 6.45) 2.69 (SD 4.73) vs. 2.68 (SD 4.66) 6.13 (SD 7.90) vs. 5.07 (SD 6.83)
Field 2020	Average drinks Maximum number of drinks	6 months	11.1 (SD 24.2) vs. 14.83 (SD 28.23) 9.35 (SD 18.77) vs. 9.01 (SD 15.54)
Kavanagh 2004	Abstinent or improved	6 months	11/13 (84.6%) vs. 7/12 (58.3%)
Maisto 2001	Days 1–6 drinks Days abstinent Drinks per drinking day Number of drinks	6 months	8.4 (SD 8.72) vs. 8.4 (SD 9.41) 19.6 (SD 9.37) vs. 19 (9.88) 4.4 (SD 3.49) vs. 5.1 (SD 4.94) 44.4 (SD 49.91) vs. 54.6 (SD 61.15)
Miller 2003	Abstinence from illicit drugs Abstinence from illicit drugs	6 months 9 months	0.76 (SD 0.31) vs. 0.77 (SD 0.29) 0.78 (SD 0.33) vs. 0.77 (SD 0.3)
Monti 2016	Average number of drinks per week CDC excessive drinking (last 30 days) FDA Heavy drinking (last 30 days) Number of heavy drinking days (last 30 days) FDA Heavy drinking (last 30 days) Average number of drinks per week CDC excessive drinking (last 30 days) Number of heavy drinking days (last 30 days)	6 months 6 months 6 months 6 months 9 months 9 months 9 months 9 months	9.2 (SD 12.4) vs. 12.6 (SD 17.9) 36.0 (SD 24.5) vs. 61.0 (SD 36.7) 108 (SD 73.5) vs. 119 (SD 71.7) 3.8 (SD 5.8) vs. 4.7 (SD 6.3) 91.0 (SD 61.6) vs. 110.0 (SD 67.1) 8.4 (SD 11.6) vs. 12.1 (17.6) 34 (SD 22.8) vs. 62.0 (SD 37.8) 3.7 (SD 5.9) vs. 4.7 (SD 6.7)
Swogger 2016	Percent days abstinent (last 90 days)	6 months	MD 0.06 (t=0.17)
Walitzer 2009	Percent days abstinent Percent days abstinent Percent days heavy drinking Percent days heavy drinking	6 months 9 months 6 months 9 months	66.1 (SD 36.6) vs. 59.8 (SD 37.4) 63.6 (SD 35.1) vs. 68.1 (SD 32.8) 9.6 (SD 21.1) vs. 17.9 (SD 30.6) 11.7 (SD 22.9) vs. 9.8 (SD 20.2)
Long‐term follow‐up
Alderson 2020	AUDIT (hazardous alcohol) ASSIST‐Y (drug use): cannabis ASSIST‐Y (drug use): cocaine ASSIST‐Y (drug use): amphetamine ASSIST‐Y (drug use): sedative ASSIST‐Y (drug use): hallucinogens ASSIST‐Y (drug use): novel psychoactive substance ASSIST‐Y (drug use): opoid ASSIST‐Y (drug use): inhalants ASSIST‐Y (drug use): other ASSIST‐Y (drug use): episodes of heavy drinking	12 months	12/17 (71%) vs. 10/20 (50%) 12/17 (70.5%) vs. 14/20 (70%) 8/17 (47%) vs. 7/20 (35%) 7/17 (41%) vs. 3/20 (15%) 6/17 (35%) vs. 5/20 (25%) 4/17 (23.5%) vs. 4/20 (20%) 3/17 (18%) vs. 2/20 (10%) 2/17 (12%) vs. 1/20 (5%) 2/17 (12%) vs. 2/20 (10%) 0 vs. 0/20 (0%) Median 1 (IQR 0‐4), Range: 0‐10 vs. 1.5 (IQR 0‐5.5), Range: 0‐9
D'Amico 2018	Alcohol use Heavy alcohol use Marijuana use	12 months	4.54 (SD 5.68) vs. 5.09 (SD 6.39) 2.44 (SD 4.60) vs. 2.85 (SD 5.17) 6.76 (SD 8.37) vs. 5.21 (SD 7.35)
Field 2020	Average drinks Maximum number of drinks	12 months	12.76 (SD 31.01) vs. 13.33 (SD 9.65) 10.23 (SD 13.1) vs. 11.02 (SD 16.46)
Kavanagh 2004	Abstinent or improved	12 months	8/13 (61.5%) vs. 3/12 (25.0%)
Maisto 2001	Days 1–6 drinks Days abstinent Drinks per drinking day Number of drinks	12 months	8.3 (SD 8.72) vs. 8.9 (SD 9.17) 20.1 (8.72) vs. 18.4 (SD 9.88) 4 (SD 3.05) vs. 4.5 (SD 3.53) 42.9 (SD 52.31) vs. 54.1 (SD 55.04)
Miller 2003	Abstinence from illicit drugs	12 months	0.81 (SD 0.29) vs. 0.77 (SD 0.34)
Saitz 2007	Drinking risky amounts Heavy drinking episodes Abstinence	12 months	87/141 (62%) vs. 93/146 (64%) 87/141 (62%) vs. 91/146 (62%) 42/141 (30%) vs. 40/146 (27%)
Walitzer 2009	Percent days abstinent Percent days heavy drinking	12 months	67.4 (SD 33.9) vs. 69 (SD 30.3) 9.9 (SD 23.5) vs. 13.4 (SD 22.9)
ASSIST: Alcohol, Smoking and Substance Involvement Screening Test; ASSIST‐Y: Alcohol, Smoking and Substance Involvement Screening Test‐Youth; AUDIT: Alcohol Use Disorders Identification Test; CDC: Centers for Disease Control;DUDIT: Drug use disorders identification test; FDA: Food and Drug Administration; IQR: interquartile range; SD: standard deviation

Table 6. Motivational interviewing versus treatment as usual: extent of substance use as reported

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Table 7. Motivational interviewing versus assessment and feedback: extent of substance use as reported

Study	Outcome as reported in the study	Follow‐up as reported in the study	Results (MI vs. assessment and feedback)
Short‐term follow‐up
Bernstein 2009	Abstinence marijuana Days per month marijuana	3 months	OR 1.15 (95% CI 0.36 to 3.73) 14.2 (SD 10.8) vs. 13.7 (SD 11.2)
Bien 1993	Blood alcohol level Percent days abstinent Standard drink units (SEC)	3 months	41.9 (SD 100) vs. 190.9 (SD 265.2) 95.7 (SD 93) vs. 80.1 (SD 26.6) 12.9 (SD 26.41) vs. 272.2 (SD 528.9)
McDevitt‐Murphy 2014	Drinking days per week Drinks per drinking day Drinks per week Past month binge days	6 weeks	1.76 (SD 1.8) vs. 2.05 (SD 1.7) 5.14 (SD 3.73) vs. 5.84 (SD 3.74) 9.53 (SD 11.53) vs. 11.26 (SD 11.38) 3.72 (SD 5.46) vs. 3.91 (SD 4.66)
Morgenstern 2012	Drinks per week	8 weeks	22.9 (SD 15.6) vs. 21.8 (SD 11.0)
Stein 2010	Percent abstinent days Percent abstinent days	1 month 3 months	OR 1.22 (95% CI 0.69 to 2.17) OR 1.96 (95% CI 1.17 to 3.30)
Walters 2009	MI (with vs. without feedback) vs. feedback vs. assessment only vs. feedback only: Drinks per week Peak BAC	3 months	11.69 (SD 12.7) vs. 13.17 (SD 13.33) vs. 11.97 (SD 11.8) vs. 13.48 (SD 14.67) 0.13 (SD 0.08) vs. 0.14 (SD 0.08) vs. 0.13 (SD 0.1) vs. 0.12 (SD 0.09)
White 2006	Freq alcohol use past month Freq marijuana past month Heavy drinking Drinks in typical week Peak BAC	4 months	1.66 (SD 1.05) vs. 1.59 (SD 1.19) 0.38 (SD 0.86) vs. 0.46 (SD 1.08) 1.2 (SD 2.09) vs. 1.36 (SD 2.34) 5.08 (SD 6.21) vs. 5.3 (SD 7.19) 0.05 (SD 0.06) vs. 0.04 (SD 0.06)
Medium‐term follow‐up
Bien 1993	Blood alcohol level Percent days abstinent Standard drink units	6 months	50.1 (SD 87.1) vs. 91.1 (SD 167.1) 71.1 (SD 38.1) vs. 81.3 (SD 34) 113.6 (SD 181.3) vs. 394.1 (SD 1176)
McDevitt‐Murphy 2014	Drinking days per week Drinks per drinking day Drinks per week Past month binge days	6 months	1.97 (SD 2.19) vs. 2.15 (SD 2.03) 4.16 (SD 2.37) vs. 5.13 (SD 3.24) 8.78 (SD 11.63) vs. 9.34 (SD 10.34) 2.97 (SD 5.26) vs. 2.77 (SD 4.05)
Sellman 2001	GAS score	6 months	70.2 (SD 7.78) vs. 67.6 (SD 8.22)
Stein 2010	Percent abstinent days	6 months	OR 1.44 (95% CI 0.84 to 2.49)
Stephens 2007	Days of marijuana use per week Dependence symptoms Number of problems Periods smoked per day	6 months	4.9 (SD 2.13) vs. 5.22 (SD 2.13) 2.59 (SD 1.65) vs. 3.26 (SD 1.65) 4.06 (SD 3.23) vs. 5.46 (3.23)
Walters 2009	MI feedback vs. assessment only vs. feedback only: Drinks per week Peak BAC MI only vs. assessment only vs. feedback only: Drinks per week Peak BAC	6 months	10.19 (SD 8.71) vs. 12.92 (SD 14.16) vs. 12.07 (SD 12.31) 0.11 (SD 0.08) vs. 0.13 (SD 0.1) vs. 0.11 (SD 0.09) 11.59 (SD 9.55) vs. 12.92 (SD 14.16) vs. 12.07 (SD 12.31) 0.14 (SD 0.11) vs. 0.13 (SD 0.1) vs. 0.11 (SD 0.09)
Long‐term follow‐up
Bernstein 2009	Abstinence marijuana Days per month marijuana	12 months	OR 2.89 (95% CI 1.22 to 6.84) 11 (SDD 10.7) vs. 13.2 (SD 11.7)
Stephens 2007	Days of marijuana use per week Dependence symptoms Number of problems Periods smoked per day	12 months	4.65 (SD 2.2) vs. 5.58 (SD 2.2) 2.43 (SD 1.42) vs. 2.88 (SD 1.42) 3.95 (SD 3.15) vs. 5.21 (SD 3.15) 1.79 (SD 0.94) vs. 1.97 (SD 0.94)
White 2006	Freq alcohol use past month Freq marijuana past month Heavy drinking Drinks in typical week Peak BAC	15 months	1.87 (SD 1.15) vs. 2.11 (SD 1.24) 1.15 (SD 1.5) vs. 1.39 (SD 2.31) 1.75 (SD 2.39) vs. 2.13 (SD 3.33) 6.84 (SD 7.77) vs. 8.29 (SD 11.45) 0.05 (SD 0.05) vs. 0.06 (SD 0.06)
BAC: blood alcohol concentration; CI: confidence interval; Freq: frequency; GAS: Global assessment scale; OR: odds ratio; SEC: standard ethanol content; SD: standard deviation; vs: versus

Table 7. Motivational interviewing versus assessment and feedback: extent of substance use as reported

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Table 8. Motivational interviewing versus other active intervention: extent of substance use as reported

Study	Outcome as reported in the study	Follow‐up as reported in the study	Results (MI vs. other active intervention)
Post‐intervention
Aharonovich 2017	Number of days with primary drug use (prior 30 days) Reduction in drug use	2 months	3.61 (SD 5.79) vs. 5.07 (SD 6.70) RR 0.68 (95% CI 0.43 to 1.080)
Anton 2005	Drinks per drinking day Percent days abstinent	Post	4.4 (SD 4.5) vs. 4 (SD 4.7) 75 (SD 32) vs. 79 (SD 26)
Kadden 2007	MET+CBT+ContM vs. MET+CBT vs. ContM vs. CaseM: ASI alcohol ASI drug Joints/ day PDA	Post	0.1 (SD 0.1) vs. 0.09 (SD 0.11) vs. 0.12 (SD 0.15) vs. 0.09 (SD 0.12) 0.12 (SD 0.09) vs. 0.15 (SD 0.12) vs. 0.1 (SD 0.09) vs. 0.14 (SD 0.1) 2.32 (SD 2.98) vs. 2.45 (SD 3.08) vs. 1.63 (SD 2.32) vs. 2.63 (SD 2.81) 0.55 (SD 0.43) vs. 0.48 (SD 0.41) vs. 0.68 (SD 0.35) vs. 0.45 (SD 0.38)
Short‐term follow‐up
Barnett 2007	Alcohol problems Drinks per drinking day Estimated BAC Drinking days Heavy drinking days	3 months	3.42 (SD 3.03) vs. 3.03 (SD 2.58) 4.77 (SD 2.89) vs. 4.49 (SD 2.41) 0.08 (SD 0.06) vs. 0.09 (SD 0.06) 4.74 (SD 3.83) vs. 4.75 (SD 4.37) 2.41 (SD 2.84) vs. 2.08 (SD 2.61)
Borsari 2005	Binge episodes Drinks per week Peak BAC RAPI Typical BAC	3 months	6.83 (SD 4.11) vs. 7.13 (SD 4.81) 18.1 (SD 11.96) vs. 17.72 (SD 10.49) 0.17 (SD 0.08) vs. 0.15 (SD 0.11) 5.9 (SD 5.56) vs. 5.73 (SD 4.84) 0.08 (SD 0.05) vs. 0.07 (SD 0.06)
Carroll 2006b	Longest duration of continuous abstinence (days) Marijuana negative urine specimens	2 months	21.5 (SD 20.2) vs. 17.3 (SD 27.3) 1.3 (SD 2.13) vs. 0.9 (SD 2.12)
Chanut 2007	AUDIT score Percent high‐risk drinking days	3 months	11.42 (SD 6.44) vs. 13.9 (SD 6.84) 71 (SD 32.35) vs. 67.8 (SD 31.73)
Colby 2018	Percent drinking days Percent heavy drinking days Standard drinks per week Percent drinking days Standard drinks per week Percent heavy drinking days	6 weeks 3 months	19.17 (SD 16.33) vs. 23.63 (SD 18.66) 10.03 (SD 13.3) vs. 16.09 (SD 15.8) 7.06 (SD 8.04) vs. 11.0 (SD 10.69) 14.32 (SD 12.23) vs. 19.52 (SD 17.92) 5.56 (SD 5.91) vs. 8.93 (SD 10.0) 8.04 (SD 9.98) vs. 13.11 (SD 13.94)
De Gee 2014	Cannabis: cannabis days/week Cannabis: number of joints/week	3 months	MD ‐0.010 (95% ‐0.62 to 0.61) MD 0.05 (95%CI ‐2.04 to 2.14)
Dieperink 2014	% days abstinent Drinks/week Heavy drinking days 30‐day abstinence	3 months	69.91 (SD 31.99) vs. 58.23 (SD 34.05) 13.35 (SD 18.86) vs. 19.94 (SD 25.50) 6.24 (SD 9.31) vs. 8.27 (SD 8.98) 24.1 vs. 13.3%
Kadden 2007	MET+CBT+ContM vs. MET+CBT vs. ContM vs. CaseM: Joints/ day PDA	5 months	2.49 (SD 3.21) vs. 1.77 (SD 2.14) vs. 1.69 (SD 2.28) vs. 2.07 (SD 2.15) 0.55 (SD 0.4) vs. 0.5 (SD 0.42) vs. 0.6 (SD 0.37)vs. 0.46 (SD 0.4)
Kahler 2004	Drinks per drinking day Drinks per drinking day	1 month 3 months	6.58 (SD 10.49) vs. 7.76 (SD 16.99) 6.29 (SD 12.67) vs. 6.04 (SD 12.9)
Mackiewicz Seghete 2022	Problem drinking (Rutgers Alcohol Problems Index)	3 months	4.25 (n=81) vs. 3.6 (n=87), t=0.82, p=0.413
Martino 2006	Alcohol Alcohol Alcohol Primary drug use Primary drug use Primary drug use Secondary drug use Secondary drug use Secondary drug use	1 month 2 months 3 months 1 month 2 months 3 months 1 month 2 months 3 months	0.33 (SD 0.91) vs. 3.27 (SD 7.21) 0.5 (SD 1.37) vs. 5.13 (SD 9.68) 0.77 (SD 1.6) vs. 5.36 (SD 9.65) 4 (SD 7.48) vs. 3.13 (SD 4.45) 3.45 (SD 6.84) vs. 5.4 (SD 9.77) 4 (SD 6.13) vs. 4.17 (SD 8.6) 0.64 (SD 1.99) vs. 0.07 (SD 0.26) 0.77 (SD 1.41) vs. 1.2 (SD 2.6) 1.91 (SD 4.45) vs. 0.47 (SD 1.25)
McCambridge 2008	30 day frequency alcohol 30 day frequency cannabis AUDIT Joints per week Units per week	3 months	4 (SD 5.5) vs. 3.7 (SD 5.7) 14.6 (SD 11.7) vs. 15.9 (SD 11.6) 4.6 (SD 5.6) vs. 4.9 (SD 5.8) 10.1 (SD 12.4) vs. 10.1 (SD 12.8) 5.9 (SD 12.1) vs. 5.7 (SD 11.2)
Parsons 2014	Any drug use	3 months	41/ 61 (67.2 %) vs. 44/62 (%)
Slesnick 2013	Percent days of drug and alcohol use (except tobacco) (last 90 days)	3 months	21.76 (SD 28.23) vs. 20.71 (SD 28.45)
Slesnick 2015	Percent days of any drug use except tobacco and alcohol Percent days of alcohol use (last 90 days) Average standard ethanol content (SECs)	3 months	45.7 (SD 43.2) vs. 53.6 (SD 49.8) 8.5 (SD 14.07) vs. 10.36 (SD 15.65) 2.76 (SD 5.26) vs. 2.7 (SD 5.4)
Stein 2017	Binge‐drinking Dual substance use Binge‐drinking Dual substance use	1 month 1 month 3 months 3 months	RR 1.17 (95%CI 0.897 to 1.52) RR 1.01 (95%CI 0.74 to 1.39) RR 1.09 (95% CI 0.83 to 1.43) RR 1.16 (95% CI 0.84 to 1.61) (not included in meta‐analysis)
UKATT 2005	Days abstinent Drinks per drinking day Log gamma‐glutamyl transferase	3 months	42.3 (SD 50.75) vs 43.2 (SD 45.02) 17.6 (SD 16.91) vs. 18.2 (SD 14.92) 3.87 (SD 1.27) vs. 3.9 (SD 1.13)
Walitzer 2009	Percent days abstinent Percent days heavy drinking	3 months	69.6 (SD 31.7) vs. 80.6 (SD 22.6) 9.4 (SD 18.6) vs. 6.1 (SD 14.1)
Wood 2007	Alcohol consumption past 30 days Alcohol consumption past 30 days	1 month 3 months	73.46 (SD 41.33) vs. 77.24 (SD 46.64) 75.86 (SD 47.06) vs. 80.09 (SD 46.74)
Medium‐term follow‐up
Aharonovich 2017	Reduction in drug use	6 months	RR 0.49 (95%CI 0.29 to 0.85) (not included in meta‐analysis)
Borsari 2005	Binge episodes Drinks per week Peak BAC RAPI Typical BAC	6 months	6.1 (SD 4.07) vs. 6.07 (SD 4.71) 18.69 (SD 9.75) vs. 21.04 (SD 14.22) 0.16 (SD 0.12) vs. 0.16 (SD 0.14) 5 (SD 5.09) vs. 6.71 (SD 5.21) 0.07 (SD 0.06) vs. 0.07 (SD 0.05)
Chanut 2007	AUDIT score Percent high‐risk drinking days	6 months	10.72 (SD 6.45) vs. 13.07 (SD 5.34) 55 (SD 37.42) vs. 69.33 (SD 30.74)
De Wildt 2002	Number of abstinent days Time to first relapse	6 months	119.1 (SD 135.5) vs. 108.5 (SD 71.2) 65.5 (SD 7) vs. 53.4 (SD 65)
Dieperink 2014	% days abstinent Drinks/week Heavy drinking days 30‐day abstinence	6 months	73.15 (SD 32.18) vs. 59.49 (SD 35.30) 14.88 (SD 27.94) vs. 21.41 (SD 29.39) 5.10 (SD 8.10) vs. 7.38 (SD 9.53) 25.4 vs. 19.7%
Feldstein Ewing 2021	Alcohol dependence (AUDIT) Alcohol use (quantity and frequency) Cannabis use (quantity and frequency)	6 months	5.75 (SD 10.19) vs. 6.78 (SD9.44) ‐0.04 (SD 0.86) vs. 0.1 (SD 0.89) 0.37 (SD 0.41) vs. 0.36 (SD 0.4)
Kadden 2007	MET+CBT+ContM vs. MET+CBT vs. ContM vs. CaseM: ASI alcohol ASI drug Joints/ day PDA Joints/ day PDA	8 months 11 months	0.11 (SD 0.13) vs. 0.09 (SD 0.11) vs. 0.13 (SD 0.13)vs. 0.1 (SD 0.1) 0.12 (SD 0.11) vs.0.15 (SD 0.11) vs. 0.12 (SD 0.09) vs. 0.14 (SD 0.1) 2.27 (SD 3.32) vs. 1.73 (SD 1.79) vs. 2.06 (SD 2.27) 0.49 (SD 0.41) vs. 0.42 (SD 0.42) vs. 4.12 (SD 17.11) vs. 0.68 (SD 0.35) vs. 0.41 (SD 0.4) 1.75 (SD 2.34) vs.1.86 (SD 2.32) vs. 1.63 (SD 2.04) vs. 2.1 (SD 3.15) 0.52 (SD 0.44) vs. 0.45 (SD 0.43) vs. 0.48 (SD 0.41) vs. 0.48 (SD 0.42)
Kahler 2004	Drinks per drinking day	6 months	2.57 (SD 5.92) vs. 6.71 (SD 13.64)
Logan 2015	Drinks per week eBAC	6 months	RD ‐0.90 (SD 0.58) RD ‐0.013 (SD 0.005) (not included in meta‐analysis)
Mackiewicz Seghete 2022	Problem drinking (Rutgers Alcohol Problems Index)	6 months	4.03 (n=72) vs. 4.27 (n=81), t=‐0.26, p=0.793
Match 1993	Drinking consequences GGT Drinking consequences GGT Drinking consequences GGT Drinking consequences GGT	9 months	20 (SD 26.8) vs. 19.6 (SD 27.9) 70 (SD 100.5) vs. 77.7 (SD 106.1) 20 (SD 26.8) vs. 19.4 (SD 28.3) 70 (SD 100.5) vs. 74.2 (SD 96.8) 23.5 (SD 23.2) vs. 21.4 (SD 24.3) 66.3 (SD 81.6) vs. 65.8 (SD 74.8) 23.5 (SD 23.2) vs. 16.7 (SD 21.8) 66.3 (SD 81.6) vs. 61.1 (SD 76.2)
McCambrigde 2008	30 day frequency alcohol 30 day frequency cannabis AUDIT Joints per week Units per week	6 months	4 (SD 5.6) vs. 4.2 (SD 6.3) 13.8 (SD 11.9) vs. 14.5 (SD 11.8) 4.6 (SD 5.2) vs. 4.9 (SD 5.5) 8.5 (SD 11.1) vs. 10.5 (SD 14.7) 4.7 (SD 9.9) vs. 8.3 (SD 22.8)
Parsons 2014	Any drug use	6 months	34/54 (62.96 %) vs. 41/55 (74.5%)
Slesnick 2013	Drug and alcohol use (except tobacco) Drug and alcohol use (except tobacco)	6 months 9 months	17.633 (SD 28.13) vs. 21.45 (SD 23.88) 14.69 (SD 14.12) vs. 29.34 (SD 17.19)
Slesnick 2015	Percent days of any drug use except tobacco and alcohol Percent days of alcohol use (last 90 days) Average standard ethanol content (SECs)	6 months	48.36 (SD 40.85) vs. 41.2 (SD 39.1) 6.23 (SD 14.93) vs. 8.8 (SD 18.27) 1.61 (SD 2.32) vs. 1.69 (SD 2.31)
Stein 2017	Binge‐drinking Dual substance use Binge‐drinking Dual substance use	6 months 6 months 9 months 9 months	RR 1.04 (95% CI 0.78 to 1.39) RR 0.97 (95% CI 0.69 to 1.38) RR 0.82 (95%CI 0.6 to 1.1) RR 0.8 (95% CI 0.56 to 1.14) (not included in meta‐analysis)
Walitzer 2009	Percent days abstinent Percent days abstinent Percent days heavy drinking Percent days heavy drinking	6 months 9 months 6 months 9 months	66.1 (SD 36.6) vs. 79.1 (SD 25.3) 63.6 (SD 35.1) vs. 80.5 (SD 21.8) 9.6 (SD 21.1) vs. 8.1 (SD 20.4) 11.7 (SD 22.9) vs. 7.5 (SD 18.6)
Wood 2007	Alcohol consumption past 30 days	6 months	72.99 (SD 53.36) vs. 84 (SD 55.41)
Long‐term follow‐up
Alderson 2020	Reduction in drug use AUDIT (hazardous alcohol) ASSIST‐Y (drug use): cannabis: ASSIST‐Y (drug use): cocaine ASSIST‐Y (drug use): amphetamine ASSIST‐Y (drug use): sedative ASSIST‐Y (drug use): hallucinogens ASSIST‐Y (drug use): novel psychoactive substance ASSIST‐Y (drug use): opioids ASSIST‐Y (drug use): inhalants ASSIST‐Y (drug use): other ASSIST‐Y (drug use): episodes of heavy drinking: median 1 (IQR 0‐4), range: 0‐10 (n=17)	12 months	RR 0.54 (95% CI 0.31 to 0.94) 12/17 (71%) vs. 7/23 (30%) 12/17 (70.5%) vs. 14/23 (61%) 8/17 (47%) vs. 5/23 (22%) 7/17 (41%) vs. 7/23 (30%) 6/17 (35%) vs. 4/23 (17%) 4/17 (23.5%) vs. 3/23 (13%) 3/17 (18%) vs. 3/23 (13%) 2/17 (12%) vs. 1/23 (4%) 2/17 (12%) vs. 1/23 (4%) 0 vs. 0/23 (0%) Median 1 (IQR 0‐4), range: 0‐10 vs.median 0 (IQR 0‐2), range: 0‐7
Barnett 2007	Alcohol problems Drinks per drinking day Estimated BAC Drinking days Heavy drinking days	12 months	2.98 (SD 2.59) vs. 3.17 (SD 3.05) 4.64 (SD 2.78) vs. 4.87 (SD 2.86) 0.08 (SD 0.05) vs. 0.09 (SD 0.06) 6.37 (SD 4.67) vs. 5.89 (SD 4.01) 3.21 (SD 3.91) vs. 2.95 (SD 3.56)
Kadden 2007	MET+CBT+ContM vs. MET+CBT vs. ContM vs. CaseM: ASI alcohol ASI drug Days of continuous abstinence Joints /day PDA	14 months	0.09 (SD 0.14) vs.0.07 (SD 0.08) vs. 0.12 (SD 0.16) vs. 0.09 (SD 0.12) 0.13 (SD 0.1) vs. 0.12 (SD 0.12) vs. 0.12 (SD 0.09) vs. 0.11 (SD 0.09) 114.57 (SD 134.34) vs. 98.71 (SD 122.82) vs. 108.88 (SD 116.09) vs. 84.14 (SD 99.07) 0.63 (SD 0.75) vs. 0.55 (SD 0.77) vs. 0.57 (SD 0.74) vs. 0.58 (SD 0.65) 0.51 (SD 0.41) vs. 0.48 (SD 0.42) vs. 0.38 (SD 0.42) vs. 0.53 (SD 0.42)
Mackiewicz Seghete 2022	Problem drinking (Rutgers Alcohol Problems Index)	12 months	2.75 (n=75) vs. 4.88 (n=81), t=‐2.42, p=0.0173
Match 1993	Drinking consequences GGT Drinking consequences GGT Drinking consequences GGT Drinking consequences GGT	15 months	16.9 (SD 23.1) vs. 19.3 (SD 29.3) 58 (SD 80.6) vs. 81 (SD 109.2) 16.9 (SD 23.1) vs. 21.2 (SD 29) 58 (SD 80.6) vs. 77.2 (SD 101.4) 19.9 (SD 23.4) vs. 19.7 (SD 21.1) 67.8 (SD 82.8) vs. 71.8 (SD 87.3) 19.9 (SD 23.4) vs. 15.9 (SD 20.7) 67.8 (SD 82.8) vs. 61.7 (SD 75.3)
Parsons 2014	Any drug use	12 months	33/59 (55.9%) vs. 33/54 (61.1 %)
Slesnick 2013	Drug and alcohol use (except tobacco) Drug and alcohol use (except tobacco) Drug and alcohol use (except tobacco)	12 months 18 months 24 months	15.89 (SD 10.18) vs. 24.63 (SD 17.89) 21.66 (SD 21.54) vs. 26.83 (SD 20.86) 26.34 (SD 19.19) vs. 33.63 (SD 23.14)
Slesnick 2015	Percent days of any drug use except tobacco and alcohol Percent days of alcohol use (last 90 days) Average standard ethanol content (SECs)	12 months	49.21 (SD 40.97) vs. 40.17 (SD 39.87) 8.94 (SD 18.41) vs. 6.66 (SD 11.82) 1.65 (SD 3.24) vs. 1.89 (SD 3.91)
Stein 2017	Binge‐drinking Dual substance use Binge‐drinking Dual substance use	12 months 12 months 15 months 15 months	RR 0.88 (95% CI 0.65 to 1.2) RR 0.89 (95% CI 0.61 to 1.3) RR 0.86 (95% CI 0.63 to 1.17) RR 0.81 (95% CI 0.56 to 1.17) (not included in meta‐analysis)
UKATT 2005	Days abstinent Drinks per drinking day Log gamma‐glutamyl transferase	12 months	45.4 (SD 55.83) vs. 46.6 (SD 49.44) 18.7 (SD 19.32) vs. 19.8 (SD 16.94) 4.01 (SD 1.61) vs. 4 (SD 1.45)
Walitzer 2009	Percent days abstinent Percent days heavy drinking	12 months	67.4 (SD 33.8) vs. 83.8 (SD 20.9) 9.9 (SD 23.5) vs.7.9 (SD 18.8)
ASI: Addiction severity index; ASSIST‐Y: Alcohol, Smoking and Substance Involvement Screening Test‐Youth; AUDIT: Alcohol Use Disorders Identification Test; BAC: blood alcohol concentration; CBT: cognitive behavioral therapy; CDC: Centers for Disease Control and Prevention; CI: confidence interval; GGT: gammaglutamyl transferase; ContM: contingency management; IQR: interquartile range; FDA: Food and Drug Administration; MET: motivational enhancement therapy; MD: mean difference; n: number of participants; PDA: proportion of days abstinent; RAPI: Rutgers Alcohol Problems Index; RR: relative risk; SD: standard deviation

Table 8. Motivational interviewing versus other active intervention: extent of substance use as reported

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Comparison 1. Motivational interviewing versus no intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Extent of substance use Show forest plot	33		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1.1 Post‐intervention	6	471	Std. Mean Difference (IV, Random, 95% CI)	0.48 [0.07, 0.89]
1.1.2 Short‐term follow‐up	19	3351	Std. Mean Difference (IV, Random, 95% CI)	0.20 [0.12, 0.28]
1.1.3 Medium‐term follow‐up	16	3137	Std. Mean Difference (IV, Random, 95% CI)	0.12 [0.05, 0.20]
1.1.4 Long‐term follow‐up	9	1525	Std. Mean Difference (IV, Random, 95% CI)	0.12 [‐0.00, 0.25]
1.2 Readiness to change Show forest plot	5	1495	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.11, 0.22]

1.3 Retention in treatment Show forest plot	2	427	Std. Mean Difference (IV, Random, 95% CI)	0.26 [‐0.00, 0.52]

Comparison 1. Motivational interviewing versus no intervention

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Comparison 2. Motivational interviewing versus treatment as usual

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Extent of substance use Show forest plot	20		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1.1 Post‐intervention	5	976	Std. Mean Difference (IV, Random, 95% CI)	‐0.14 [‐0.27, ‐0.02]
2.1.2 Short‐term follow‐up	14	3066	Std. Mean Difference (IV, Random, 95% CI)	0.07 [‐0.03, 0.17]
2.1.3 Medium‐term follow‐up	9	1624	Std. Mean Difference (IV, Random, 95% CI)	0.12 [0.02, 0.22]
2.1.4 Long‐term follow‐up	8	1449	Std. Mean Difference (IV, Random, 95% CI)	0.06 [‐0.05, 0.17]
2.2 Readiness to change Show forest plot	2	150	Std. Mean Difference (IV, Random, 95% CI)	0.06 [‐0.27, 0.39]

2.3 Retention in treatment Show forest plot	5	1295	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.34, 0.16]

Comparison 2. Motivational interviewing versus treatment as usual

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Comparison 3. Motivational interviewing versus assessment and feedback

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Extent of substance use Show forest plot	9		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1.1 Short‐term follow‐up	7	854	Std. Mean Difference (IV, Random, 95% CI)	0.09 [‐0.05, 0.23]
3.1.2 Medium‐term follow‐up	6	688	Std. Mean Difference (IV, Random, 95% CI)	0.24 [0.08, 0.40]
3.1.3 Long‐term follow‐up	3	448	Std. Mean Difference (IV, Random, 95% CI)	0.24 [0.07, 0.41]

Comparison 3. Motivational interviewing versus assessment and feedback

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Comparison 4. Motivational interviewing versus other active intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Extent of substance use Show forest plot	24		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1.1 Post‐intervention	3	338	Std. Mean Difference (IV, Random, 95% CI)	0.07 [‐0.15, 0.29]
4.1.2 Short‐term follow‐up	18	2795	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.03, 0.13]
4.1.3 Medium‐term follow‐up	15	2352	Std. Mean Difference (IV, Random, 95% CI)	0.08 [‐0.01, 0.17]
4.1.4 Long‐term follow‐up	10	1908	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.07, 0.13]
4.2 Readiness to change Show forest plot	5	988	Std. Mean Difference (IV, Random, 95% CI)	0.15 [‐0.00, 0.30]

4.3 Retention in treatment Show forest plot	12	1945	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.23, 0.14]

Comparison 4. Motivational interviewing versus other active intervention

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