Motivational Interviewing Interventions for Harmful Substance Use Amongst Adults in Low- and Middle-Income Countries (LMICs): A Systematic Review

Background Harmful substance use is a major challenge globally with far reaching detrimental effects on social, economic and health systems. This burden weighs more heavily on underdeveloped countries as they do not have the infrastructure needed to manage the consequences of substance use. In high-income countries, several evidence-based brief intervention models are used for HSU including Motivational Interviewing (MI). However, fewer studies have been conducted in low-resource settings. Aim In this review, we systematically reviewed studies utilising motivational interviewing as a component of interventions with adults presenting with harmful substance use in LMICs. Methods Adhering to Cochrane and PRISMA guidelines, we systematically searched for studies published between 2010 and 2022. The search was conducted in PubMed, EBSCOhost, Web of Science, the Cochrane Library, [clinicaltrials.gov][1] and the GSK Clinical Study Register. A narrative analysis was done, and The Joanna Briggs Institute (JBI) Critical Appraisal Tools were used to assess the quality of the studies included. Results The search yielded 518 publications. Eleven studies from five different countries met inclusion criteria. These consisted mainly of RCTs with some employing qualitative or mixed methods approaches. The focus of the interventions varied, with most targeting alcohol use, while a few addressed opioids, and other drugs. The interventions used different strategies, including MI blended with other interventions (such as CBT, BA, and imaginal desensitization) or using MI-informed approaches. Overall, MI was shown to improve substance use outcomes in seven of the 11 studies with significant reduction in substance use based on outcomes measured. Conclusions This review highlights that, interventions incorporating MI demonstrated positive effects in improving substance use outcomes in the majority of the studies reviewed. Further research with larger sample sizes and more rigorous study designs is necessary to strengthen the evidence base and address potential sources of bias. ### Competing Interest Statement Authors have completed the ICMJE uniform disclosure form at [www.icmje.org/coi_disclosure.pdf][2] and declare: no support from any organization for the submitted work; DJS has received research grants and honorariums from Discovery Vitality, Johnson & Johnson, Kanna, L Oreal, Lundbeck, Orion, Sanofi, Servier, Takeda, and Vistagen., SS has received clinical supplies from Gilead Sciences, Inc., Indivior, Inc., and Alkermes, Inc., no author has been paid for developing and delivering educational presentations, no author does consultancy for companies; no other relationships or activities that could appear to have influenced the submitted work. ### Clinical Protocols ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [clinicaltrials.gov][1]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the corresponding author. [1]: https://clinicaltrials.gov [2]: https://www.icmje.org/coi_disclosure.pdf