REDUCING POLYDRUG USE AMONG METHADONE ASSISTED THERAPY PATIENTS: AN EXAMINATION OF THE MOTIVATIONAL INTERVIEWING STRATEGY

Polydrug use continues to rise across the world with more victims suffering from substance use disorders (SUD). Methadone Assisted Therapy (MAT) has shown significant results in reducing morbidity, increased treatment retention and reduced use of illicit psychoactive substances. This study founded on the self-determination theory, sought to find out the effectiveness of Motivational Interviewing (MI) on Polydrug Use (PDU) reduction among Methadone Assisted Therapy (MAT) patients. Using a mixed methods approach with a quasi-experimental research design, with pre and post strategy in experimental group site A and control group site B, both treatment and control group received baseline and endline assessment, as well as MAT treatment. The experimental group received MI with instant assessment and feedback to reduce polydrug use through self-rating readiness ruler, while the control group received Zero MI treatment. The population of the study comprised 2121 patients from which, a sample of 120 respondents was obtained through random sampling technique where 60 respondents were assigned to the treatment group and the other 60 to the control group. Base line assessment was done for 5 to 10 minutes using: TimeLine Fallback for polydrug use, WHO (Five) well-Being for MAT patient’s wellbeing, self-rating readiness ruler for readiness to reduced polydrug use. Motivation Interviewing took 15 to 25 minutes, 10 participants per group in the treatments group of 6 sessions for one and half months. Data analysis was done both descriptively and with inferential inform of regression and correlations analysis. At three months follow up, effectiveness of MI in the treatment group is evidenced by MAT patients’ significant reduction in polydrug use, improved wellbeing, increased adherence, reduced MAT dosage, increased MAT patients on cessation of MAT dosage, as well as reduced patient dropping out MA. Reduction of polydrug use by MAT patients require case management approach, methadone assisted therapy cannot reduce polydrug use, however, MAT clinicians need to combine motivation interview together with Methadone assisted therapy to reduce polydrug.


I. INTRODUCTION
Polydrug use is the concurrent use of more than one psychoactive substance for a non-medical purpose (United Nations Office on Drugs and Crime [UNODC], (2018b).Despite the strong evidence in application of MAT for reducing opioids use, polydrug use exists among MAT patients and interferes with MAT treatment outcome (Wagner et al., 2018).Methadone assisted Therapy (MAT) is a

A. Self-Determination theory (SDT)
The Self-Determination theory (SDT) by Ryan and Deci (1985) informed this study's psychological and cognitive experiences of polydrug use in MAT patients, the MI process among the MAT patients and what informs their decision to reduce polydrug use.The study, through MI, emphasized on psychological and cognitive factors that foster or undermine the MAT patient's competency, relatedness and autonomy, leading to polydrug use or non-use (Ackerman, 2021).The major proponents of SDT theory are to optimize intrinsic motivation development for self-regulation.The SDT is rooted in the humanistic psychology approach by Rogers (1959) and posits that MAT polydrug users are trustworthy, understand themselves and are capable of resolving their problems.Intrinsic motivation is the inherent human tendency to seek out novelty and challenges, active personal commitment leading to change from precontemplation, contemplation, preparation, action and maintenance (Prochaska, 2008).

B. Effectiveness of Motivational Interviewing on Polydrug Use Reduction
Methadone Assisted therapy for opioid use disorder is evidence-based and is a life-saving intervention.
However, studies show that 66% of MAT patients continue to use illicit opioids despite being in the MAT treatment program (Shams et al., 2019).It has widely been reported that MAT patients show differences www.kabarak.ac.keLink: http://ojs.kabarak.ac.ke/index.php/kjri/article/view/567 Vol 12 | Issue 1 | July 2022 60 in treatment outcomes for mode of intake for opioids' users such as those who inject drugs and those who smoke (Morgan et al., 2019;Massah & Moradi, 2018).
Motivational interviewing is one of the most effective techniques for addiction recovery (SAMHSA, 2020b).It is a technique that is used to help MAT patients change their destructive behavior of polydrug use (Levounis et al., 2017).It requires the commitment to reduce polydrug use through engaging, focusing, evoking and planning (SAMHSA, 2020).It calls for the patients past successful strategies and their history of recovery (SAMHSA, 2020a).According to the treatment protocol by (SAMHSA, 2020a) and (NIDA, 2020b) the length of methadone treatment should be a minimum of 12 months, though, it may take 24-36 months, or many years.To evaluate the effectiveness of MI on reducing cannabis polydrug use, Papinczak et al. (2020) conducted a study on addictive effectiveness and feasibility of the theory driven instant assessment and feedback system in brief cannabis intervention in Australia.Results indicated that those assigned to MI increased motivation to change cannabis polydrug use than those in treatment, as usual from pre-and post-results.Motivational interviewing is effective in reducing unhealthy alcohol use among primary health care workers with HIV (Satre et al., 2019;D'Amico et al., 2018) and reduction in craving and dependency (Mojahed & Navidian, 2018).The MI therapist engages polydrug users in the MAT care plan to talk about their polydrug use, concerns, hopes and establishing trusting relations (Levounis et al., 2017).
Recently, Murphy et al. (2019) conducted a study to evaluate the effectiveness of brief alcohol intervention supplemented with substance free activity sessions or relaxation training.Results from generalized linear mix model, indicated reduction in polydrug use of alcohol and polydrug problems where MI was used in a group (Murphy et al., 2019).The study by Clair-Michaud et al. (2016) found MI effective in reducing polydrug use.Motivation Interviewing with standardized simulation has a promising effect on patients' knowledge and confidence in MI techniques to manage OUD among older adults (Chang et al., 2019).Motivational Interviewing decreases the desire to use, and probability of use among female drug users (Oveisi et al., 2020).Mojahed and Navidian (2018) found MI to be effective in reducing polydrug use, craving and dependency on hookah for pregnant women in Iran.A study by Mitcheson et al. (2006) found it feasible to include adjunctive MI to reduce crack cocaine use in patients undergoing MAT in UK.The results showed that those in MI had a large and statistically significant reduction in heroin use after a single session of MI (Mitcheson et al., 2006).During MI intervention, patients struggle with lack of motivation (Levounis et al., 2017 impact on reducing polydrug use (Witbrodt et al., 2019).Motivational Interviewing and Cognitive behavior treatment (CBT) yields reduction in polydrug use (Chermack et al., 2019).
In Kenya, a study on a randomized clinical trial on intervention for alcohol use problems, found mobilebased MI intervention effective in reducing alcohol use problems among adults visiting primary care (Harder et al., 2020).Results show no difference between MI in person and mobile MI after 1 month follow up, signaling a mind shift on MI in person as a superior strategy compared to mobile based technology.

III. METHODOLOGY
The study adopted a quasi-experimental research design in a control group and experimental group.The study also made use of a mixed methods approach which entailed collection of both quantitative and qualitative data (Nardi, 2018).While quantitative data addressed the adoption of MI in reducing polydrug use among MAT patients through an instant MI assessment, MI self-rating readiness ruler and feedback, and self-report, the qualitative data presented data from the interviews addressing the views of MAT patients on their thoughts about cutting down on polydrug use, with the help of MI.

IV. RESULTS
The WHO (Five) well-being index is used to assess the current well-being of the patients in MAT during    95% Cl (27.37,32.25).This shows that the score was <50 (less than 50).The results are shown in Figure 4 (Source: Researcher, 2021         Comparing the findings on whether the MAT patients had ever dropped out of MAT, there was a significant decrease in MAT patients from the treatment group that dropped out of MAT, that decreased by 49.97% after being administered with MI (35 vs. 5) and also a decrease in the number of MAT patients from the control group that dropped out of MAT by 18% (11 vs. 5).While 5 of the study participants dropped out of MAT, 1 of the respondents was re-inducted after defaulting from the MAT program.The study further investigated on the prognosis of MAT patients being in the MAT treatment during the study period, at least four months based on their history in the MAT clinical records.The results analysis showed that the majority of the respondents, 80%, showed good prognosis during the period of the study, while 15% showed bad prognosis during the period of the study.The result analysis is shown in Figure 9.

Evoking MI Stage
Findings from the MI assessment and feedback revealed that 100% (n = 60) admitted to being ready for the new chapter of poly drug use reduction.The respondents were also given the self-rating readiness ruler to indicate how important and confident they were about reducing poly drug use.The results revealed that 83.33% (n = 49) were very important (8-10) on making the change while 16.67% (n = 10) indicated that they are somewhat important (4-7).The results are shown in Figure 10.

Confidence About Reducing Polydrug Use
Findings on confidence on reducing polydrug use revealed that 66.67% (n = 39) of the respondents were very confident on making the change while 33.33% (n = 18) indicated they were somewhat confident in making the change.The results are shown in Figure 11.A Pearson correlation test was done to investigate if there is a significant relationship between self-rating readiness ruler and polydrug use reduction.The results presented in Table 3 show that there is no significant relationship between self-rating readiness ruler and polydrug use reduction.The 7 MAT patients from the treatment group who were found to be on cessation of MAT during endline assessment had all indicated on the self-rating readiness ruler they were between 6 and 10. 5 of them indicated they were very important in making the change (10) only one indicated they were somewhat important in making the change (7).On how confident the MAT patients were on making the change, 2 indicated 6 and 2 indicated 7 showing they were somewhat confident in making the change.Only 2 indicated 10 on the self-rating readiness ruler revealing they were very confident in making the change.
This reveals that they were all either somewhat confident/important, or very important/confident about polydrug use reduction.

MAT Dosage
During Baseline assessment, the treatment group reported 41.7% (n = 25) MAT patients whose MAT dosage was below 60mg compared to 53.3% (n = 32) MAT patients from the control Group whose MAT dosage was above 60mg.The results findings are shown in Figure 12.MAT clinical records revealed the duration in MAT of the study participants as shown in Figure 14.
Majority of the respondents 23.33% (n = 28) duration in MAT was between 6 to 7 years, 20.83% (n = 25) between 3 to 4 years, 16.67% (n = 20) between 2 to 3 years, 14.17% (n = 17) between 1 to 2 years, 12.5% (n = 15) between 0 to 1 years, 5.833% (n = 7) between 7 to 8 years, 5% (n = 6) between 4 to 5 years and 1.667% (n = 2) between 5 to 6 years.The duration of MAT patients in MAT clinic was distributed over a period of 10 years, with the mean duration being 3.7 years (SD= 2.239 years).At three months, majority of the respondents (93.6%) from the treatment group reported to be on the action stage, as far as polydrug use reduction is concerned using the stages of change as depicted in Figure 15.

V. DISCUSSION
At three months follow up, the results from baseline and endline assessment showed that after Motivation Interviewing, there was a reduction in polydrug use, improved wellbeing, adherence to MAT dosage, reduction in quantity of the MAT dosage, reduction in number of MAT patients missing their MAT dosage, addition of MAT patients on cessation and reduction of MAT patients dropping out of MAT.

A. Polydrug Use Reduction
Reduction in polydrug use is attributed to MAT.Past studies support the 7.18% reduction in polydrug use in the treatment group such as Singh et al. (2019) (Miller & Rollnick, 2013) and is found to be effective in polydrug use reduction.Motivational interviewing is one of the most effective techniques for addiction recovery (SAMHSA, 2020b).The control group on polydrug use reduction supports that MAT is considered to have largely contributed to polydrug use reduction (Carlsen et al., 2020).Therefore, the current finding reveals that combining MAT and MI results in a positive treatment outcome than MAT alone.During MI evoking phase, the MAT patients were asked how important and confident it was for them to reduce polydrug use.Through MI self-rating ruler, they indicated very important, the study findings are echoed by SAMHSA, ( 2020) that MI works well with MAT patients who are in the contemplation phase of change; patients become curious about their experience and possible solutions.

B. Well-Being of the MAT Patients
There was improvement in the well-being of the MAT patients in the treatment group in comparison to those in the control group.Both treatment and control groups received WHO (Five) well-being bassline and endline assessment, in addition, the treatment group received MI and MAT treatment dosage as usual.
At three months, the treatment group increased wellbeing from 25.52 to 41.85, increase of 16.33 and control from 25.07 to 29.81 increase of 4.74, a difference of 11.59.Current study outcomes on improved wellbeing contribute to the global sustainable development goal No. 3 on good health and wellbeing (Rieckmann et al., 2017).
The increase of wellbeing by 11.59 in the treatment group is attributed to the effectiveness of MI.This finding is supported by the argument that an effective MI plays a vital role of reducing polydrug use among patients undergoing MAT risks associated with its use to increase health outcomes and quality of life.Other studies support that Motivational interviewing empowers MAT patients to gain mastery and develop skills needed for achieving successful MAT recovery goals (Carlsen et al., 2020).Overall, the wellness and quality of life (QoL) outcome (Syvertsen et al., 2019;NIDA, 2019).On the other hand, the increase of 4.74 wellbeing in the control group is attributed to MAT.The findings are echoed by SAMHSA (2020b) that Methadone medication improves wellbeing of patients undergoing MAT.Despite the improvement in the wellbeing in the treatment group and control group, the average score was <50 at 95% confidence level.The study's positive outcome on improved wellbeing is echoed by the mental health task force on mental health and wellbeing towards happiness and national prosperity, Kenya (Ministry of Health Kenya, 2020).

C. Adherence to MAT Dosage
The result from baseline assessment revealed that the treatment group's 58.33% (n = 35) MAT patients had missed MAT dosage and 65.00% (n = 39) MAT patients from the control group missed MAT dosage at times due to polydrug use.At three months follow up, the endline assessment established MAT patients who missed MAT dosage at times due to polydrug use had a significance decrease in the number of MAT patients from the treatment group that missed MAT dosage by 38.33% after being administered with MI (35 vs. 12), and an increase in the number of MAT patients from the control group that missed MAT dosage by 11.67% (39 vs. 46).The effectiveness of MI is supported that it plays a critical role in the MAT continuum of care in relation to adherence (Singh et al., 2019).The findings agree with a study by Martino et al. ( 2019), who found that 20.5% of patients favored polydrug use reduction after MI focused on adherence and competence.
Other studies support this study's findings on the effectiveness of MI on reducing MAT patients' polydrug use and reduction in polydrug use among MAT patients, resulting in MAT retention and adherence (Syvertsen et al., 2019;Mital et al., 2015;Rhodes & Rhodes, 2018).The current study used MI and focused on adherence of assessment of missed MAT dosages and self-determination through MAT patients self-reports which assessed some of the skills that the respondents have gained since engagement, which included Self-control, confidence, assertiveness, calmness, control, trust, empowerment, different ways to reduce poly drug use, self-awareness, planning, effects of drugs on methadone, self-regulation, avoidance, setting targets, patience, MAT meaning, time management, set regulations, strategic skills, self-care, discipline, relaxing and polydrug use reduction skills.The listed outcomes are ground Self-Determination theory (SDT) by Ryan and Deci (1985) supporting intrinsic motivation development for self-regulation after MI.As a result, during MI, the MAT patients increased their desire to reduce polydrug use, internalized the skills gained through MI and integration of the skills as their own for their well-being and increased motivation.The study did not assess adherence to MAT dosage and education level and gender.

D. MAT Dosage
The study found that there was reduction in quantity of the MAT dosage in the treatment group from above 60mg during baseline assessment, to below 60 mg in endline assessment by 16 MAT patients after MI.There was an increase in quantity of the MAT dosage in the control group from below 60mg during baseline assessment, to above 60 mg in end line assessment by 7 MAT patients with no MI.Studies support that MI reduces MAT patients polydrug use therefore, increasing wean off /reduction of methadone dosage (Syvertsen et al., 2019;Mital et al., 2015;Rhodes & Rhodes, 2018).The findings of this study on reduction MAT dosage is supported when the client regains responsibility in life, and indicators of quality of life are lived and experienced (Syvertsen et al., 2019;Sharma et al., 2016;WHO, 2019).Since both treatment and control groups are on their usual MAT dosage, the reduction in the MAT dosage may be attributed to the effectiveness of MI.Through MI interaction, the MAT clients gain selfefficacy through positive and sustainable change, through honest feedback from the investigator and other MAT patients in the group sessions, Lee (2019) supports the argument.The finding is grounded on social learning theory (SLT) by Bandura (1977) that supports learning through modelling and observation by MAT patients that increased confidence to and readiness for change resulting in change of plans, a view agreed by (Levounis et al., 2017).The findings on MAT dosage increase or decrease is supported by SAMHSA (2018b), that while monitoring the patient's withdrawal and intoxication, each patient's methadone dose is commonly adjusted to achieve maintenance dose between 60-120mg.The patient's methadone dose is titrated until the patient reaches maintenance level where no withdrawal is experienced.
The maintenance may be higher or lower, based on individual physiological characteristics and history of opioids use.However, it is worth noting that inadequate dosing of polydrug and other non-medical use psychoactive substances (Heikman et al., 2017).

E. Addition of 7 MAT Patients on Cessation of MAT
At three months follow up during endline assessment, the study found addition of 7 MAT patients on cessation.Out of the 7, 5 reported they were very important and 2 very confident on reducing polydrug use before MI.These findings support MI self-rating ruler prediction on test -retest as supported by MI outcome.Motivational interviewing self-rating ruler predict readiness, importance and confidence to reduce polydrug use which concurs with the 5 on important and 2 on confidence (NHS Health Scotland, 2015).Cessation of MAT is started when the client regains responsibility in life, and indicators of quality of life are lived and experienced (Syvertsen et al., 2019;Sharma et al., 2016;WHO, 2019).The MAT patients revealed gaining skills such as self-control and made own plans to reduce or to stop polydrug using values and strategies gained through MI.This anchored in Self-Determination theory (SDT) by Ryan and Deci (1985)  Despite the study finding, no significant relationship between self-rating readiness ruler and polydrug use reduction, at three months, 93.6% MAT patients reported to be on the action stage as far as polydrug use reduction is concerned using the stages of change showing that MI had a positive impact.The endline was done at three months, maybe a relationship between self-rating readiness ruler and polydrug use reduction can be found at more than three months.Through self-report, MAT patients developed support plans to continue supporting polydrug use reduction past the MI through the skills gained.The strategy agreed by SAMHSA (2020a) that MI calls for the MAT patients past successful strategies and their history of recovery (SAMHSA, 2020a).
Findings from the study established that the mean duration in MAT was 3.7 years (SD = 2.2 years).
However, the recommended MAT treatment period is a minimum of 24 months (CDC, 2020b) through which the patients are gradually weaned off Methadone.According to the treatment protocol by (SAMHSA, 2020a) and (NIDA, 2020b), the length of methadone treatment should be a minimum of 12 months though, it may take 24-36 months or many years, a view supported by this study n = 34 had been in MAT for over 6 years and a therapy treatment less than 90 days is considered less effective.The study did not however assess MAT patients on cessation per gender, level of education and support from the MAT significant others, correlation cessation of MAT after MI and duration in MAT which may have yielded valuable information.

F. Reduction of MAT Patients Dropping out of Therapy
The study found reduction in MAT patients dropping out of the therapy from baseline and endline assessment.and length has no influence on the effectiveness of MI.The length of the sessions ranged from five (5) minutes to (1) hour session, to one session or more than six (6) sessions of 1 hour (Levounis et al., 2017;Bahafzallah et al., 2019).

VI. CONCLUSION(S)
At baseline follow up, there is more reduction in polydrug use in treatment group with MI than it is with control group with no MI.In addition, there are differences in polydrug use reduction of 7.18% between treatment and control group.Both treatment group and control received MAT dosage as usual hence, the difference shows effectiveness of MI in polydrug reduction.Well-being of the MAT patients in both treatment and control groups had poor well-being of less than 13 at baseline treatment group.After MI, MAT patients scored a higher well-being index at endline than the control group with no MI.Therefore, an improvement of the wellbeing index was reported among MAT patients for treatment group improved from average of 25.52 for baseline assessment, to 41.85 for end line assessment after MI.The differences of wellbeing index score in treatment group on average is associated with MI and that in the control group is associated with MAT.VIII.

Figure 1
Figure 1Data Collection Procedures baseline and end line assessment.The results shown in Figure 2 (Source: Researcher, 2021), reveal that there is a change in the well-being of the MAT patients in the treatment group after administering motivation interview.During baseline assessment 100% (n = 60) of the participants in the treatment group indicated poor well-being of less than 13 on the five-statement scale.During end line assessment 7, participants indicated a well-being of more than 13 showing an improvement in the well-being of the MAT patients in treatment group by 13%.

Figure 3 :
Figure 3: Control Group Well Being

Figure 4
Figure 4Control and Treatment Group Well-Being After MI

Figure 5 :
Figure 5: Whether MAT Patients Missed MAT Dosage at Times Due to Polydrug Use Before MI

Figure 6 :
Figure 6: Whether MAT Patients Missed MAT Dosage at Times Due to Poly Drug Use After MI

Figure 7 :
Figure 7: Ever Dropped Out of MAT Before MI

Figure 8 :
Figure 8: Ever Dropped out of MAT after MI

Figure 9 :
Figure 9: Prognosis of MAT Patient Being in the MAT Treatment During the Study Period at Least Four Months Based on the History in the MAT Clinical Record Figure 10:

Figure 11 :
Figure 11: How Confident are you about Making this Change?

Figure 13 :
Figure 13: MAT Dosage after MI Figure 14: Duration in MAT

Figure 15 :
Figure 15: Where do you Think you are Right now as far as Poly Drug Use Reduction is Concerned Using the Stages of Change?
There are differences in MAT patients who missed the MAT dosage reduced from n = 23 in treatment group and increased by n = 10 in control.Both treatment group and control received MAT dosage as usual.Therefore, the difference missing MAT dosage in treatment and control group shows effectiveness of MI in improving adherence to MAT dosage.The study finds a reduction in quantity of the MAT dosage in the treatment group from above 60mg during baseline assessment, to below 60 mg in endline assessment by 16 MAT patients after MI.There was an increase in quantity of the MAT dosage in the control group from below 60mg during baseline assessment, to above 60 mg in end line assessment by 7 MAT patients with no MI.Both treatment group and control receive MAT dosage as usual.Therefore, the MAT dosage reduction in treatment and increase in control group of MAT dosage shows effectiveness of MI in reduction of MAT dosage.Reduction of MAT patients dropping out of MAT was high for treatment group associated with MI than for control group associated with MAT.Both groups received MAT treatment as usual.There was difference in reduction of polydrug use between treatment and control group, the former of which demonstrated effectiveness of Motivational Interviewing among MAT patients.www.kabarak.ac.keLink: http://ojs.kabarak.ac.ke/index.php/kjri/article/view/567Vol 12 | Issue 1 | July 2022 81 VII.RECOMMENDATIONS This study makes the following recommendations: a) Methadone assisted therapy clinicians should incorporate Motivation interviewing into their clinical practice to: Reduce polydrug use, improve wellbeing of the patients in MAT, increase adherence, reduce MAT dosage, increase patients in MAT on cessation of MAT dosage and reduction of patients in MAT dropping out to help them build a rational understanding of the impact of MI. b) Reduction of polydrug use by MAT patients requires case management approach, methadone assisted cannot reduce polydrug use, however, MAT clinicians need to combine motivation interviewing together with Methadone assisted to reduce polydrug.c) Implementation of motivation interviewing in MAT to reduce polydrug use by MAT clinicians is cost effective and reliable.Engaging patients in MAT increases intrinsic motivation and leads to transformation through skills, knowledge and attitude gained from MAT clinicians that impact on polydrug use reduction.d) Implementation of MI through group-based therapy by MAT clinicians provides patients in MAT with a support system, shared experiences and reduction strategies that promote reduction of polydrug use.e) For further research, motivation interviewing among patients in MAT with outcomes across gender, duration in MAT, MAT dosage, level of education and as a standalone with polydrug users outside MAT.

MAT dosage After MI Percantage www
During Baseline assessment, the treatment group reported 58.30% (n = 35) MAT patients who dropped out of MAT compared to 18.33% (n = 11) MAT patients from the control Group who dropped out of MAT.The results findings are shown in Figure7(Source: Researcher, 2021).

Table 2 :
Engaging and Focusing MI stage

Table 3 .
Correlation Between Self-Rating Readiness Ruler and Polydrug Use Reduction Link: http://ojs.kabarak.ac.ke/index.php/kjri/article/view/567Vol 12 | Issue 1 | July 2022 73 July 2022 76 continuum of care in relation to adherence, retention and reduction of polydrug use.The study echoes that MI is one of the brief psychotherapy interventions who argue that MI plays a critical role in the MAT www.kabarak.ac.keLink: http://ojs.kabarak.ac.ke/index.php/kjri/article/view/567Vol 12 | Issue 1 | www.kabarak.ac.ke that support MAT patient's intrinsic motivation development for self-regulation.Current findings revealed during end line assessment, among the 7, MAT patients had stopped polydrug use of heroin, alcohol, sedatives and hypnotics or otherwise, had reduced Cannabis /marijuana use from www.kabarak.ac.ke Link: http://ojs.kabarak.ac.ke/index.php/kjri/article/view/567Vol 12 | Issue 1 | July 2022 79 The reduction of MAT patients dropping out was depicted by 49.97% for treatment group and by 10% for control group.Eric (2019) supports the findings, that MI is an adjunctive psychosocial treatment among MAT patients and at times, first line treatment for most patients with an OUD.The treatment and control group received MAT treatment as usual.The reduction of polydrug use by 49.97% in treatment group is associated with MI and 10% in control group with MAT.Therefore, the difference of 39.97% between treatment and control group is associated with MI.