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Motivational Interviewing for Substance Abuse

It is a common misconception that people with a substance use disorder, or addiction, continue using drugs or alcohol because they don’t want to change. Motivational Interviewing (MI) is a therapeutic approach that enhances the motivation for a person with a substance abuse disorder to change. Importantly, practitioners of MI believe that the potential for change exists within everybody.

Like other therapy or treatment, motivational therapy can only help if people struggling with addiction or dual-diagnosis seek help. According to the National Institute on Drug Addiction, more than 22 million Americans needed treatment for a problem related to alcohol or drugs. Yet, only 2.5 million people received treatment at a drug and alcohol treatment facility. For people with a substance use disorder, the likelihood of recovery and improved quality of life increase drastically with specialized treatment and support.

What is Motivational Interviewing

Motivational Interviewing has been a popular approach in the alcohol and addiction treatment community for more than two decades. First described in 1983 by Dr. William R. Miller, motivational interviewing builds on the optimistic and humanistic psychology theories that employ a nonjudgmental, empathetic-focused interaction between therapist and patient. The goal of MI is to elicit and strengthen a person’s resolve and ability to change destructive behaviors, like abusing drugs and alcohol.

MI was developed in specific reaction to trying to aid in interventions of people’s drug and alcohol problems. Rather than demand complete abstinence during an intervention, MI’s goal, in the very beginning, is to open the door of possibility for the alcoholic or addict to consider treatment.

It is crucial in motivational interviewing that the specialist make it clear what their intentions are with the other person. It is important for people to understand that motivation for change in one area of life (like quitting cocaine) does not always mean that that person will be motivated to change all areas of life (that person may still decide to continue drinking or refuse to go to treatment).

As a practice, motivational interviewing is a technique that usually lasts for no more than 4 weeks. It is intended to be a brief, intervention-like approach to enhance the motivations for change rather than as a directive, take-it-or-leave-it approach.

Motivational Interviewing involves two distinct phases. First, the therapist works with the patient to understand, and then to sort out, the reasons for the patient’s resistance to change. During this phase, the practitioner helps the patient develop a greater and more accurate sense of importance and strengthen their conviction that they can, indeed, change for the better.

When a person demonstrates a readiness for change, the therapist begins the second phase. Signs that suggest a willingness to change may include asking for advice or guidance on how to solve their problems, stating new intentions to change, or explain the reason why change is necessary for their life. The second phase works towards strengthening the patient’s newfound commitment for transforming their behavior and life choices. At this point, the practitioner and individual with the substance abuse disorder develop a “change plan” in a democratic, cooperative manner.

Motivational Interviewing Is Not…

  • Does not consider addiction or alcoholism as a disease
  • Does not emphasize total abstinence from drugs and alcohol
  • It is not Cognitive Behavioral Therapy
  • Does not require the person practicing MI to provide personalized feedback or help balance decision-making skills
  • Does not agree that people with substance use disorders experience powerlessness when it comes to using drugs or drinking alcohol

What Guides MI

Five principles guide practitioners during motivational interviews. They include:

  1. Express empathy through reflective listening: An empathetic style include communicating respect for and acceptance of clients and their feelings; encourages a nonjudgmental, democratic relationship; allows the practitioner to be a supportive and knowledgeable consulting resource; use compliments; actively listens; persuade while understanding that any decision is the client’s alone; and provide support throughout the recovery process.
  2. Develop Discrepancy: focuses on developing awareness of consequences to help someone examine their own behavior. Allow the client to present arguments for why a change should occur.
  3. Avoid Argument: avoids labeling clients as an addict or alcoholic. Instead, the goal is “walk with” clients through recovery and treatment rather than force them into treatment.
  4. Roll with Resistance: Permits the therapist to view resistance from the client as a signal that the person sees the situation differently. Part of this includes repeating statements neutrally, replicate an exaggerated form of their account, pointing out conflicting statements he or she has said in the past, and shifting focus away from obstacles and towards solutions.
  5. Support Self-Efficacy: To encourage people who may have a distorted sense of self that they are capable of change and to help improve self-esteem.

Motivation and Addiction

According to the National Institute on Drug Abuse, Motivational Interviewing as a drug and alcohol treatment therapy depends on the drug of choice and the goals of the intervention. It has been more successful in helping people with alcohol problems reduce drinking and engage in treatment. When combined with cognitive behavioral therapy, it has been effective for people with marijuana substance use disorders. Overall, MI appears to be more effective for addicts and alcoholics already in treatment than for producing changes in drug use. If you have further questions about motivational interviewing and other therapeutic modalities, Boardwalk Recovery is available to clarify which modalities we use in our addiction treatment programs and how we can help you or a loved one overcome addiction.

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