Motivational Interviewing for Substance Abuse

Motivational Interviewing seeks to help a person find internal motivation and desire to want to change behaviors, thoughts, and actions that are disruptive and destructive, such as substance abuse. It is a short-term process designed to create positive life changes. 

Motivational interviewing is especially beneficial for individuals who are not ready or motivated to change — those who do not see a problem with their substance use, for example. It can help these individuals to find the motivation to get help or stop abusing substances.

What Is Motivational Interviewing?

A communication technique instead of a full intervention, motivational interviewing is a counseling method that helps to address ambivalence to change. 

As an evidence-based therapy model, motivational interviewing is a goal-oriented and guiding style of communication that encourages people to find motivation to make positive lifestyle changes. This can be beneficial in substance abuse treatment to examine behaviors and make necessary changes, such as stopping or reducing drug and alcohol use.

Motivational interviewing can be particularly useful in the following situations:

• When people are ambivalent and have mixed feelings about change
• When people do not have a lot of desire to change
• When people have little confidence in their ability to change
• When the importance of change seems low, as in benefits of change and disadvantages of the current situation are not clear

Motivational interviewing is a collaborative relationship between the therapist and individual. It is a short-term therapeutic approach that is often used in tandem with other therapies and methods for treating substance abuse and addiction.

Key Facts About Motivational Interviewing

Motivational interviewing is highly adaptable and effective as an adjunct treatment for substance use disorders. Results of MI include the following:

• Motivational interviewing is effective around 80 percent of the time as an intervention strategy for treating disease and lifestyle problems.
• Motivational interviewing can increase treatment retention as much as 30 percent in drug-free programs.
• Studies show that MI can be effective in treating a variety of issues, including substance use disorders, weight loss, stopping smoking, adhering to medications, improving health behaviors in children, diabetes, and cancer care.
• Motivational interviewing can improve treatment engagement and retention and overall quality of life. It can have positive treatment outcomes.

How Does Motivational Interviewing Work?

Motivational interviewing is most commonly used as a therapeutic method of communication in conjunction with other forms of therapy in addiction treatment. It helps to develop a collaboration between the therapist and individual to drive the decision to make positive lifestyle changes. 

Motivational interviewing focuses on empathy and respect in a nonjudgmental setting. Instead of telling a person what to do, MI strives to help a person make the decision that they want to change and then supports them through this process. 

MI uses four main processes to accomplish this:

1. Engaging: This involves establishing the collaboration between individual and therapist and getting to know the person. This is the “who.”
2. Focusing: This involves finding a clear direction and goal for treatment. This is the “what.”
3. Evoking: This involves working toward the “why” and the reasons behind a desire for change.
4. Planning: This involves building motivation toward making changes and “how” this will be accomplished.

Engaging

During this phase of motivational interviewing, the partnership between therapist and individual is formed. The therapist is empathetic and understanding. The conversation is free from judgment and allows the individual to be in control of making their own goals and decisions about treatment and their future. 

This part of the process focuses on the individual’s strengths. It is based on mutual respect and collaboration toward self-realized goals. 

Focusing

During this process, the client and therapist will focus on their goals — the reason for treatment and what they hope to accomplish. 

Treatment can be either court-mandated and have some specific goals already in place, or it can be voluntary. Either way, during the focusing phase of MI, client and therapist will work together to identify the goals for change.

Evoking

The evoking phase of MI helps to better understand the reason behind seeking change. Once the goals have been identified, this process helps to build motivation for change by highlighting the reasons for it. 

It works to enhance personal motivation for positive change and uses “change talk” to bring out personal desires and reasons behind wanting to recover. Therapists work to strengthen this motivation by recognizing and calling attention to subtleties in the conversations. Self-confidence is built through this phase as well.

Planning

During the planning process, the individual and therapist will design a plan toward achieving the goals outlined in previous phases. This addresses exactly how the changes can be made and sets a plan into motion. 

During this phase of motivational interviewing, individuals will learn coping skills and mechanisms for reaching their goals and sustaining recovery. If the goal is to be free of substances, this phase can determine how to best manage triggers to avoid relapse. 

What Is OARS & How Does It Work?

The communication skills involved in motivational interviewing are OARS. 

• O: open questions
• A: affirming
• R: reflecting
• S: summarizing

These communication skills are used during the four processes of motivational interviewing. 

Open questions help individuals to continue talking and elaborate on answers, as the therapist listens empathetically to build trust and expand on the issues at hand. 

Affirming recognizes the strengths of the individual, highlighting progress, enhancing self-examination, and improving self-confidence. 

Reflecting involves both simple and complex reflections. Simple reflections involve the therapist reiterating what the client has said, while complex reflections seek to look deeper beyond what has been said directly to something potentially implied. 

Summarizing compiles all of the details and information learned and shared throughout the MI process. This helps an individual to better realize their own “change talk” to strengthen their desire to seek sobriety.

Motivational Interviewing for Alcohol Abuse

Motivational interviewing uses four main principles:

1. Express empathy: Reflective listening techniques that are nonjudgmental help a person to feel valued.
2. Develop discrepancy: This helps the individual to recognize and differentiate between who they are in this moment and who they wish to be.
3. Adjust to resistance: This involves listening to the individual’s perspective and changing direction when needed.
4. Support self-efficacy: This involves developing tools and skills needed to facilitate a major lifestyle change, often over several different steps.

These principles can help to decrease alcohol abuse without judgment. There is often a measure of shame involved in alcohol abuse and addiction. When a therapist uses MI and offers empathy and no judgment, it can foster a positive collaboration that can help facilitate change. 

MI first builds rapport between the individual and therapist. Then, it seeks to make positive change, as in drinking less or not at all. MI has been proven to reduce the amount of drinking as a short-term counseling intervention and minimize the severity of alcohol problems.

Motivational Interviewing for Substance Abuse Treatment

When used in substance abuse treatment, motivational interviewing can be an effective therapy method to encourage and motivate an individual to stop using drugs and alcohol. It is best used in conjunction with other techniques to address the underlying and root causes of substance abuse and additional mental health issues. 

Motivational interviewing is a collaboration between a therapist and individual that can help to reduce drug and alcohol use and enhance long-term recovery.

What Are the Benefits of Motivational Interviewing?

Motivational interviewing is scientifically proven to be beneficial in increasing motivation to make healthy and positive lifestyle changes, which can make it useful for drug and alcohol addiction treatment, especially when used with other therapies and treatment methods. 

Benefits of MI in substance abuse treatment can include the following:

• Increased retention in treatment
• Less alcohol and drug use
• Improved self-confidence and self-reliance
• Reduced rates of relapse
• Motivation to make changes for a healthier future

Motivational interviewing is not linear. It can be adaptable for each person’s specific needs and circumstances, making it a highly flexible and useful method of communication that supports a collaborative relationship between provider and client. Since it is self-driven, the individual will often have more desire to change and stick to the goals that they themselves set.

How Effective Is Motivational Interviewing?

Motivational interviewing can be highly effective at helping a person find the desire within themselves to seek positive change and decide that sobriety is the goal.  

MI can be helpful to improve self-confidence and increase self-motivation to get and stay sober. It is a non-judgmental form of intervention involving conversations and communications within a collaborative environment. 

MI improves retention in treatment. It is an effective intervention to enable health-related behavior changes that can include stopping drug and alcohol abuse.

Are There Limitations to This Type of Treatment?

Motivational interviewing is most effective when used in conjunction with other treatment methods. Its use as a standalone therapy has not been well documented. 

It does not directly address the underlying causes of substance abuse and addiction, which is an important aspect of addiction treatment. MI also does not take into account co-occurring disorders, such as depression or anxiety, which are commonly also present with substance abuse and addiction. 

MI is designed to help a person find motivation to make positive changes in their life. When other mental illnesses co-occur, specialized dual diagnosis treatment is optimal.