Motivational Interviewing (MI) for Addiction Treatment

One of the many counseling approaches that can be used in addiction treatment is motivational interviewing (MI). MI is a technique used to motivate patients to change unhealthy learned behaviors including substance abuse behaviors by creating a drive and motivation to change even when change is difficult.

How Motivational Interviewing Works

Change is always difficult, and this therapeutic technique recognizes that. Motivational interviewing was first developed in 1983 by William R. Miller to motivate individuals to change ambivalent behaviors. In other words, behaviors that cause conflicting thoughts or emotions. For many struggling with addiction, this concept is familiar. It’s hard to categorically see a damaging substance as bad when they have positive emotional associations with the high or feeling they get when they use the substance.

Motivational interviewing gets to the root of this issue and helps to highlight the negative consequences experienced throughout the course of drug abuse and addiction. Rather than imposing a treatment plan on an individual, the clinician uses MI to help individuals take charge of their own recovery. MI can facilitate recovery by giving individuals more motivation to quit using and by engaging the individual in their own treatment plan.

This technique works by inspiring motivation, the lack of which is one of the most often cited reasons for not seeking addiction treatment. Through motivational interviewing, the clinician can help a person see that seeking treatment is better than the alternative, despite perceived roadblocks. For instance, some people may think that treatment is too expensive or that their substance abuse problem is not that serious. These perceptions often get in the way of recovery.

The process of Motivational Interviewing (MI)

There are certain elements that inform how MI progresses. These ideas or fundamental beliefs underlie the way that MI effects change and ultimately provide a foundation for change. These elements are:

  • True motivation arises in the individual, not outside sources.
  • The individual must take responsibility for resolving his or her own ambivalence about addiction.
  • Ambivalence cannot be resolved through persuasion from outside sources.
  • The counselor’s job is to elicit information from the individual that can help them recognize and resolve their ambivalence.
  • Readiness to change can fluctuate; it’s not a permanent state.
  • The counselor and individual should collaborate on a treatment strategy.

With these elements in mind, treatment progresses through four phases, which are designed to help the individual resolve their ambivalence and increase their motivation toward recovery. These phases are:

Engaging
During this process, the clinician talks to the individual, developing rapport that will enable a person to open up about their issues and concerns. This trusting relationship forms the basis of many successful therapeutic interactions, leading to better outcomes.

Focusing
During focusing, the clinician steers the conversation toward the substance abuse and addiction, helping the individual identify their own drug and alcohol abuse habits and their desired outcome from treatment. During this process, the ambivalent thoughts become clearer, providing a roadmap for treatment.

Evoking
Evoking involves eliciting individual motivation by emphasizing the importance of change and developing confidence that change can occur. During this time, the clinician validates underlying concerns while pushing the individual toward the realization that becoming sober is more advantageous than continuing to use.

Planning
Once an individual has resolved their ambivalence and is ready to enact change, the planning stage can begin. During this stage, the clinician works with the individual to outline practical steps that are required to make the desired changes. In this case, to achieve long-term sobriety.

The OARS structure

Motivational interviewing uses several techniques that are suited to the function of the therapy. These are summarized by the acronym OARS:

Open-ended questions
Using open-ended questions rather than questions that can be answered using “yes” or “no,” a person has more freedom to explore ideas and emotions.

Affirmations
Clinicians using MI use affirmations in order to show empathy and increase rapport. Affirmations are a way to celebrate small accomplishments during therapy.

Reflective listening
Reflective listening is a technique that can help elicit conversation which helps individuals increase their readiness for change. This is a key component of being a guide rather than a lecturer.

Summaries
By summarizing what the individual says, the clinician can highlight important parts of the discussion and help lead the patient to achieve their goals.

How effective is MI?

Studies analyzing the effectiveness of MI in treating drug and alcohol abuse and addiction show that there is significant evidence that this kind of treatment can help. In one study, individuals addicted to alcohol reported drinking less on average per month when they received MI compared to those who hadn’t. Evidence on sustained change is less clear, but research shows that when combined with other therapies, MI can provide people with the motivation to maintain long-term changes.
Limitations of MI
Effective addiction treatment is not one-size-fits-all. Though MI can help many people get motivated to overcome their substance abuse issues, it may not be the best course of treatment for everyone. It is ideal as part of a large treatment plan, providing needed motivation early in the process. However, people with complex addiction or mental health problems may not see as much benefit from this treatment. In some cases, motivation is not enough to create change. In other cases, certain mental health disorders can affect a person’s ability to reach sound conclusions about their own wellbeing. A thorough clinical assessment can help determine whether motivational interviewing would be appropriate for you.
Benefits of Motivational Interviewing (MI) in Recovery

Research suggests that MI can help treat substance abuse and addiction in several ways. Some of these benefits include:

  • Improved addiction treatment retention and better adherence to treatment.
  • Improved engagement with the recovery process.
  • Improved likelihood of success, particularly when combined with other treatments.
  • It is cost effective and brief, which may be motivating for individuals.
  • It is adaptable in various settings.
  • It can help create individual motivation for treatment where motivation is lacking.
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