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Motivational Interviewing (MI) for Substance Abuse Treatment

Treating substance use disorders often involves a combination of therapeutic approaches to best match your recovery needs. Evidence-based behavioral therapies—such as motivational interviewing (MI)—can be essential to an addiction treatment plan.

Today, you will gain an in-depth look at what MI is, including its fundamental principles and goals, how it can be used to treat a substance use disorder (SUD), what you can expect from MI, and addiction treatment programs near you that offer motivational interviewing.

What Is Motivational Interviewing for Substance Use Disorders?

Motivational interviewing for substance abuse is a therapeutic approach that addresses your ambivalence or resistance to change and works to increase your internal motivation to change your behavior.1 It finds resolution to ambivalence using a patient-centered approach and cognitive behavioral techniques.2 Motivational interviewing was developed by William Miller and Stephen Rollnick to treat alcohol addiction.2

Under the MI umbrella, there is motivational enhancement therapy, or MET, which is a variant of MI. Motivational enhancement therapy works to achieve the same goal as MI, with an additional focus on personalized assessment, feedback, and plans for behavioral change.1

Motivational interviewing for alcohol and drug use is different from other types of behavioral therapy because of its unique approach. While other therapies support you along the stages of the recovery process, MI seeks to quickly increase your motivation for change through collaboration.3

Eliciting rapid change is done through applying the 4 main processes of MI, which are engaging, focusing, evoking, and planning.4 A distinct feature of MI is its emphasis on collaboration. More specifically, it focuses on developing a collaborative relationship between the therapist and the patient; this is referred to as the “spirit” of MI.4 This is the cornerstone of MI’s effectiveness and an essential element of the therapeutic process.

Processes of Motivational Interviewing

The 4 main processes or principles of MI are:4

  • Engaging: This process is considered the relational foundation of MI. Engaging occurs when a mutually trusting and respectful helping relationship is established.
  • Focusing: Agenda and change goals are identified in this process. Focusing allows the patient and counselor to develop a mutually agreed upon agenda that will help promote change, as well as establish a target behavior for discussion.
  • Evoking: This process employs core MI skills and strategies to help move the patient toward a specific change goal. Evoking serves as the core of MI and makes it different from all other counseling strategies.
  • Planning: An acceptable, accessible, and appropriate change plan is developed during this process. This final process serves as the bridge to behavior change.

When Is Motivational Interviewing Used?

MI has been used for treating substance use disorders, and it has also been used in treatment plans to address HIV risk behaviors, smoking cessation, diet and exercise, eating disorders, and physical health conditions like asthma.2

Motivational interviewing can be utilized by a number of different healthcare professionals in various settings, such as hospitals and jails.2 However, MI practitioners must meet certain educational and competency standards to be able to practice, regardless of the treatment setting. A quality-control instrument that is used to ensure fidelity to the MI model is the Motivational Interviewing Treatment Integrity (MITI).2

Key Components of Motivational Interviewing

To better understand the role of motivational interviewing in enhancing the motivation to change in cases of substance use disorders, it is helpful to know that the counseling style is based on several assumptions:4

  • Indifference or ambivalence about substance use is a normal part of the process, and it is a crucial barrier to behavior change.
  • The therapist-patient relationship is collaborative in nature, where both parties bring essential insight and expertise.
  • Ambivalence can be resolved by exploring the patient’s internal values, goals, and motivators.
  • Change occurs through the development of a person-centered counseling style that involves empathy and support.

The cornerstone of MI is the collaboration between the counselor and patient, also referred to as the spirit of MI. Without a strong therapeutic alliance, therapeutic techniques utilized in MI are ineffective.4

The spirit of MI is comprised of 4 key elements, which are:4

1. Partnership

Counselors are empathetic with the patient, which increases their willingness to engage and express concerns. Though a collaborative partnership is important, the patient should ultimately lead the conversation.

2. Acceptance

The counselor respects and provides approval for the patient, thereby demonstrating willingness to understand and validate the patient’s perspective. There are 4 features of acceptance, and they are:

  • Affirmation: Recognizing the patient’s inherent strengths, values, and talents.
  • Autonomy Support: Respecting the patient’s ability and right to make their own decisions and to be self-directed.
  • Absolute Worth: Reinforcing the patient’s potential and internal self-worth.
  • Accurate Empathy: Through reflective listening and authentic curiosity, the therapist makes an intentional effort to understand the patient’s internal experience, including thoughts, feelings, and attitudes.

3. Compassion

The therapist prioritizes the patient’s welfare, goals, and needs.

4.  Evocation

The therapist explores the strengths, resources, talents, and motivators that the patient already has and works with the patient to build upon them.

What to Expect From Motivational Interviewing for Substance Abuse

It is helpful to know what to expect during an MI session. MI clinicians apply 4 core counseling skills intended to help develop a collaborative relationship and help increase your motivation for change.

The core counseling skills and strategies follow the acronym OARS, which stands for:4

  • Open-ended Questions: Asking open-ended questions allows space for the patient to reflect and provokes elaborate responses to help develop trust and a therapeutic alliance between the patient and clinician.
  • Affirming: Therapists express unconditional positive regard for the patient, validate their perspective, and verbalize appreciation. This helps to strengthen the patient’s confidence and increases feelings of self-efficacy.
  • Reflective Listening: The therapist expresses empathy through reflective listening by verbalizing respect and encouraging collaboration between the patient and therapist.
  • Summarizing: Summarizing reflects back to the patient what they expressed in therapy. It confirms to the patient that you are listening and that you understand their truth.

MI/MET commonly takes place in 1-hour sessions and may be repeated over a span of 1–4 treatment sessions.2 Researchers have analyzed more than 200 clinical trials and found MI to be highly successful in treating SUDs.4 MI has several benefits, including:4

  • Reducing/ending substance use: Successfully decreasing or stopping substance use in patients.
  • Reducing risk: Reducing or eliminating other risky behaviors associated with the SUD.
  • Resolving ambivalence: Supporting the resolution of indifference that stops patients from achieving their life goals.
  • Ease of use: MI is versatile; it can be used in a variety of settings and in conjunction with other treatment approaches, such as CBT.
  • Cost-effectiveness: MI is brief in nature, can be used with other brief interventions, and can include significant others in the process.
  • Versatility among healthcare professionals: MI can be used by a number of healthcare professionals.

Goals of the Therapist in Motivational Interviewing

In MI, the counselor’s primary goals are to express empathy and elicit a patient’s reasons for and commitment to changing substance use behaviors. This takes place through discussion of potential consequences of staying the same and/or changing and evaluation of where they are right now versus where they want to be.2 Helping patients evaluate their goals compared to where they are currently can help reduce ambivalence about change and increase motivation for change.

MI embraces “humanistic counseling” and the “person-centered approach of Carl Rogers,” which postulates that patients have the ability for self-determination and that an essential element for change is counselor empathy.4 Under the person-centered approach in MI:4

  • Therapists act as facilitators for the patient’s natural propensity for change.
  • The patient knows best and is the expert in their life.
  • Patients present to treatment with their own resources, strengths, and talents, and a counselor’s role is to help patients access these strengths.
  • Change requires the counselor’s understanding of the patient’s truth.
  • Arguments are avoided, and the counseling relationship is collaborative in nature: it is not a power struggle between the patient and counselor.
  • The patient determines when change occurs.
  • Motivation for change is not assigned or given to the patient; it is evoked from the patient.
  • Patients’ needs come before the organization’s and therapist’s objectives and needs.
  • Patients engage in treatment when the therapist expresses unconditional acceptance and positive regard, is warm and genuine, and can effectively express empathy.

Find MI Counselors and Rehab Centers Near Me

If you are seeking treatment for a SUD, MI may be an effective part of your treatment plan. Substance abuse treatment can help improve your functioning across many areas of your life.Rehab programs are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. You can use SAMHSA’s Behavioral Services Locator to search for facilities that offer MI. Many state government websites will also provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.

At American Addiction Centers (AAC), we understand the importance of providing you with effective and individualized care to help you end your addiction. When you call us free at , you will speak with a trained and compassionate admissions navigator who can answer any questions you may have about the treatment process and verify the insurance coverage offered by your health insurance provider. You can also locate an AAC rehab center.

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