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Motivational interviewing (MI) is a collaborative therapy type to strengthen your motivation and commitment to make a change.1 Motivational interviewing for addictions was developed specifically to improve motivation to change and enter substance abuse treatment. Research has shown it is effective in helping people cut down and stop the use of alcohol, drugs, and tobacco.
What is Motivational Interviewing for Addictions?
Motivational Interviewing (MI) is a person-centered approach to enhance motivation for change.1,2 This form of addiction therapy acknowledges your expertise within your own life and your problems. MI is designed to help empower you to develop your own motivation to quit using drugs or alcohol.2
MI is a highly flexible approach to therapy. The relationship between you and your provider is viewed as a partnership rather than a relationship whereby they are the expert, and you are the patient.2
The concept of motivation is an important factor in long-lasting recovery from substance use disorders.3 There are two types of motivation: intrinsic and extrinsic.
Intrinsic motivation is change due to the internal desire to achieve inherent satisfaction and enjoyment, whereas extrinsic motivation is change due to external factors, such as a punishment or reward.3
For example, MI is a psychosocial intervention designed to enhance intrinsic motivation. MI enhances this motivation by eliciting and strengthening your commitment to change.3 Additionally, MI helps explore and resolve ambivalence about entering addiction treatment.4 This exploration and resolution increase motivation and commitment.
Motivational Interviewing Techniques and Goals
Motivational Interviewing techniques and goals are designed to create nonjudgmental guidance toward increasing your readiness to change.4 This includes empathically listening and evoking your reason(s) for change.
Characteristics of MI include:5
- Person-centered
- Sensitive to your culture
- Directive style of interaction
- Communication style that is similar to counseling
- Bidirectional
- Collaborative
- Attention to building trust
- Respectful towards another
- Nonjudgmental
- Inspires change
- Facilitates change
- Instills confidence and hope
- Enhances self-efficacy
General principles of MI include:5
- Expressing empathy
- Recognizing discrepancies
- Rolling with resistance
- Supporting self-efficacy
Expressing Empathy
Your provider expresses empathy by conveying a level of understanding of your perspective and your situation. The provider also creates a space that is nonjudgmental and attends to things without criticism.5
Techniques utilized in expressing empathy include active and reflective listening.
Active listening requires your provider to listen to what it is you are truly saying. Your provider then paraphrases what they hear and repeats it to you to ensure what they heard was, in fact, what you said. This helps the provider demonstrate sincerity and strengthens the relationship.
Reflective listening requires your provider to clarify the emotions and words they heard you express in a nonjudgmental way to deepen understanding. This reinforces change talk by allowing your thoughts and feelings to be more visible.5
Recognizing Discrepancies
Your provider will work with you on identifying differences between your current state and what you want your future state to be like. Your provider will help you recognize how to achieve these goals and help you enhance your ability to become familiar with these desired behaviors.5
Techniques utilized in recognizing discrepancies include eliciting and selective reflection.
Eliciting is the purposeful questioning that your provider utilizes to influence you to examine a thought, emotion, concern, or action that would have otherwise been unaddressed. This helps continue to share information and resolve challenges.
Selective reflection is when your provider paraphrases specific things you say to encourage discussion. This helps identify good and not-so-good things about behavioral changes.5
Rolling with Resistance
Your provider will create an environment where you are free to express your hesitation and reluctance to change. Your provider will allow you to express these concerns and challenges and will also share these experiences with you. Furthermore, your provider will accept your behaviors even when they are not positive or do not indicate progression towards your goals.5
Techniques used within the principle of rolling with resistance include accepting and respective autonomy.
Accepting is an interaction between you and your provider whereby they acknowledge a situation without attempting to change or protest it. This usually refers to a negative or undesirable outcome or decision. This technique helps reveal various forms of ambivalence and barriers to your behavioral changes.
Respecting autonomy refers to your provider respecting your right and capacity to choose your own path and rate of speed to change. This also helps with revealing ambivalence and barriers to change.5
Supporting Self-Efficacy
Regardless of how small, your provider will affirm your successes and accomplishments. Your provider will also help you identify your strengths and help you acknowledge these strengths, encouraging you to utilize them for continued change.5
Techniques that are used to support self-efficacy include enhancing and affirming.
Enhancing refers to your provider summarizing what you have said over time together, with a special focus on the important parts that link you to change. This helps by pointing out when you have not recognized your own sense of change.
Affirming is when your provider vocalizes support for you and your efforts of change. This helps by increasing your level of self-confidence and esteem. Furthermore, this increase in self-confidence and esteem helps create continued behavior change.5
What Motivational Interviewing Questions Will the Therapist Ask?
Not all therapists utilizing motivational interviewing (MI) were trained in the same fashion. Research has shown some providers have been informally trained, such as reading a book, whereas other providers have participated in structured workshops ranging from eight hours to four weeks.2
Due to the difference in training, all therapists may not ask the same questions. However, the questions are designed to improve your motivation for change. A few motivational interviewing questions could include:5
- What are some good things about continuing the use of substances?
- What are some not-so-good things about continuing the use of substances?
- What are some good things about cutting down or quitting your substance use?
- What are some not-so-good things about cutting down or quitting your substance use?
- What are some ways that you can think of that would assist in achieving your goal?
- How confident are you that you can achieve your goal?
- What makes you feel you will be successful this time?
- What makes your confidence level this high rather than lower?
- How can you improve your level of confidence?
- What has helped you succeed in the past?
- What would you like your life to look like in 2-3 years?
Benefits of Motivational Interviewing
Research for motivational interviewing (MI) does provide clear evidence of its benefit in the treatment of substance use disorders. MI can help you identify areas of your life you would like to change. It can help you identify plans to make these changes happen.
How Effective is Motivational Interviewing?
Motivational interviewing (MI) has consistently shown its effectiveness in treating substance use disorders. Some studies have shown MI can be effective in as little as one 15– to 20-minute session.2 Additional studies have shown effectiveness in as little as three sessions for the misuse of substances and more than three sessions for other health-related problems. Furthermore, studies show a significant decrease in the use of alcohol and substances within six sessions.2
Another consideration in the effectiveness of your MI treatment is the level of training practice your provider has accomplished. Research has shown that the higher level of professional training your provider has, the potential effectiveness of their interventions increases.2
Limitations
Research thus far has shown motivational interviewing (MI) is beneficial in the treatment of substance use disorders.1,2,3,4 MI was originally developed to be a one-on-one, face-to-face type of therapy.1 Studies examining alternative methods of providing MI (e.g., over the telephone) have shown some mixed results. Overall telephone-based MI has shown some evidence of effectiveness.1 There appears to be some general but nondefinitive support for the use of MI in:1
- Group therapy
- Text-based therapy
- Internet-based therapy
Outside of alternatives to MI implementation, there does not appear to be stipulations on who can improve from brief MI interventions. As with all therapies, you may experience some variance in how you, as the client, will respond to the techniques.
MI utilizes a collaborative and nonjudgmental approach that many respond positively to. MI can be used to treat not only substance use disorders but other chronic health conditions and lifestyle changes, making it adaptable to your unique needs. However, no one approach fits everyone, and if you find this approach to be ineffective for you, speak with your provider.
On its own MI may be labor-intensive and time-consuming and even impractical for some treatment agencies.1 Therefore, many providers will augment MI with additional forms of therapy, such as cognitive-behavioral therapy or contingency management. Research has also shown that the level of proficiency your provider has in MI can impact the effectiveness of the interventions, a significant limitation if your provider is not well-versed in this form of therapy.
In general, limitations to the existing research is a lack of long-term follow-up studies.1 As MI continues to be studied, this will help advance understanding of how MI can be utilized in daily practices and for additional physical and mental health conditions.
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Resources
- Jiang, S., Wu, L., & Gao, X. (2017). Beyond face-to-face individual counseling: A systematic review on alternative modes of motivational interviewing in substance abuse treatment and prevention. Addictive Behaviors, 73, 216-235.
- VanBuskirk, K., & Wetherell, J. (2013). Motivational interviewing with primary care populations: A systematic review and meta-analysis. Journal of Behavioral Medicine, 37(4), 768-780.
- Sayegh, C., Huey, S., Zara, E., & Jhaveri, K. (2017). Follow-up treatment effects of contingency management and motivational interviewing on substance use: A meta-analysis. Psychology of Addictive Behaviors, 31(4), 403-414.
- Satre, D., Leibowitz, A., Sterling, S., Lu, Y., Travis, A., & Weisner, C. (2016). A randomized clinical trial of Motivational Interviewing to reduce alcohol and drug use among patients with depression. Journal of Consulting and Clinical Psychology, 84(7), 571-579.
- Tahan, H., & Sminkey, P. (2012). Motivational Interviewing. Professional Case Management, 17(4), 164-172.