Motivational Interviewing for Substance Abuse

Many people with addiction struggle to make changes in their lives. Motivational interviewing was created with this in mind, and it helps therapists meet clients where they are.

Motivational interviewing (MI) has become a popular form of treatment for substance use disorders in recent decades. It was originally designed to be a respectful and compassionate therapeutic approach. However, its basic principles have been applied by many types of professionals helping to cultivate behavior change.

What Is Motivational Interviewing? 

Motivational interviewing is an evidence-based counseling style used to create and strengthen a person’s motivation to change. It focuses on helping individuals resolve their mixed feelings regarding behavior and lifestyle changes. 

History of Motivational Interviewing

Dr. William Miller and Dr. Stephen Rollnick developed motivational interviewing in the 1980s to treat individuals with substance use disorders. It was designed as a client-centered approach that built on a participant’s strengths and developed their internal desire to change. 

MI has now spread beyond substance treatment to various fields, including education, public health, medical care, social work, housing services and criminal justice. Due to its focus on respectfully collaborating with clients to bring about change, it works well in the field of human services. 

What Is Motivational Interviewing Used For?

MI treatment is often used to motivate addicted individuals to change their risky and unhealthy behaviors. It can also help treat those with co-occurring mental health diagnoses and substance use disorders. However, a person must not be in an active crisis or psychosis to the point where they cannot make decisions while going through MI treatment. 

MI has also spread into other areas of health care. It is used with clients with physical health problems such as diabetes, high blood pressure, heart disease and asthma. MI helps manage their conditions by allowing them to make healthier life choices. 

Principles of Motivational Interviewing 

The four core principles of motivational interviewing align with person-centered counseling and provide the foundation for how therapists should work with clients. These principles include: 

• Express empathy: MI therapists work to facilitate change by helping clients feel safe and accepted. They understand that having mixed emotions about making changes is normal. 
• Develop discrepancy: Therapists help clients see that their behaviors don’t align with their values or what they want out of life. 
• Roll with resistance: Within MI, therapists avoid arguing or challenging resistance. Instead, they view defensiveness as a way to learn more about the client. They also see it as a signal to try a different approach.
• Support self-efficacy: MI therapists believe that clients have the ability to make changes in their lives and are responsible for doing so. The therapist helps build the client’s belief in their own ability to change. 

Motivational Interviewing Spirit

The MI spirit refers to how a therapist interacts with a client and helps form a collaborative relationship together. The key components of the MI spirit include:

• Partnership between the client and therapist
• Drawing out the client’s ideas and strengths
• Full acceptance of the client for who they are
• Compassion toward the client

Partnership

For MI to be effective, a therapist and client must collaborate and have an active partnership. The client is an equal partner and leads the conversation — the therapist isn’t the authority.

Evocation

The therapist has a strengths-based approach and works to draw out the client’s strengths, values and resources. They also help draw out the client’s motivation and build out their reasons to change. 

Acceptance

The therapist works to understand the client’s perspective. They believe the client has inherent worth and strengths, and they respect the client’s right to self-determination. The therapist also believes in the client’s ability to change. 

Compassion

The clinician cares for the client and puts their needs and well-being first. 

Motivational Interviewing OARS 

OARS refers to the core skills of motivational interviewing that therapists use throughout their time with clients. The acronym stands for open questions, affirmations, reflections and summarizing. 

Open Questions

An open question prompts the client to share more information and opens up the conversation. It’s the opposite of a closed question, which is a question that can be answered with a short statement or a simple yes or no. An example of a closed question might be, “Did your doctor ask you to stop drinking?” A therapist has to carry the conversation when they rely on closed questions.

Open questions help the therapist learn more about the client and understand their perspective. They are sometimes phrased as statements that help accomplish the same goal. An example might be, “Tell me more about your job.”

Examples of Motivational Interviewing Questions

• What do you think you want to do about your amphetamine use?
• Tell me about your family.
• What do you want to do about your drug use?
• What has your drinking been like this past week?

Affirmations

A therapist expresses their unconditional acceptance of their client by using affirmations. They don’t praise the client. They’re communicating, “I accept you. You matter, and I desire to understand your thoughts, feelings and perspective.” Affirmations acknowledge the client’s strength, bravery, commitment and effort. 

Example affirmations include:

• You felt defeated yesterday, but you still showed up to your AA meeting. 
• You kept your promise to yourself. 
• You took a big step by coming to your appointment today. 

Reflections

MI therapists use reflective listening to repeat back or rephrase what they heard the client say. In doing so, they communicate to the client, “I’m here with you. I hear you. I’m following.” The therapist reflects on the meaning behind what the client shares. They draw attention to specific ideas regarding the client’s motivation to change.

Summarizing

Therapists summarize or recap what they’ve heard the client say throughout the session. They use this to wrap up the conversation and highlight themes or revelations the client made. 

Attending to the Language of Change 

During the conversation, the therapist points out when the client talks about being for or against change. They also prompt the client to elaborate whenever change enters the conversation.

Exchange of Information

Within motivational interviewing, the client is seen as an expert in their own life. The therapist is not the authority. The client and therapist both contribute to the partnership and share information.

Motivational Interviewing Stages of Change

The transtheoretical model, also known as the stages of change model, is used to understand an individual’s readiness to make changes in their life. The original model outlined five stages that individuals move through when changing behaviors. In recent years, a sixth stage (termination) was added, but many don’t include that when using the model to understand clients. 

Precontemplation

An individual within the precontemplation stage is likely unaware or partly unaware that there is an issue. They may be unwilling to change or feel too defeated to believe change is possible. This individual is not planning to change their behavior. 

Contemplation

A person within the contemplation stage is starting to become aware that their substance use may be a cause for concern. They are still using substances, but they may have thought about stopping at some point. The person has mixed feelings about changing because they see reasons to change and reasons not to change. Someone may stay in this stage for a long time as they bounce back and forth between wanting and not wanting to make changes in their life. 

Preparation

When an individual enters the preparation stage, they have decided to change and stop substance use soon. They are likely making plans for how to change and get support. This individual believes making changes is worth it to reduce the negative impact substance use has on their life. They’re still using substances in this stage, but they may have made small changes like reducing their amount of substance use. 

Action

An individual in the action stage has chosen a course of action and is changing their behavior. They’re likely dealing with the challenges of stopping substance use, such as withdrawals or cravings. However, they’re committed to changing. 

Maintenance

During the maintenance stage, an individual is working to maintain the changes they have made. They are developing coping skills and working to identify triggering circumstances that may prompt substance use. These individuals are building new lives without substance use. 

Termination

An individual in the termination stage doesn’t have any desire to return to their substance use and is certain they won’t relapse. This stage wasn’t part of the model when it was first developed, and most practitioners do not include this stage in their addiction treatment work. 

Goals of Motivational Interviewing

The goal of motivational interviewing is to partner with the client to help them resolve ambivalence towards change. The therapist works to elicit the client’s motivation and help them develop an internal desire to change their behaviors.

Effectiveness of Motivational Interviewing for Substance Abuse

One of the main draws of motivational interviewing is that it is an evidence-based treatment approach. In other words, it has the research to back it up. 

Many studies support the use of MI in adolescents and adults. One study reported that MI interventions were effective with individuals struggling with alcohol, tobacco and marijuana use. In addition, around 75% of selected MI studies in a large review found that motivational interviewing led to significant improvements in psychological disorders and physical diseases. Substance use disorders carry elements of both.

Find Treatment for Substance Use Disorder in New Jersey

If you or someone you love is struggling with addiction in the Greater New Jersey area, help is available. The Recovery Village Cherry Hill at Cooper provides comprehensive addiction treatment in a state-of-the-art facility located just 20 minutes outside Philadelphia. Our team of experts provides evidence-based treatment in programs ranging from medical detox to long-term aftercare. Contact us today to learn how we can help in your situation.