Principles of Motivational Interviewing

People who suffer from substance abuse are generally resistant to treatment. The relapse? rate for those suffering from substance abuse is between 40 and 60 percent. There are many more who do not seek help. It has been estimated that only 19 percent of people who need treatment receive it. The primary reason people do not seek therapy is that those who are addicted have no motivation to stop; their urges overpower morality, empathy, and reason. Motivational Interviewing for substance abuse is a therapy that directly addresses the lack of motivation evident in people who are hooked on drugs and alcohol. Let’s take a closer look at how motivational interviewing can assist in treating clients with substance abuse disorders.

Principles of Motivational Interviewing

Motivational Interviewing for substance abuse operates from four overarching concepts, otherwise known as RULE:

Resist the righting reflex

This refers to the tendency of therapists to advise clients toward what they think is the correct road to mental health. Unfortunately, ambivalent clients often resist advice, causing a paradoxical effect. As a result, it is recommended that clinicians restrain themselves from telling a client what they should be doing and instead explore their willingness to change. The emphasis is on a collaborative relationship rather than the clinician as an expert.

Understand the patient’s motivations

In Motivational Interviewing for substance abuse, it is posited that change must come from within. Therefore, a therapist must understand a client’s background, values, and concerns to explore their motivations. Pointing out that a client’s goals and their current behavior are often at odds is critical in promoting the change process.

Listen with empathy

A non-judgmental listening approach is essential in MI. Therapists are not trying to confront their clients or counter their resistance. Clients need to feel like they are free to express themselves and will be understood, no matter their behavior. Reflective listening is a core component of MI.

Empower the patient

Ultimately, the client must motivate themselves to make a change. The therapist assists them in recognizing that they have the skills and strength to help themselves. Empowerment comes from a collaborative client-therapist relationship where the clinician expresses belief in their ability to change.

Core Strategies of Motivational Interviewing for Substance Abuse

OARS is the acronym used to describe the main strategies used by clinicians in motivational interviewing:

Open-Ended Questions

Motivational Interviewing in substance abuse is not a directive therapy. The goal is to get the client to understand that they possess the desire and ability to change their previous substance abuse behavior. To that end, open-ended questions are used to elicit the client’s history and personal values. Open questions allow the client to talk freely rather than answering specific questions that are conducive to narrow answers. An example of an open-ended question is “tell me about your drinking history” or “why do you believe you need to change your behavior?”

Affirmation

Clinicians use affirmations to provide the client with messages that promote self-efficacy and build a positive self-image. For example, a therapist might tell a client “thank you for sharing your difficult story” or “you really have shown a lot of strength and courage the past few weeks”. As a therapist, you want to use affirmation to build confidence in your client.

Reflections

First, reflection is used to convey comprehension and empathy. Additionally, it may be used to promote further understanding. A therapist may say: “it sounds as if you are saying that drinking is a blessing and a curse. While it helps you deal with anxious situations, it has also led to the ruination of important relationships”. This example illustrates a critical aspect of reflection. By reflecting on the client’s own words, the clinician can point out an inner conflict that fuels the desire for change.

Summarizing

Therapists use summarizing to convey an understanding of the overarching conclusions of a discussion. While a reflection may be about one specific point, summarizing takes into account the essential aspects of multiple exchanges. It is used to reinforce what the client has said and to promote goals. For instance, a clinician may say: “let’s look at what we talked about today. Despite alcohol helping you through some tough situations, you appear to believe that the negatives outweigh the positives. Although you think it will be difficult for you to stop drinking you believe you can do and it is necessary to ensure your future happiness”. As you may note from this example, it is always a good idea for a summary to include optimism when possible.

Eliciting Change

Although eliciting change is not strictly a part of OARS, it is integral to motivational interviewing. Therapists using motivational interviewing in substance abuse want to solidify the commitment to change and build a plan for the future. To encourage change, a clinician might ask “what are the disadvantages if you continue drinking?” or “how did you feel when you stopped drinking before?”. An example of a question cementing future goals would be “what do you want to do to address the changes we discussed?” The more a client thinks about the reasons they need to change and how to go about it, the better chance they will implement those plans.

Does Motivational Interviewing Work?

Motivational Interviewing is effective in reducing substance abuse, especially in the short term. This makes sense in that motivation often wanes over time without continuous reinforcement. Although MI appears to be effective in eliciting change, it is not significantly more effective than other forms of therapy. An effective framework for substance abuse treatment might be to use MI to help someone motivate to change and then—when they appear ready— institute another intervention that will help them better address their specific drug or alcohol problem.