Motivational Interviewing For Substance Abuse

Motivational Interviewing

Motivational Interviewing (also known as MI) is a therapeutic method that has many applications but is particularly helpful in addressing substance abuse disorders. Motivational Interviewing works by enforcing a patient’s motivation and commitment to healthy goals, such as achieving sobriety. 

Overcoming a lack of motivation is one of the biggest hurdles to achieving sobriety through treatment. Many addictions develop because substances are used as coping mechanisms to help deal with other traumas and issues in people’s lives. 

Despite the awareness of the many harms of addiction, millions of people a year still fall prey to the pitfalls of many substances such as alcohol, painkillers, heroin, and the like. For most addicts, the idea of living without these substances is difficult to imagine. Even knowing all the potential health consequences cannot always outweigh the draw of addiction. 

Giving up your drug of choice can seem like a mountain that is too hard to climb, so many people do not think they have the motivation to do it. This is where motivational interviewing can be extremely effective. 

Having realistic small goals can help addicts reframe sobriety as something achievable for them. Motivational interviewing, if done well, can help people find the motivation to kick these harmful habits and achieve a lifetime of sobriety. 

What Is Motivational Interviewing?

Motivational Interviewing was pioneered by Dr. William Miller, an Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico. The technique was coined in a 1983 issue of Behavioral Psychotherapy and he has built upon his original idea in several other published books and scholarly articles. Motivational Interviewing builds on the principles of social psychology and is highlighted by practitioners treating motivation as an important interpersonal process rather than an inherent personality trait. The result of this process is that motivation is treated as something that can be learned and improved. 

Several important concepts set motivational interviewing apart from other types of substance abuse treatment. First, treatment sessions are referred to as interviews. Collaboration between therapist and patient is emphasized and confrontation about habits, etc, is generally avoided. 

Patients in the motivational interviewing process are encouraged to create their own goals and communicate what motivates them towards health, as opposed to following a script or defaulting to the wishes of the therapist. This makes motivational interviewing more personal and customizable than the average addiction treatment technique. 

Feeling like you are in control of your recovery journey is an extremely important aspect of successful treatment. This encourages patients to set goals and continue to be motivated towards recovery. The uniqueness of each patient’s journey and psyche are paramount to the success of the motivational interviewing technique.

For many people in recovery, going to treatment can feel like surrendering their individuality and control. Motivational interviewing focuses on empowering individuals to seek what uniquely motivates them and helps patients feel responsible for their recovery journey. This creates an environment that is more likely to maintain long-term sobriety. 

Motivational interviewing is also notable for what it does not focus on. Most other therapeutic techniques are eager to dive into past trauma, family dynamics, and hidden secrets, but MI is generally not concerned with those things. MI is usually intended to be a secondary technique that accompanies other methods, such as cognitive-behavioral therapy (CBT). Motivational interviewing is most effective when combined with some of these more traditional methods. 

The 4 Processes Of Motivational Interviewing

The founders of motivational interviewing, Dr. William Miller and Dr. Stephen Rollnick describe MI as “a therapeutic tool intended to be used in addition to other forms of therapy for addiction treatment.” MI is intended to help inspire change by helping patients set achievable, personalized goals that can lead to bigger picture achievements like long-term sobriety. The founding Dr’s devised four central, client-focused processes that are designed to help patients identify and achieve goals. Those processes are as follows:

  1. Engaging: Establishing a trusting patient/counselor relationship
  2. Focusing: Coming to a shared goal for the focus of treatment
  3. Evoking: Highlighting the clients own ideas for a path forward
  4. Planning: The client can believe change is possible and manifest it

Engaging

Perhaps the most important part of any treatment is the relationship between therapist and patient. This is especially true with motivational interviewing, as the client must fully trust that therapist is on their team. This relationship ensures that the team can work together towards common goals that the patient is comfortable with. This relationship relies on mutual respect and the ability of the patient to have agency in making treatment decisions. During this stage, the counselor must focus on building rapport and trust with the client. This can seem informal or less useful than a direct approach, but the trust relationship is essential to the success of MI and it takes time to build that. 

Focusing

While some patients in treatment come in with a clear focus, most need help getting from admitting there is a problem to having an achievable plan for recovery. 

In the focusing phase of Motivational Interviewing, the counselor helps the client determine what is most important to them and what they want to get out of their treatment experience. Using this information, the counselor can set the tone for their sessions moving forward and help their patient find their desire to change.

While the goals of recovery must be mutually agreed upon, the patient must do the hard work of identifying problems and finding goals that work for them uniquely. The focusing portion of MI allows the therapist to focus the conversation on problems that the patient identifies. Then the hard work of recovery can truly begin. This portion of motivational interviewing can take hours or weeks to get through, depending on the stage a patient is at when they enter into treatment. 

Evoking

The evoking portion of motivational interviewing involves the discovery of a client’s deep motivations for change. The therapist must take what was learned in the focusing portion and bring this to the attention of the client in a usable way. The therapist must stay locked in on these shared goals and the intrinsic motivations that will keep a patient working towards recovery. 

Maintaining the momentum of the change language and moving towards the recovery goals consistently are the most important aspects of motivational interviewing. During this phase, the counselor reiterates the client’s agency in making change and continues to instill confidence that they can achieve the goals set before them. It is the therapists’ job to maintain focus on the goals and help the client reflect on what they are revealing in sessions. This will help the patient continue to visualize change and manifest it through change language and action. 

Planning

The planning stage of motivational interviewing is arguably the most important for the long-term health and sobriety of the patient. It is in this stage that the client will develop the coping mechanisms and awareness to maintain sobriety. Treatment is a short-term solution to a long-term problem, and the most important part of any sobriety journey is developing real-life skills to help patients cope once they re-enter the real world. 

In this stage, the therapist must walk the line between guiding the client and taking the reins from them. Maintaining the independence of making their own decisions is at the center of the motivational interviewing technique. 

OARS

OARS is a directed motivational interviewing technique that stands for:

  • Open Questioning- This is the portion of the process that brings the patient into a good relationship with their therapist. The questions may or may not be directed towards the “reason” someone entered treatment, but can be open-ended and geared towards relationship building.
  • Affirming strengths- The patient needs to believe that they can conquer addiction and the therapist must encourage them by pointing out strengths and achievements in the process. 
  • Reflecting- Simple and complex reflections are directed by the therapist towards observations made about what the client thinks and believes. Emphasis is placed on hurdles overcome and goals achieved. 
  • Summarizing- The therapist relays what they are hearing from the client and helps turn observations into what is called “change talk”. Change talk is a tangible goal that comes from observations in the MI process. 

Motivational Interviewing And Addiction Treatment

Motivational interviewing is a highly effective form of treatment for addiction therapy. It is especially popular when a patient has relapsed or shown to not respond well to more traditional treatments. Lack of motivation is something that plagues even the most healthy of us at times, and this is especially true for those in recovery. MI helps patients find accountability within themselves and find the motivation to maintain sobriety for the long haul. 

MI also helps by giving a patient a true ally in the addiction recovery process. The relationship between therapist and client is paramount to the success of MI. Someone who has completed a motivational interviewing treatment plan will emerge with the confidence to stay healthy and the comfort of knowing they truly have someone in their corner. Motivational interviewing can be especially helpful for people with co-occurring mental health and addiction disorders. 

Relapse can sap the confidence of a recovering addict and increase uncertainty in the next phase of treatment. It can also increase indifference towards drug or alcohol use. This attitude is often found to be at the heart of relapse, but the techniques and self-confidence learned in motivational interviewing can help. 

Motivational Interviewing can be especially effective for alcohol addiction treatment. Research shows that because of the greater social acceptance and the legality of alcohol use, people with alcohol abuse disorders tend to be more nonchalant regarding their addiction. According to a study published in the Journal of Clinical Psychology, MI is up to 20% more effective than other methods of treatment when addressing alcohol use disorder.

Motivational Interviewing And Substance Abuse Treatment at Granite Mountain

Motivational interviewing is just one of the many tools at our disposal at Granite Mountain Treatment Center. Our beautiful Prescott, Arizona campus offers both inpatient and outpatient treatment options. We are taking great measures to maintain high cleanliness and safety measures amid the ongoing COVID-19 pandemic. 

Our licensed and professional counselors are ready to assist you with every step in the treatment process-from detox to reintegration plans that work for your life and schedule. If you or a loved one are struggling with addiction, call Granite Mountain today to begin your journey to sobriety. 

Article Reviewed by Gregory Struve

Greg received a Master’s in Counseling from the Adler Graduate School in 2006. He trained at one of the top trauma and anxiety treatment centers in the world until 2008 when he became a faculty member at Grand Canyon University. From 2011 to 2016 he directed a program that leads the field in terms of innovative treatment of anxiety and trauma. During that time he even made several appearances on A&E’s intervention.