woman conduction motivational interviewing to hellp a person with addiction
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Summary: Motivational interviewing can help people with addiction by guiding them through a process of addressing and resolving resistance, hesitancy, and doubt about committing to treatment and recovery. An MI therapist helps a patient recognize and articulate their personal need for change in their lives and guides them toward making those changes.

Key Points:

  • MI recognizes that personal/internal motivation is both an essential component of successful addiction treatment and a powerful predictor of successful recovery.
  • The MI approach is patient-centered and relies on a positive and productive therapeutic alliance between patient and provider.
  • MI therapists focus on establishing trust and creating a non-judgmental treatment environment.
  • By prioritizing hopes for the future and personal goals for recovery, the MI process can spark internal motivation more effectively than focusing on the negative consequences of addiction.
  • MI recognizes that internal motivation is the most powerful driver and predictor of successful addiction treatment.

Motivational Interviewing: Empathy Over Authority

At its core, motivational interviewing is exactly what it sounds like. It’s an interview, or a conversation, during which a therapist asks a potential patient or client questions about where they are and where they want to be.

If a client isn’t satisfied with where they are, the therapist asks targeted, thoughtful questions to help them identify their values. This, in turn, helps them define their goals. Having a clear idea about their personal values and goals can help a patient find the motivation to commit to the process of making positive changes in their lives

In 2019, the Substance Abuse and Mental Health Service Administration (SAMHSA) published Treatment Improvement Protocol 35 (TIP 35), called “Enhancing Motivation for Change in Substance Use Disorder Treatment,’ which addresses the importance of identifying personal values and goals:

“An essential element in motivational SUD interventions is helping people who misuse substances raise awareness of their values and hopes for a healthy life. Using strategic conversational approaches can increase clients’ internal motivations to take actions toward wellness.”

Motivational therapists lead with empathy and compassion with techniques such as reflective listening and proactive affirmation of patient/client strengths. Then the therapist applies the four core processes of MI:

  1. They engage with the patient to create a foundation for making change. Engagement is open, honest, and positive.
  2. They focus conversations in order to create a patient-generated agenda for change. In addiction treatment, the focus of conversations is creating goals to change substance use behavior.
  3. They evoke change talk that moves a patient toward their goals. MI therapists use open-ended questions and affirming reflections to help patients vocalize their internal reasons for needing change in their lives.
  4. They help the patient make concrete plans to enact change in their lives. In an MI session for a person with addiction, the plan to enact change may be to commit to an addiction treatment program.

Evidence shows that when motivational interviewing is part of the assessment, intake, and admissions process for addiction treatment, long-term outcomes improve. And when combined with methods such as cognitive-behavioral therapy during treatment, MI can increase the likelihood of sustained recovery.

The data leads to this definition of MI:

“Motivational interviewing (MI) is an effective, evidence-based technique for helping clients resolve ambivalence about behaviors that prevent change.”

The research shows MI works, and can help people with addiction. But where does it come from?

How Motivational Interviewing Can Help People With Addiction: The Stages of Change

Motivational interviewing has a solid theoretical basis in change theory, which is a subject in the field of behavioral psychology. First described in the 1970s by counselors helping people with quit smoking cigarettes – i.e. recover from nicotine use disorder – the concept has grown to encompass the change process in a wide variety of contexts.

Current MI practice is based on The Transtheoretical Model (TTM) of the Stages of Change (SOC), which identifies the following process related to making significant behavioral change for people with substance use disorder (SUD):

Precontemplation

    • In this stage, an individual is not thinking about recovery. They may not know they have a problem, may not think their behavior is problematic, or are so discouraged by their own behavior and circumstances they’re unwilling to consider entering recovery.

Contemplation

    • In this stage, an individual begins to realize they may need to make a change. They still use substances, but may think about cutting back, and may seek information about treatment and recovery. An individual may stay in this stage for years before deciding to commit to treatment and recovery.

Preparation

  • In this stage, an individual has weighed the pros of entering treatment or stopping substance use against the cons of avoiding treatment and continuing substance use, and has decided they need to take action to make change. They may make plans to enter treatment of some sort, and begin reducing substance use.

Action

    • In this stage, an individual makes real behavioral change with the goal of completely stopping substance use, addressing the problems caused by substance use, and start the change – and healing – process.

Maintenance

    • The maintenance phase of change is about consolidating gains, managing recovery, following a long-term relapse prevention plan, and taking steps to restore motivation for recovery if it fades.

Understanding and leveraging this process is one of the ways motivational interviewing can help people with addiction change their behavior. It acknowledges that motivation might not appear instantly, or overnight, but can appear quickly, with the help of a skilled MI therapist.

In some cases, only a brief intervention is needed to help a patient overcome resistance to addiction treatment.

It also recognizes that an individual in treatment may need to renew or rediscover their motivation – the maintenance phase – for various reasons. When motivation to continue recovery wanes, a counselor or therapist can use MI to get a patient remotivated, recommitted, and back on track. In that way, we can see MI as a valuable tool that can help people with addiction both begin and sustain recovery.