Motivational Interviewing For Addiction Treatment
Motivational interviewing works on the basis of developing a person’s desire and willpower to quit substance use.
The goal is then to strengthen a person’s personal resolve so that they become more determined to achieve and maintain sobriety.
Public Health England reported that 74,618 people in treatment for alcohol use in 2019/20.
Supporting clients to find alternative ways to cope is instrumental in long-term success, and MI helps to facilitate this.
What Drives People To Use Drugs And Alcohol Despite Negative Consequences?
It’s important to think about what drives a person to use substances.
People usually turn to drugs and alcohol in order to cope.
Addiction develops from an unhealthy coping strategy and this is key in directing change.
Despite this, returning to substances for what people feel are their benefits can outweigh the aforementioned negatives.
The “addict brain” is great at weighing out in favour of continuing use.
That being said, the vast majority of people with addictions are aware of the negative effects.
Motivational interviewing draws from the thought processes of an individual.
It explores where the person is in their readiness to change and uses this to support them towards healthier choices.
Substances As A Coping Mechanism
It’s common knowledge that addiction to a substance is incredibly hard to quit.
Many feel that benefits of stopping the substance don’t outweigh the consequences.
It’s useful to remember that sometimes the individual is likely to feel that the substance has got them through a lot of difficult times.
Almost like an old friend.
This is especially challenging where people find it hard to talk and open up about their thoughts and feelings.
In this case, drugs and alcohol become unhealthy coping mechanisms.
On top of this, entering rehabilitation can feel intimidating or scary.
Some will still be in denial of their addiction or its severity even on entering rehab, whilst others might view the challenge to stop using as just too hard.
Negative thoughts can be really tricky to overcome.
Drugs and alcohol alter the balance of brain chemicals, meaning that it’s harder to feel positive.
Motivational interviewing can be extremely beneficial in countering this while a person’s working on regaining their health.
The Goal Of Motivational Interviewing
Motivational interviewing works on the assumption that ambivalence is normal.
This is partly why it’s so effective.
It supports people to overcome their fears and worries about what quitting drugs and alcohol might mean.
The main goal of this therapeutic approach is to help individuals find the drive to quit.
Where its strength lies is in how it uses the client’s own thought processes around ambivalence and what change will mean.
Practitioners guide the client to find inspiration to change from the person’s own thoughts.
This helps them gain autonomy.
Where Motivational Interviewing Came From
Motivational is a brief intervention used to treat addiction.
It was developed in the 1980s by Dr William Miller, who was a professor of psychology and psychiatry, and Stephen Rollnick.
Dr Miller argued that motivation can be encouraged.
He proved that it’s an interpersonal process rather than an innate and unmovable personality trait.
The goal of this therapeutic work is to direct people to solve their own problems.
It’s a practice that incorporates cognitive dissonance, humanistic and positive psychological approaches.
For many, that’s a positive.
It focuses on the here and now and introduces steps for the future.
The Three Concepts Of Motivational Interviewing
There are three main motivational interviewing techniques that drive the process.
These can be used as part of a motivational enhancement therapy structure, and include:
1. Collaboration Not Confrontation
This refers to the relationship between the facilitator and the person in treatment.
MI is intended to feel less “intense” than a typical therapy session might.
2. Elicit rather Than Educate
Rather than suggesting to the person in treatment what they should do, the professional supports the client to set their own goals.
It’s much more effective when goals come from the individual themselves.
MI gives the person control to make their own decisions.
This can be really motivating and helps to build self-confidence and self-belief, especially when goals are achieved.
3. Autonomy Over Authority
The client is empowered – change is in their hands.
When the person finds motivation from their own internal resources, they feel responsible for their own recovery.
This increases chances of remaining sober long-term.
The Four Processes Of Motivational Interviewing
Motivational interviewing is patient – centred.
A trained therapist or counsellor will facilitate it, but all of the work is led by what the client says.
The approach also takes into account that readiness to change fluctuates.
It is not set in stone and so the process can also be flexible.
That being said, MI is very effective at supporting the client to get past the question of whether they want to quit, so that they are ready to.
It’s essential that the therapist builds a relationship with the client.
This is where the professional gets to know the individual using warm and effective communication skills to build trust and respect.
Engaging the client helps to reduce resistance going forward, makes the person feel more comfortable, and enables conversation around change.
Many people enter treatment without goals.
Some might have been forced into treatment through a court order, or by being given an ultimatum or an intervention from their family.
The therapist supports the individual to focus and discover what they want from treatment and recovery.
The goal is to help the person see what makes them want to quit, rather than what others around them want.
- Communication And Rolling With Resistance
An essential communication skill in MI is adopting the “rolling with resistance” approach.
Here, the patient starts identifying why they need to develop healthier behaviours but they might start with saying that they have “Been forced into treatment”.
In a roll with resistance instance, the therapist might respond with, “You’ve been asked to come by family and feel that drink isn’t a problem, tell me how alcohol works for you.”
- Patterns And Habits
Focus can also draw attention to a person’s patterns and habits.
This is a space where the counsellor can develop discrepancy, where how current unhealthy behaviours differ from desired-behaviours.
Exploration about how the person feels about this is highly motivating.
Eventually, the therapist and client will come to a shared agreement on what the person’s focus or goal for recovery will be.
To evoke is where the therapist takes the information the client has divulged and uses this to guide them to see clearly their ambivalence around drug use.
This is much more inspiring than imposing another’s beliefs.
This is a critical stage of the MI process which leans on the person’s confidence and readiness to change.
It pulls out the person’s own thoughts and drives them towards change by emphasising why they want to recover.
A key point here is the importance of an experienced professional who can pick up on the more subtle cues which suggest the person wants to change.
It takes a lot of skill, especially where a person isn’t ready to change.
When the individual uses change talk, however, this is highlighted and reflected back by the counsellor.
This is how the person’s own thoughts around quitting can be used to create determination to change.
In motivational interviewing, the client will reach a point where they are willing and ready to plan and begin the process of change.
The planning stage outlines triggers and things that can cause the person to relapse so that they can develop healthy strategies around them.
The client will identify new strategies, guided by what they find helpful, but will have suggestions from the therapist where this is beneficial.
OARS Interviewing Skills In MI
The OARS approach is excellent at supporting a person to develop self-efficacy.
OARS is the skill a counsellor uses the talk with the individual and create new motivation based on what they say.
OARS stands for:
- Open Questions – Open questions means conversations are more interactive and the client talks more. Open questions might sound like: what do you like about using drugs? What are your concerns around drinking alcohol?
- Affirming Strengths – Pointing out and positively commenting on a person’s strengths reminds the person of what they have done well so far and is positively encouraging.
- Reflect – Reflecting what the person communicates -including non-verbal communication- helps to draw attention to what the person has said, especially useful around change talk. It might simply include reiterating what the person has said, or could be finely-tuned speculation based on non-verbal cues. It’s important during reflection that the counsellor uses statements, rather than questions which can come across as accusatory.
- Summarise – It’s important to summarise what’s been said. This demonstrates active reflective listening, but what’s essential is that the client, on hearing everything back, can feel strengthened by their own resolve.
How Motivational Interviewing Can Be Useful When People Have Relapsed Many Times
Motivational interviewing can be really useful where other therapies haven’t worked previously.
Therapists focus on developing a warmer relationship where a rapport and connection is built.
For some, this is really helpful – Addiction is often linked to feelings of isolation, so a friendly therapist can go a long way.
This approach also encourages the client to take accountability and to develop agency.
Many people with addictions have lost these skills, so MI helps to build it and thereafter self-belief and the motivation to change.
Motivational Interviewing In Context
Research shows people are more likely to stick to treatment goals and have better outcomes where motivational interviewing has been used.
In medical settings, motivational interviewing has proven to be especially effective.
It has reported to be useful in treating people in recovery for alcohol use disorder.
While motivational interviewing can be really effective at helping a person reach the point of change, it must be thought about in relation to the cycle of change.
Those in precontemplation won’t engage as thoroughly as someone who is actively wanting to quit substances.
The approach is, however, flexible and can change as the recovery path unfolds
MI can be used to treat all types of addiction, including:
- Alcohol addiction
- Drug addiction
- Behavioural addictions (such as gambling addictions or porn addictions)
However, it might not be as effective at treating people with a dual diagnosis where, for instance, addiction exists alongside depression, or a mental health disorder which impairs cognitive clarity such as schizophrenia or bipolar disorder.
Motivational interviewing is a key brief intervention which is a key stage in many rehabilitation programmes throughout the UK.
It is especially useful at supporting improved recovery outcomes for people addicted to alcohol and drugs.
That being said, motivational interviewing isn’t as effective when treating people with severe comorbid conditions.
For instance, a person with depression and addiction will find it more difficult to find motivation to change than a person who doesn’t have depression.
Due to how therapists work, those who engage with motivational interviewing can find it really beneficial.
This is because the emphasis is placed on what they want to gain from recovery.
Get Help Today
To find out more about motivational interviewing at your local rehab clinics, contact Rehab Recovery today.
Our team of experts are ready to guide you on the path towards recovery, referring you to the best treatment services for your unique condition.
There is no reason to suffer alone: there is always help available.