Motivational Interviewing – An Intervention for Addiction

“Marijuana is all natural and, in fact, I have evidence that it is not only not bad for me but is actually helping me!” “I don’t have an anger problem, my parents just don’t get me.” “It not my fault that I’m failing my classes, the teacher doesn’t like me.”

If you are like me, you have spent countless sessions or consultations trying to convince, show evidence, and provide data to individuals we work with that they have behaviors that cause problems in their lives. We find ourselves becoming irritated, frustrated and often hopeless about our ability to help people change when they don’t even see that they have a problem. When the person is struggling with a substance use disorder, this can be even more difficult.

So, how should we respond?  Do we continue to engage in the argument for the need to change?  Or is there a different way to respond?

Traditional approaches often suggest that change is motivated by discomfort.  If we make people feel bad enough, they will change.  Many of us have been taught that people have to “hit bottom” before they are ready to change or that people don’t change if they haven’t suffered enough.  Have you ever heard statements like, “If you don’t stop, I’ll need to contact your probation officer, or parent?”

As clinicians confronting the disease of addiction, we know that these statements not only don’t work, but often make the individual more defensive or resistant to talking to us at all.   Many of us can relate both personally and professionally to fighting against a perceived threat.

What motivates people to change? If there is a need, there is a motivation!

Think about the last major change you made in your life. Picture who you go to for support when trouble hits.  Most of us recall someone supportive who believes in us or reminds us of positive changes we’ve made in our lives and our ability to do it again.

Motivating people for change requires understanding that people are ambivalent about change. People will often continue their behavior because of that ambivalence.  Remember how long it took you to decide to go to school? Change jobs? Get married or get divorced? Keeping these thoughts at the forefront of our practice can foster an environment where people with addiction are properly motivated to recover.

What is Motivational Interviewing?

As an established practice which evolved from clinical experience with problem drinking, Motivational Interviewing has shown exceptional efficacy with patients struggling with substance use disorders. Key features of this time-honored method include:

• Respectful of client autonomy, exploring change through a collaborative relationship
• Utilizes Client Resistance and Ambivalence to actually increase Motivation
• A subtle, yet highly effective method
• Works well with other models (12-Step Facilitation, CBT, etc.)

This modality can easily be integrated into any practitioner’s treatment methodology and can be key to eliciting change for people ages 18 – 25.

Motivation Interviewing Assumptions

The counselor’s style is a powerful determinant of client resistance and change. An empathic style is more likely to bring out self-motivational responses and less resistance from the client. Each person has powerful potential for change. The task of the counselor is to release that potential and facilitate the natural change process that is already inherent in the individual.

We know that:

• Confrontation is a goal, not a style.
• Ambivalence is normal, not pathological
• Arguments are counterproductive
• Resistance is a signal to change strategies

Examples of Addictive Thought Processes Along the Stages of Change

Before we are able to help facilitate change, we must explore some thoughts about different stages people go through when big change is necessary.  Porchaska and DeClemente developed six stages of change in 1982. Here are a few common statements that counselors might hear as they approach each stage:

• Pre-Contemplation – Individuals don’t see the need to change, or are hopeless about their ability to change.
  • Thought Process: “As far as I’m concerned, I don’t have a drinking problem that needs changing.”

• Contemplation – Individuals both considers change & rejects it.  They may simultaneously see reasons to change and reasons to not change.
  • Thought Process: “I know if I don’t stop, I may not get to play basketball. But all of my friends are smoking weed and it helps relax me when I’m stressed out.”

• Preparation – Individuals want to do something about the problem.
  • Thought Process: “I’ll call the therapist my mom wants me to see and make a plan to meet him.”

• Action – Individuals takes steps to change.
  • Thought Process: “I’m have found a sponsor and am going to rigorously work the 12-Steps.”

• Maintenance – Individuals maintains goal achievement.
  • Thought Process: “I may need a boost right now to help me maintain the changes I have made.”

Motivational Interviewing is the process of helping people move through the stages of change.  People who have treatment interventions matched to their stage of change demonstrate better outcomes than clients who are mismatched or not matched at all.

Why Choose Motivational Interviewing?

Motivational Interviewing has been said to help facilitate referrals into treatment, increase the likelihood that clients will return for services, help clients coerced into treatment move beyond the initial feelings of anger and resentment and is a means to overcome client defensiveness and resistance.

Motivational Interviewing promotes the belief that all individuals have the ability to change. Even when a person begins treatment unaware of the severity of the problems in their lives, it is possible to direct them through the stages of change, using specific motivational techniques to facilitate and maintain change. This can help them reach their goals based on their own values, feelings, and desires for life change. Through this widely respected, evidence-based modality, clients with substance use disorders can find a path for success as they embark on their journey to recovery.

You deserve a better life. Call (561) 841-1296

 By Deb Lynsky-Lake, LCSW, Clinical Director at Hanley Center at Origins