Motivational Interviewing for Addiction Recovery

Motivational Interviewing for Addiction Recovery

Most people fear change. Blame it on the brain, specifically the part of the temporal lobe called the amygdala (also known as the lizard or reptilian brain). The amygdala, the most primitive region of the brain, perceives change as a threat to the body and so releases stress hormones that provoke a fight or flight response.

It doesn’t matter if the change is good, bad, or indifferent, the human brain is hardwired to fear it. That’s one reason that people with substance use disorders are afraid to stop using alcohol or drugs.

Intellectually, they may understand that they would be better off if they stopped using, that their substance use is destroying their lives, relationships, and finances. The lizard brain still fears change, as well as the physical changes that come with abstinence such as a drop in the “happy” neurotransmitters and withdrawal symptoms. To argue with them only makes them more determined to resist.

That’s the idea behind motivational interviewing: to encourage clients to want to change without trying to make them, persuade them, or even tell them.

What Is Motivational Interviewing?

Most psychotherapy is nondirective, which means that clients, not therapists, lead the process. These forms of psychotherapy encourage understanding and acceptance that may lead to change. Motivational interviewing, meanwhile, is a form of directive psychotherapy.

Nondirective or client-centered (as opposed to therapist-driven) psychotherapy emphasizes a therapist-client relationship that is nonjudgmental, accepting, and respectful. To show that the therapists are paying attention, they repeat the same language the clients use without making suggestions or offering advice (reflective listening).

Motivational interviewing is subtly different. It also uses a form of reflective listening but works to bring out the clients’ ambivalence to change their behaviors. It is gentle guiding through summarizing what the client said and asking open-ended questions to make the clients conclude that they need to change.

What to expect in a motivational interview is a collaborative process between therapist and client, a conversation about change with the client doing most of the talking.

When Is Motivational Interviewing Used?

Motivational interviewing was created to treat clients with alcohol use disorders but has since been expanded to treat other types of addiction problems as well as other chronic health conditions, such as diabetes, asthma, and heart problems.

Generally, individuals know they have a problem but lack the urgent motivation to change. If aggressively confronted, they may become defensive and double-down rather than seek help.

Motivational interviewing is most often used and is most effective during the early stages of substance use disorder in the early contemplation stage of change. The individual is sitting on the fence, but is at least considering change. Motivational interviewing helps the individual sort through the pros and cons.

Goals of the Therapist in Motivational Interviewing

One of the goals of the therapist in motivational interviewing is to get the clients to acknowledge that they want to change their destructive behaviors. To accomplish this, they utilize these key elements of motivational interviewing:

  • Show empathy. Demonstrate that you are interested in and paying attention to what the clients are saying by restating their words.
  • Develop discrepancy. Build on the disparity between the clients’ stated desire for change or goals and their behavior.
  • Avoid arguments. When clients resist, don’t argue or confront them directly. Try to reframe the question.
  • Support self-efficacy. Express optimism that the client can change. This will motivate the client to change, becoming a self-fulfilling prophecy.

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How Does It Work?

At one time, substance abuse counseling was aggressively confrontational because counselors and therapists thought they had to be to get through to their clients. Then research showed that this approach had worse results than “a supportive, compassionate style” an approach “showing high levels of empathy.”

Motivational interviewing won’t work if the clients don’t want to change, but if they do, it can overcome their natural ambivalence and strengthen their resolve in just one or two sessions. According to one motivational interviewing developer, those entering rehab with just one session were more motivated and had “double the abstinence rate” of those who did not.

Other reviews found motivational interviewing outperformed other treatments for alcohol use disorder, particularly among young drinkers with either low or heavy dependencies who voluntarily sought help.

What to Look for in a Motivational Interviewer

The qualities required for motivational interviewing are similar to those required for other therapists, with an emphasis on empathy and listening.

Motivational interviewing requires a relationship with the therapist or counselor, so clients must be comfortable with the therapists they choose.

For the large COMBINE study of pharmacotherapy for alcohol dependency, participating motivational interviewing therapists were required to have:

  • A master’s degree in a counseling field
  • At least two years of counseling experience
  • Accurate empathy skills
  • The ability to listen without trying to persuade or problem-solve

About one-sixth of the therapists tested couldn’t pass an additional screening test for empathy though they were allowed two attempts. They gave in to the temptation to elicit facts and give advice.

The therapist you choose should be well-versed not only in the techniques and strategies of motivational interviewing but also the style and spirit of motivational interviewing. The process requires patience, letting the clients put their ambivalence into words, waiting until the clients feel ready to make a change, allowing the clients to make their own choices and face the consequences.

Motivational interviewing has strict rules of behavior for the therapist, but it’s not an either-or treatment. It can be used in conjunction with other therapies such as cognitive behavioral therapy. If the clients relapse at any stage, they can try again, hopefully having learned something and improving with each attempt.

Recovery from substance use disorders is like any chronic physical or mental health issue. Relapse is common and should not be judged. That’s the best way to ensure that clients keep trying.


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