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Motivational Interviewing for Substance Abuse

Table of Contents

MI (motivational interviewing) is a behavioral intervention often used to treat substance use disorder (addiction) and to help manage physical health conditions like asthma, diabetes, and heart disease.

Those who engage with motivational interviewing to address substance abuse issues can become more motivated to change those behaviors that prevent them from making better, healthier choices. Motivational interviewing can also help prepare people for more specific follow-up therapies.

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While motivational interviewing can deliver positive outcomes in those who are initially unprepared or unmotivated for change, this intervention is less effective for those already primed and motivated to make changes.

What is Motivational Interviewing?

MI is an evidence-based intervention first developed to treat addiction. 

Motivational interviewing sessions allow clients to undertake a collaborative and ongoing conversation with a qualified therapist. The therapist supports the client’s autonomy to make changes rather than approaching the intervention from the position of an expert. 

This collaboration can strengthen the client’s motivation for change and their commitment to make necessary changes. 

MI is an approach that helps clients to identify their personal reasons for change. Those reasons should be based on the client’s values and interests. Both the client and therapist are considered experts in this therapeutic approach, working together to overcome any defensiveness and resistance to change the client is experiencing. 

Motivational interviewing should be delivered with a spirit of: 

  • Collaboration
  • Compassion
  • Acceptance
  • Evocation

The spirit of motivational interviewing is grounded on the principles of client-centered therapy. This intervention was developed by psychologist Carl Rogers and is also known as Rogerian therapy.

For change to occur, the therapist should view the client with unconditional positive regard, supporting the client whether or not they agree with the client’s decisions. Motivational interviewing is predicated on trust. 

First created to help those with substance use disorders, motivational interviewing is used worldwide in various settings and for a variety of applications related to changing behavior. 

What Are the 4 Principles of Motivational Interviewing?

To better understand the essentials of motivational interviewing as a therapeutic approach, it is necessary to familiarize yourself with the core processes of MI, as well as the four principles of motivational interviewing. 

The MI spirit consists of these aspects: 

  • Partnership
  • Compassion
  • Acceptance
  • Evocation

While everyone will have a different experience of motivational interviewing, the counselor will always be guided by the following principles during the recovery process. 

Express empathy

If you have resisted engaging with addiction treatment for fear of being judged, this will not happen during motivational interviewing. Instead, the therapist will try to understand the situation from the client’s viewpoint. 

It is not necessary for the therapist to agree with the client in order to show empathy. Empathy involves surrendering personal opinions to better understand another person. 

When the therapist adopts an empathetic approach, the MI session becomes a safe space where the client can comfortably share their concerns without fear of judgment. 

Develop discrepancy

According to motivational interviewing theory, a client can become more motivated to make behavioral change when they become aware of the discrepancy between where they are in life and where they would like to be. 

The therapist will guide the client to identify their personal values and goals. A collaborative conversation then ensues in which the client and therapist develop goals and actions for therapy. 

Roll with resistance

A therapist delivering motivational interviewing understand that change will not always occur just because the client wants change. 

An experienced counselor will not challenge, oppose, or criticize clients involved in motivational interviewing. Instead, the counselor will help the client to view themselves and their behavior through a different lens. Often, this will involve the therapist helping the client to reframe situations – to interpret things differently. As the client’s viewpoint changes, this can increase their motivation to make changes based on their core values and goals. 

Support self-efficacy

Self-efficacy is an individual’s belief in their ability to perform certain behaviors. A counselor delivering motivational interviewing will support the client, boosting their confidence of making relevant lifestyle changes. The counselor acts as a guide throughout the process of change, offering encouragement and support rather than disapproval or judgement. 

The process of motivational interviewing, then, is twofold: 

  1. Increases the client’s motivation to make behavioral changes.
  2. Client makes the commitment to making relevant changes.

During the MI process, the counselor will assume a role based more on listening than intervening. 

MI is frequently delivered in combination with other interventions like support groups, stress management, or CBT (cognitive behavioral therapy).

Common Motivational Interviewing Techniques

Motivational interviewing calls for some key communication skills making up a system known as OARS – more on this below. 

OARS is an acronym for a combination of the following communication skills: 

  • Open-ended questions
  • Affirmations
  • Reflective listening
  • Summarizing

These communication skills can enhance the process of the therapist eliciting motivation for change from the client. 

Open-ended questions

Open-ended questions cannot be answered with a “yes” or “no”, encouraging the client to think more deeply about the issue. 

Common examples of these open questions are: 

  • How have you tried to make changes in the past?
  • Tell me about your relationship with your partner.
  • How would you prefer things to be now?

Affirmations

An affirmation is a positive statement that recognizes the client’s core personal strengths and acknowledges positive behaviors. When properly implemented, affirmations can build the client’s confidence in their ability to affect change. 

Common examples of affirmations are: 

  • You coped very well in that situation.
  • I know it can be hard to seek help, and I’m glad you attended today’s session.
  • You are a resourceful person.
  • I understand that it took lots of strength for you to discuss this issue today.

Reflective listening

Reflection listening, also known as reflection, is a foundational skill of MI. 

By demonstrating to the client that they are actively listening, the therapist is able to express empathy. 

Summarizing

Summarizing techniques allow the therapist to tell the client what they believe the client has said in their own words. 

Summaries are a sub-type of reflection which the therapist can use throughout the conversation.

Sample Questions

The therapist can initiate change talk by asking the following questions based on DARN. DARN is an acronym for: 

  • Desire for change
  • Ability to make changes
  • Reasons for making changes
  • Need to make changes

Sample desire questions include: 

  • How much alcohol would you like to drink?
  • Why are you attending therapy?
  • How do you wish things were different?

Sample ability questions include: 

  • How confident do you feel that you could…
  • How do you think you could achieve…
  • How likely is it that you will be able…

Sample reason questions include: 

  • What are your reasons for…?
  • List your top three reasons for…
  • What is the main problem with maintaining the current situation?

Sample need questions include: 

  • What do you feel needs to change in your life?
  • How urgently do you need to…?
  • What needs to happen for you to…?

OARs in Motivational Interviewing

OARS in motivational interviewing involves the therapist utilizing these core communication skills: 

  • Open-ended questions: Enabling the client to elaborate and tell their story, facilitating dialogue.
  • Affirmations: The therapist using affirmations liberally but not to excess. Trust within the therapeutic alliance can be compromised if the client senses that the therapist is not being genuine or congruent when making affirmations.
  • Reflective listening: This is the primary method of the therapist demonstrating empathy for the client.
  • Summarizing: The therapist reinforcing what the client has said with brief summaries of a few sentences and a conclusion when the session finishes. The therapist may also use summaries to shift the direction of the conversation.

Get Help at California Detox

If you need help with an addiction to alcohol, prescription painkillers, or illicit narcotics, we offer a full suite of substance abuse treatment programs here at California Detox in Laguna Beach. All of our programs offer access to motivational interviewing as one component of a comprehensive treatment plan. 

We understand that all addictions are unique and that everyone has different motivations for recovery. We provide treatment programs at all levels on American Society of Addiction Medicine’s continuum of care, including: 

  • Supervised medical detox
  • Inpatient treatment (residential rehab)
  • OPs (outpatient programs)
  • IOPs (intensive outpatient programs)
  • Virtual IOPs (remote therapy via video calls)
  • PHPs (partial hospitalization programs)

Whether you require inpatient or outpatient treatment for substance use disorder, you can take advantage of a supervised detox at our luxury detoxification center. Once detoxed from drink or drugs, you can access the following treatments at California Detox: 

  • Group counseling
  • Individual counseling
  • Motivational interviewing
  • Family therapy
  • Psychotherapy (CBT and DBT)
  • MAT (medication-assisted treatment)
  • Holistic therapy

When you complete your treatment program here in Orange County, you can step down to a less intense form of treatment or transition straight back into sober living. Your treatment team is here to help you build the most stable foundation for ongoing abstinence without relapse. 

Call 844.427.6002 for immediate assistance, even if you do not feel motivated to change.

FAQs

MI is an evidence-based intervention developed to treat addiction. Through motivational interviewing sessions, clients can undertake a collaborative and ongoing conversation with a therapist. This collaboration can strengthen their motivation for change and their commitment to make changes. The therapist supports the client’s autonomy to make changes.
The primary goal of motivational interviewing is to enhance the client’s motivation for making healthy behavioral changes – discontinuing substance use, for example. As an offshoot of this main goal, clients will explore and overcome any mixed feelings or ambivalence toward change.

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