Motivational Interviewing as a Treatment for Addiction

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Motivational interviewing is a therapeutic technique used to help people make positive changes in their lives. This approach can make it easier to stick with an exercise routine or healthy eating plan, for instance, which is helpful for lasting weight loss.

Research reveals that motivational interviewing can also aid in addiction treatment. For instance, one review of 39 studies noted that 67% of the studies noted a significant improvement in outcomes for teens with substance use issues.

What exactly is motivational interviewing? It is a therapy approach that follows three key concepts and incorporates the use of four guiding principles.

3 Key Concepts of Motivational Interviewing

Motivational interviewing is based on three key concepts that are directly related to the therapist-patient relationship. These concepts are:

  • Collaboration over confrontation
  • Drawing out an individual's ideas rather than the therapist imposing their ideas
  • Autonomy of the person with the addiction instead of the therapist having authority

What do these concepts mean and how do they make it easier to overcome addiction? Let's look at them individually.

Collaboration vs. Confrontation

Collaboration is a partnership that is formed between the therapist and the person with the addiction. In motivational interviewing, this relationship is based on the point of view and experiences of the person with the addiction.

This contrasts with some other approaches to addiction treatment, specifically those in which the therapist is confrontational. In those treatments, the therapist imposes their own point of view about the person's addictive behavior.

Collaboration has the effect of building rapport between the therapist and the person with the addiction. It allows the person to develop trust towards the therapist, which can be difficult in a confrontational atmosphere.

This does not mean that the therapist always agrees with the person with the addiction when using motivational interviewing. Instead, the therapeutic process involves creating a mutual understanding in which no one is right or wrong.

Drawing Out Ideas Rather Than Imposing

The notion of the therapist drawing out the individual's ideas rather than imposing their own opinions is based on the belief that motivation to change comes from within. As such, it cannot come from the addiction therapist.

No matter how much the therapist might want a person to change their behavior, it will only happen if that individual also wants to change. So, it is the therapist's job to "draw out" the person's true motivations for this change.

Once these motivators are identified, the person with addiction can use them to make the recovery process easier or to help them keep going when they want to give up. This creates a much different feel than a therapist telling the person with the addiction what to do.

Autonomy Over Authority

Unlike treatment models that emphasize the therapist as an authority figure, motivational interviewing recognizes that the true power for making changes rests within the person with the addiction. The therapist cannot demand this change.

Put another way, it is up to the individual to take the actions necessary to achieve addiction recovery. They must put in the work. This is self-empowering to the individual, but also gives them personal responsibility over their actions.

4 Guiding Principles Behind Motivational Interviewing

Although each person's journey is different, therapists who use motivational interviewing hold true to four principles throughout the recovery process. These principles are vital to establishing trust within the therapeutic relationship.

Principle #1: Offer Empathy and Acceptance

People with addiction are often reluctant to go into treatment, because they don't believe that the therapist will understand why the addictive behavior means so much to them. They are afraid that they will be judged.

Some even feel guilty about their addictive behavior, making that judgment valid in their eyes. But judgment is not what motivational interviewing is about.

Instead of judging the person with addiction, the therapist focuses on understanding the situation from the addicted person's point of view. This is known as empathy.

Empathy does not mean that the therapist agrees with the person, but that they do understand the individual's behavior. It makes sense to them, or did at the time the behavior was carried out. This creates an atmosphere of acceptance.

Principle #2: Help People to Make Up Their Minds

Motivational interviewing recognizes that quitting an addiction is hard. Also, people with addictions are usually ambivalent and uncertain about whether or not they want to change.

Their addiction has probably already had negative consequences for them, which have brought them into treatment. Yet, they have developed their addiction as a way of coping with life and do not necessarily like the idea of giving that up.​​

Motivational interviewing helps overcome this issue by assisting people with deciding how to move forward through the stages of change. It helps them look at the advantages and disadvantages of different choices and actions.

Goals and actions are developed in a trusting, collaborative atmosphere free from pressure. This offers an environment that is based on the individual's needs, wishes, goals, values, and strengths.

Principle #3: Develop a New Understanding

Motivational interviewing understands that change doesn't always happen just because the individual wants it. It is natural for them to change their mind many times about whether they want to give up their addiction and what that process or their new lifestyle looks like.

Rather than challenging, opposing, or criticizing the person with the addiction, the therapist helps them reach a new understanding of themselves. They also work to change what their addiction means to them.

One way they do this is by reframing or offering different interpretations of certain situations. This changing viewpoint increases the person's motivation to change. It is based on their own goals and values.

For example, if a person reveals that they started drinking as a way to cope with a partner's infidelity, the therapist might help them reframe the situation. Instead of blaming themselves, they may begin to see that the person cheated because of their own issues.

Principle #4: Be Supportive

A therapist following a motivational interviewing approach supports the person with addiction, reinforcing their power to make the changes they want. They walk with them through the addiction recovery process, offering encouragement along the way.

Studies show that feeling supported is critical to recovering from addiction. It works by helping the person create a new identity as someone who is no longer engaged in addictive behavior. It also increases their self-esteem.

In the beginning, the therapist may have more confidence in the individual than they have in themselves, but this changes with ongoing support. Soon, the person with addiction starts to recognize their abilities and strengths in achieving a full recovery.

Effectiveness

Research suggests that in adult populations, motivational interviewing may be effective in reducing binge drinking as well as the frequency and quantity of alcohol consumed.

Research has found that motivational interviewing is not effective in young adults, a population that may have a genetic predisposition to drink. Because of this, they may not be as responsive to motivational interviewing.

One study, however, did find that motivational interviewing may be more effective than other types of brief interventions when used with young people in emergency care settings.

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  1. Barnett E, Sussman S, Smith C, Rohrbach L, Spruijt-Metz D. Motivational interviewing for adolescent substance use: A review of the literature. Addict Behav. 2012;37(12):1325-1334. doi:10.1016/j.addbeh.2012.07.001

  2. Britt E, Hudson SM, Blampied NM. Motivational interviewing in health settings: a review. Patient Educ Couns. 2004 May;53(2):147-55. doi: 10.1016/S0738-3991(03)00141-1

  3. Frost H, Campbell P, Maxwell M, et al. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviewsPLoS One. 2018;13(10):e0204890. doi:10.1371/journal.pone.0204890

  4. Foxcroft DR, Coombes L, Wood S, Allen D, Almeida Santimano NM. Motivational interviewing for alcohol misuse in young adults. Cochrane Database Syst Rev. 2014 Aug 21;(8):CD007025. doi: 10.1002/14651858.CD007025.pub2

  5. Kohler S, Hofmann A. Can motivational interviewing in emergency care reduce alcohol consumption in young people? A systematic review and meta-analysis. Alcohol Alcohol. 2015 Mar;50(2):107-17. doi: 10.1093/alcalc/agu098

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