Motivational Interviewing and
Dual Diagnosis Treatment

Motivational Interviewing (MI) Treatment

Motivational Interviewing (MI) can help facilitate change. At AAC, we believe we can help clients achieve success by utilizing MI, a strength-based approach that highlights their ability to change harmful behaviors.

Benefits of Motivational Interviewing (MI) Treatment Modality

For clients seeking addiction treatment at AAC, two of the most common obstacles for individuals are ambivalence/uncertainty and the fear of change. Frequently, according to the Substance Abuse & Mental Health Services Administration (SAMHSA), individuals struggling with addiction are usually aware of the dangers of their substance-using behavior but continue to use anyway. These experiences are normal and despite the health risks and consequences of substance use, client feelings of ambivalence arise. This is a natural reaction.

For some clients with substance abuse issues, there is an internal struggle of “wants” — they want to stop using, but at the same time, they don’t want to. For example, at some point in their lives, the use of drugs provided benefits (i.e. self-medication, fun, partying, etc.) that they don’t want to lose. At other points in their lives, their pattern of drug use was harmful and led to negative and often illegal consequences (i.e. relationships, job, DUI, etc.).

Uncertainty about the severity of their substance use may be related to the client’s motivation to change. Entering treatment programs, many individuals claim their substance use is “not all that serious”, despite medical problems, inability to remain employed, etc. Individuals experience these natural disparate feelings regardless of their state of readiness. Ambivalence should not be interpreted as denial or resistance and utilizing MI can facilitate exploration of stage-specific motivational conflicts that can potentially hinder further progress.

AAC takes the clinical stance adopted by the U.S. Department of Health & Human Services/SAMHSA:

Motivation is not static. It is a dynamic, intentional, purposeful, and positive — directed concept toward the best interests of the self.

(Treatment Improvement Protocol (TIP) Series 35: Enhancing Motivation for Changes in Substance Abuse Treatment)

Specifically, motivation is related to the probability that a person will enter into, continue, and adhere to a specific change strategy. Substance abuse treatment staff can influence changes by developing a therapeutic relationship that respects and builds on the client’s autonomy and, at the same time, makes the treatment clinician a partner in the change process.

Using MI techniques places greater responsibility on the clinician, whose job is now expanded to include engendering motivation. In an addiction treatment setting, instead of dismissing the more challenging clients as unmotivated, clinicians are equipped with the skills to enhance the client’s motivation and establish partnerships with their clients.

MI Treatment Research-Supported Benefits:

  • Increased treatment program retention rates
  • Increased treatment program participation rates
  • Increased probability of successful treatment outcomes
  • Higher treatment post-program abstinence rates

Upon admission, the staff at AAC strives to encourage all clients to reflect on where they are and how their behavior is not working for them, and to begin to identify their own individual strategies for change — then the important task of goal setting and steps towards recovery can begin.

In treating individuals struggling with addiction, studies indicate that drug addiction treatment does not have to be voluntary in order to be effective. While clients may enter treatment involuntarily, MI has shown to be effective in treating their addiction. By using MI treatment, we’re able to embrace the spirit of MI, which is about “meeting the client where the client is,” which can help nudge a client towards change by utilizing motivation enhancing techniques. In the later stages of change, MI can help the client realize that the costs of their substance addiction have begun to outweigh any perceived benefits.

How is Motivational Interviewing (MI) used at AAC Treatment Centers?

With an integrated addiction treatment plan consisting of attending classes and therapy groups, AAC clients develop awareness about the costs/benefits of addiction, recognition of the ability to effect change in their own lives, and the possibility of a future life without substance use.

In addition to attending classes and therapy sessions, clients complete writing and reflecting exercises utilizing our dual diagnosis curriculum Embracing Change: Recovery for Life workbooks. Featuring exercises that complement AAC treatment services these curriculum workbooks are the result of our collaboration with addiction treatment specialists and multidisciplinary professionals with over 30 years of experience in the addiction treatment industry.

Currently, our curriculum is comprised of five workbooks:

  1. Stages of Change
  2. Cognitive Behavior Therapy
  3. Coping with Addiction
  4. Living in Recovery
  5. What Are the 12 Steps: Steppin’ a New Life

Besides being a research-based workbook series, it was designed specifically for AAC clients as the foundation and primary tool used by our clients. It not only serves as a resource for self-exploration and recovery, but a learning tool featuring exercises to complement the other therapeutic components of our program, including the MI treatment modality.

As a major section of our curriculum workbook, the Stages of Change section focuses on motivational interventions including MI. Following the AAC client’s alcohol detox program or drug detox program (if clinically indicated), they begin completing written workbook exercises on moving through the stages of change. Since their disease of addiction has contributed to harmful behaviors, clients work through the tangible stages of change in discussions with AAC therapists and within group therapy settings using the principles of MI. The workbook helps clients identify their distinct stages of change and enables them to recognize the importance of the motivation to change and an action change plan.

AAC recognizes that the client’s motivation is the fuel that provides belief for the client’s focus, energy, and effort necessary to roll through the entire change process. MI can be used to assist individuals in accomplishing the tasks required to transition from the pre-contemplation stage through the maintenance stage.

AAC uses MI because:

AAC has chosen to utilize Motivational Interviewing (MI) as a component in our dual diagnosis addiction treatment curriculum due to many encouraging MI treatment outcome results and change stage benefits including:

  • Well-suited for managed care setting
  • Designed as brief intervention
  • Normally delivered in 2-4 outpatient sessions
  • Triggers change in high-risk lifestyle behaviors
  • Large effects from brief motivational counseling have held up across a wide variety of real-life clinical settings
  • Mobilizes client’s own resources for change
  • Invokes behavior change
  • Delivered within context of larger healthcare delivery system
  • Compatible with health care delivery
  • Does not assume a long-term client-therapist relationship
  • Single sessions have invoked behavior change
  • Emphasizes building client motivation — a strong predictor of change
  • Clients learn something that is likely to help them within first few sessions.
  • Enhances adherence which improves treatment outcomes

Motivational Interviewing (MI) Treatment

Recognized as a best practice in addiction treatment, AAC utilizes MI as one research-based treatment modality for all levels of care because it has been used successfully in treating addiction and resistance to behavioral change for over three decades. MI represents a general theory of behavior change associated with a set of positive attitudes (“spirit of motivational interviewing”) and pragmatic, operationally defined intervention techniques.

AAC has integrated MI as part of our drug treatment curriculum because it has long been practiced and applied successfully to many problem behaviors but the evidence remains strongest for drug and alcohol problems.

MI was first described by William Miller in 1983 and further developed in collaboration with Stephen Rollnick. Since its inception, MI has been robustly researched, with its research-based findings widely disseminated. The effectiveness of MI has shown to have broad applications in the fields of addictions, mental health behaviors, psychotherapies, criminal justice, and other domains.

Motivational Interviewing (MI) & Substance Abuse

MI is one of several types of cognitive behavioral therapy (CBT) modalities used by addiction professionals to help individuals struggling with substance use address the psychological components involved in their substance issues. According to the American Psychological Association (APA), commonly used addiction therapies in drug rehabilitation centers are cognitive behavioral coping skills treatment and motivational enhancement therapy, which were both developed by psychologists. These therapies can help people boost their motivation to stop drinking/using, identify circumstances that trigger drinking, learn new methods to cope with high-risk drinking situations, and develop social support systems within their own communities.

Additional therapies include 12-step facilitation approaches that assist those with drinking problems in using self-help programs such as Alcoholics Anonymous.

Because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so.

National Institute on Drug Abuse

Features of Motivational Interviewing (MI) Treatment

In the early stages of addiction treatment, MI enhances the change process because it fosters a therapeutic relationship whereby clients partner with their clinicians to facilitate change. This collaboration helps clients examine their own situations (i.e. consider pros/cons of change and making decisions about change). At AAC, we believe this non-threatening supportive manner encourages the client to take responsibility for his or her own recovery. According to research, the collaboration is the best predictor of change and one reason why MI works so well.

Identified stages of change:

One obvious connection between motivational interviewing and stages of change is that MI is an excellent counseling style to use with clients who are in the early stages. For example, those in pre-contemplation do not want to be lectured or given “action” techniques when they are not ready to change. Those who are in contemplation, or considering the possibility of change but not quite ready to commit, can be resistant to more traditional approaches that encourage (or try to force) them to make changes for which they are not yet ready.

  • Pre-contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Relapse/recycle

Drug addiction treatment does not have to be voluntary in order to be effective.

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