Motivational Interviewing in Addiction Treatment

Motivational Interviewing (MI) is a counseling approach first described by Professor William R. Miller, PhD, in an issue of Behavioral Psychotherapy in 1983.

Consulting With Expert.As the name suggests, this technique is about motivating the client to change a destructive behavior. This is often used for addiction as lack of motivation to quit can be one of the greatest barriers for individuals struggling with addiction, even in spite of health issues and financial, social, and legal consequences.

The thought behind Motivational Interviewing is that all individuals dealing with addiction are at least partially aware of the negative consequences of drug abuse and addiction. Each individual is also currently in a certain stage of readiness when it comes to changing their behavior. The MI therapist facilitates the process of getting ready to change by overcoming ambivalence or a fear of change, increasing the client’s own motivation.

According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health, in 2009, there were 23.5 million Americans in need of treatment for addiction disorders. Many addicted individuals lack motivation to change for three main reasons. Firstly, they don’t think that their substance abuse problem is as serious as it really is. Secondly, they don’t want to give up the positive sensations associated with their drug use. Lastly, they fear the consequences of ceasing substance use, including withdrawal symptoms and cravings. Many addicted persons actually go through stages of grief after giving up their drug of choice.

Motivational Interviewing has been shown to be effective not only in clients who have voluntarily sought out treatment, but also in those who have been given required addiction treatment as part of a legal settlement or pressured into it by loved ones.

There are seven key points to MI that should be maintained across variations in MI technique. These are:

  • Motivation comes from the client, not from outside sources.
  • The client is responsible for resolving ambivalence, not the counselor.
  • Ambivalence cannot be resolved through direct persuasion.
  • The counselor quietly elicits information from the client.
  • The counselor guides the client in recognizing and resolving ambivalence.
  • Readiness to change is a fluctuating result of interpersonal interaction, not a trait.
  • The client-counselor relationship should resemble a partnership.

Motivational Interviewing is a fairly simple process that can be completed in a small number of sessions. The typical steps are as follows:

Engaging: Talking to the client about issues, concerns, and hopes, and establishing a trusting relationship

Focusing: Narrowing the conversation to the topic of patterns and habits the client desires to change

Evoking: Eliciting client motivation for change by increasing the sense of the importance of change, confidence that change can occur, and readiness for change

Planning: Developing a set of practical steps the client can use to implement the desired changes

MI is a client-centered model of counseling, meaning that the focus is on figuring out what clients want, not what the counselor thinks is best for them. This requires high levels of empathy, reflective listening, and the ability to form a strong bond with the client in a short period of time. In one study, students addicted to tobacco who received this treatment were four times more likely than those in the control group to either attempt quitting or cutting down.

The main point of MI is overcoming the internal battle over whether one really wants to quit or not. Even though there are clearly many reasons to stop abusing drugs or get serious treatment for an addiction, to an addicted individual, there are also many reasons not to. Clients may go back and forth many times, feeling motivated to quit after encountering health or legal consequences of drug abuse or a conversation with a loved one, but losing that motivation the next morning.

MI aims to clearly lay out the pros and cons of quitting based on what the client feels is important. Once clients overcome denial and come to their own conclusions about the pros and cons of drug abuse, their desire to change, what that change looks like, and how they want to implement that change, it becomes a lot easier for that change to take place. Clients don’t feel forced to give up something they love. Instead, they’re pursuing a life change that they themselves have chosen.

Motivational Interviewing can be very beneficial for those who have not had good results with Cognitive Behavioral Therapy (CBT). A lack of motivation can make changing one’s thought and behavior patterns very difficult, so addicted individuals experiencing ambivalence about quitting may need to go through MI first. MI is also better than CBT for individuals who need a lot of support, validation of their feelings, and a close relationship with their counselors, and feel that CBT does not provide this.

MI may also be especially beneficial for those who have relapsed after attempting to get clean in the past. Ambivalence about the consequences of drug abuse can be a considerable factor in repeated relapse. Helping such a person navigate through this lack of motivation, and find their own inspiration to quit that isn’t based on guilt or pressure from loved ones and health professionals, can significantly reduce the change of future relapse and lead to long-term health.

This method of counseling appears to be especially effective for alcohol addiction, likely due to the fact that it’s easier to be ambivalent about use of legal substances due to greater social acceptance than there is about the use of illicit drugs. According to an analysis of studies published in the Journal of Clinical Psychology, MI is up to 20 percent more effective than other treatment methods for alcohol addiction.

The success of MI in treating substance addiction has resulted in it being tried for other types of addiction, mental illness, and behavioral issues. These include gambling addiction, eating disorders, low self-esteem, parenting practices, and increasing motivation for positive behaviors like healthy eating and exercise. Research into MI’s effectiveness in these areas is preliminary.


Although MI has helped many people to find the motivation to get on the path to recovery, it’s not the ideal course of treatment for everyone. For those who have co-occurring mental illnesses and more complex addiction issues, simple motivation may not be enough. MI in particular is designed to last for as little as four sessions. An individual with significant underlying mental illness will need a much more in-depth method of counseling, possibly combined with medication, in order to get to a place where motivation is even a possibility. This is especially true for individuals with major depressive disorders, which are often characterized by a lack of motivation.

Clients who lack the cognitive clarity to focus on pros and cons, and come up with a plan, are also unlikely to be helped by MI.
This could include individuals with more severe mental illnesses, such as bipolar disorder or schizophrenia, as well as persons with intellectual disabilities. Also, those who have been recently medicated for mental illness often experience temporary side effects that reduce their ability to focus. These clients may need time to adjust or find the right medication before MI will be effective for them.

The key to whether or not MI will be effective often depends on the counselor. MI is a difficult treatment method to master, as the counselor needs to be able to build trusting relationships with many different types of people since just about anyone can become addicted to a substance. Substantial patience and understanding are necessary, yet the process is also designed to go quickly due to the fact that many individuals are unable to pay for much therapy or may be in the midst of legal battles related to drug use. However, a counselor who can overcome these challenges may be able to help those who have been unsuccessful with other treatment methods.

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