Motivational Interviewing in Addiction Treatment

3 min read · 8 sections

Motivational Interviewing (MI) is a counseling approach used to motivate clients to change ambivalent behaviors.1

What is Motivational Interviewing (MI)?

MI was first described by Professor William R. Miller, Ph.D., in an issue of “Behavioral Psychotherapy” in 1983.2

This technique of changing ambivalent behaviors 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.1

The thought behind MI is that all individuals dealing with addiction are at least partially aware of the negative consequences of drug misuse and addiction.1 Each individual is also currently in a certain stage of readiness when it comes to changing their behavior.1 The MI therapist facilitates the process of getting ready to change by overcoming ambivalence or a fear of change, increasing the individual’s own motivation.1

According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health, in 2020, 41.1 million people aged 12 or older needed treatment for substance use disorders, a medical condition defined by the uncontrollable use of a substance despite the negative consequences.3 Only 1.4% (or 4 million people) received any substance use treatment in 2020.3

Many individuals with substance use disorders lack motivation to change their behaviors for a number of reasons. Some don’t think that their substance misuse is serious. In 2020, 37.5 million people did not feel they needed treatment.3 Others don’t want to give up the positive sensations associated with their drug use, which may include forgetting family or financial problems, anxieties, and worry; or feeling happy and less tired. Other individuals may fear that treatment is outside their grasp—too expensive or too far away.4

Research indicated that MI may be effective not only with individuals who voluntarily sought out treatment, but also for those required to attend addiction treatment as part of a legal settlement.1

Motivational Interviewing (MI) Objectives & Steps

There are key elements that make up the spirit of MI, including:5

  • Motivation comes from the individual, not from outside sources.
  • The individual is responsible for resolving ambivalence, not the counselor.
  • Ambivalence cannot be resolved through direct persuasion.
  • The counselor quietly elicits information from the individual.
  • The counselor guides the individual in recognizing and resolving ambivalence.
  • Readiness to change is a fluctuating result of interpersonal interaction, not a trait.
  • The individual-counselor relationship resembles a collaborative partnership.
Motivational Interviewing is a fairly simple process that can be completed in a small number of sessions. Four processes remain the basis for the MI approach and include:1
  • Engaging: Talking to the individual about issues, concerns, and hopes, and establishing a trusting relationship makes for better treatment outcomes, research suggests.
  • Focusing: Narrowing the conversation to the topic of patterns and habits the individual desires to change provides an agenda for the process.
  • Evoking: Eliciting individual motivation for change by increasing the sense of the importance of change, confidence that change can occur, and readiness for change differentiates MI from other counseling methods.
  • Planning: Developing a set of practical steps the individual can use to implement the desired changes in their life.

MI is a person-centered model of counseling, meaning that the focus is on figuring out what the individual wants, 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 in a short period of time.1

Motivational Interviewing and Substance Abuse Treatment

MI emphasizes enhancing the internal motivation to change.1 Even though there are numerous reasons for an individual to stop misusing drugs and seek addiction treatment, most people believe they can stop using drugs on their own.6 Clients may go back and forth many times, feeling motivated to quit after encountering drug-induced health or legal consequences but then quickly lose motivation.

In one study, students addicted to tobacco, who received MI treatment, were four times more likely than those in the control group to either attempt quitting or cut down.7

MI aims to clearly lay out the pros and cons of quitting based on what the individual feels is important.1 Once individuals confront denial and come to their own conclusions about the pros and cons of drug misuse, 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.1 Individuals don’t feel forced to do something. Instead, they’re pursuing a life change that they chose.

Find Rehabs That Offer Motivational Interviewing

Is MI Covered by Insurance?

MI, when used in a formal rehab treatment plan, may be covered by insurance. This depends on your insurance coverage provider. Use our online verification form below to see if insurance may be able to cover the cost of treatment.

Effectiveness and Success of MI

Studies indicate that there is moderate quality evidence supporting the effectiveness of MI. For alcohol use, for instance, limited research suggests that MI has a positive effect relating to the frequency or volume of alcohol consumption and short-term (less than 4 months) outcomes. Sustained outcomes, on the other hand, is less consistent.8 When combined with other evidence-based therapies, such as cognitive-behavior therapy (CBT), MI may help people with substance use disorders (SUDs) maintain long-term behavior changes.9 Research also suggests that MI works for a variety of populations, including adolescents, pregnant women, individuals in the criminal justice system, people with co-occurring mental illnesses and SUDs, and college students, among others.9 

Benefits of MI

There are several benefits of MI in the treatment of substance use disorders, including:1,10

  • Increased treatment program retention and adherence rates.
  • Better individual engagement during treatment.
  • A higher probability of success in terms of alcohol consumption, alcohol misuse, nicotine abstinence, and marijuana abstinence.
  • Effectiveness even as a brief intervention, which can also be cost effective.
  • Adaptability to a variety of settings.
  • Mobilizing an individual’s own resources for change.

Limitations of MI

While MI shows promise in helping individuals with major mental health problems—beyond addiction—evidence comes with limitations.11 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 with severe mental health disorders and more complex addiction issues, motivation may not be enough. 

Furthermore, the key to whether 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. Thus, provider loyalty is often difficult to maintain, can be costly, and the proficiency on individual outcomes can be hard to measure.12

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