Motivational Interviewing for Addiction Treatment

Substance use disorder treatment can include a variety of evidence-based therapies.¹ One of these is motivational interviewing. This page will explore motivational interviewing, how it works, what it treats, and its ability to treat addiction.

What Is Motivational Interviewing (MI)?

Motivational interviewing (MI) is a collaborative approach to addiction therapy where a therapist helps a person:²

• Recognize their own motivation for change.
• Resolve ambivalence to change.
• Set realistic goals to achieve that change.

Motivational interviewing was first implemented in substance use disorder treatment to facilitate positive, self-motivated change. It can be used as a standalone intervention or in concert with other treatment interventions. For example, it might be used during initial contact and evaluation of a patient and redeployed periodically whenever a patient’s motivation wavers during treatment.³

It has since been employed for a number of other purposes (such as reducing HIV risk behaviors and modifying diet and exercise) outside SUD treatment with promising outcomes.⁴

How Does Motivational Interviewing Work?

Motivational interviewing fosters a collaborative therapeutic alliance between the therapist and the patient, enabling the patient to discover their intrinsic motivation for change.²

The effectiveness can of motivational interviewing can be found in 3 main elements:

• The spirit of MI.
• The language of MI and the exchange of information.
• The four fundamental processes of MI.

These elements form a foundation from which the therapist and patient build trust and ultimately empower patients by helping them resolve ambivalence, develop momentum for change, and cultivate a belief in their ability to change.

The Spirit of Motivational Interviewing

The spirit of motivational interviewing is often referred to as “a way of being with people.”⁵ It helps to establish the collaborative relationship between the patient and practitioner.^5,6 Collaborative counselor-client relationships are the lifeblood of MI.⁶ The spirit of MI is comprised of four essential principles – PACE – that all work together. These are:⁵

• Partnership. The patient and provider work to establish mutual trust and build the collaborative work where the provider gently influences the patient, but the patient drives the conversation.
• Acceptance. The provider demonstrates an active acceptance and understanding of the patient, and a desire to truly understand the patient’s point of view. The four components of this process are: absolute worth, accurate empathy, autonomy support, and affirmation.
• Compassion. The provider prioritizes the patient’s welfare and needs.
• Evocation. The provider works to help the patient identify their motivations, strengths, values, and resources.

OARS: The Language of Change

MI is a person-centered approach to counseling that involves the “artful exchange” of communication – or open dialogue between the therapist and patient.⁵ To facilitate this exchange, providers will use the OARS technique. OARS stands for open-ended questions, affirmation, reflective listening, and summarization.^2,5

• Open-ended questions invite patients to express their history in a meaningful way that shows what is important to them. Through these questions, a counselor can begin to understand their patient’s values, beliefs, and goals.
• Affirmation flows from genuinely listening to a patient’s story and communicates positivity about a person’s strengths.
• Reflective listening is one of the most important aspects of MI. The provider reflects back what they have heard after the patient shares part of their story. It gives the patient a chance to confirm that the provider has a correct understanding and gives the provider a chance to express empathy and strengthen the relationship.
• Summarization follows reflective listening and gives the counselor the opportunity to process what has been said and guide the theme of the discussion.

The Four Processes of Motivational Interviewing

During MI sessions, the therapist uses the four fundamental principles that are geared toward helping patients resolve their ambivalence and find the disconnect between where they are now and where they want to be.^2,3 These are:^2,3

• Engaging. This forms the foundation of the relationship between the provider and the patient.
• Focusing. In short, this process finds a direction for the conversation to go based on a mutually agreed upon agenda. From this agenda, a behavioral topic is chosen to frame the discussion around.
• Evoking. Rather than discussing a problem and how it might be solved, the provider guides the patient to recognition that substance use may be contributing to issues in their lives. However, the patient has a choice about how to move forward to improve their lives, health, and relationships. This process helps to elicit the motivation for change and is the core of MI.
• Planning. The therapist and patient work together to establish a change plan that is appropriate, acceptable, and accessible. This often involves choosing a target area and identifying steps that the patient can take toward accomplishing that goal. Additionally, the therapist will work with the patient to strengthen their commitment to change.

Motivational Interviewing for Addiction Treatment

MI has been used in addiction treatment for 40 years and has helped numerous people evaluate the gap between their current behavior and future goals.³ By identifying how substance use behaviors are hindering their future health, social, or relational goals, MI can help patients find the motivation to change their behaviors.³

Motivational interviewing (MI) can be an effective standalone treatment for substance use disorders or be used in conjunction with other evidence-based therapies, such as cognitive behavioral therapy (CBT). Studies suggest that MI, when combined with CBT, may increase patients’ likelihood of maintaining long-term positive behavior changes.²

Benefits of Motivational Interviewing

Using motivational interviewing in substance use disorder treatment can help to achieve better outcomes. Additional benefits can include:²

• Improvement in treatment retention following detoxification.
• Reduction in alcohol and drug use.
• Adaptability and flexibility for use with other evidence-based therapies supporting behavioral change.

Does Insurance Cover Motivational Interviewing?

Most insurance plans cover substance use disorder treatment to some degree. As a part of evidence-based substance use disorder treatment, it is possible that your insurance plan could also cover motivational interviewing. It’s always a good idea to check with your specific insurance plan by calling your insurance provider to verify your benefits and coverages.

MI and Addiction Treatment in Orange County

If you or a loved one are in need of addiction treatment, Laguna Treatment Center, a drug rehab in Orange County, is available to help. By utilizing motivational interviewing and other evidence-based therapies, you can start addiction treatment with confidence.

Compassionate admissions navigators are available 24/7 to answer any questions you may have about levels of care for substance abuse treatment,  how to pay for rehab, or the rehab admissions process. Call today to get on the road to recovery and back to living the life you deserve.