Motivational Interviewing in Addictions

Today's article contains some of the strategies used from Miller and Rollnick's motivational interviewing in addictions.
Motivational Interviewing in Addictions

Last update: 20 March, 2021

Motivational interviewing in addictions is a psychological resource Miller and Rollnick designed in 1991. This is because the motivation to change is fundamental and you must take it into consideration from the moment a patient enters the consultation room.

It’s common for people with addictions, be it to substances, people, or new technologies, to be unaware of their problems. In fact, they usually deny having a problem and are convinced that what they do is entirely normal. Thus, they see no reason to give up their addiction. In addition, it’s common for them to have a bias called “illusion of control”. What this means is that they truly believe they’re in total control of their behavior.

Motivational interviewing in addictions

This method is essential in the approach to any addiction, as it’s the gateway to treatment.

For example, motivational interviewing makes it possible to address the issue of lack of motivation in those subjects who, according to Prochaska and Di Clemente’s transtheoretical model, are in the pre-contemplation or contemplation phases. In other words, those who believe they don’t have an addiction problem and don’t want to change, even though they really do. These individuals are actually beginning to perceive there’s a certain problem with their behavior they might need to modify.

A distressed person.

Eight strategies for motivational interviewing in addictions

  • Giving information and counseling. It’s important to provide the patient with scientific and objective information they can understand. To do this, you must identify those with a serious problem that has risks and consequences. It isn’t a matter of instilling fear in a patient, but of providing them with information they may not be aware of. They must understand why they need to change and you have to let them know this option is available.
  • Remove obstacles. Help the patient seek treatment and have them know there’s no excuse not to do so. A brief intervention in a short period of time, instead of a long waiting list, facilitates adherence and involvement in therapy.
  • Give them a variety of options to choose from. They must feel free to choose the one they like the most. This is because the feeling of being able to choose without coercion and external influences increases a person’s motivation to change. Also, it’s important for them to clarify the goals they want to achieve and visualize whether their choices are leading to those goals in any therapy. This is the best way to reinforce their active role.
  • Decrease the factors that make the addictive behavior desirable. This is because they’ll become dependent on any behavior that leads to positive consequences. As you can see, it’s necessary to identify them in order to either eliminate them entirely or just reduce them as much as possible. The awareness of harmful consequences or social contingencies that decrease the positive consequences and increase the negative ones are some of the procedures one can use to limit these factors. It’s also important to weigh the pros and cons or do a cost/benefit analysis.

More strategies for motivational interviewing in addictions

  • Promote empathy. Resistance to change is quite common in patients with addictions. In this regard, empathy and active listening help remove that resistance and make the patient feel more inclined to make changes.
  • Giving feedback. The therapist must provide feedback to the patient: how they see it, what they think they’ve achieved, and the risks and/or consequences. This has an impact on those who stay motivated and also promotes self-efficacy.
  • State clear goals. They must be realistic, achievable, and accepted by the patient. This is because they won’t be feasible if this isn’t the case and, thus, they’ll either reject them or just won’t care to attain them. As you can imagine, motivation will decline.
  • Active help. Although the therapist’s role is important, the patient is the one who decides whether to change or follow treatment or not. Calling them directly or having another person take an interest in the reason for their absence increases the likelihood of them attending or returning if they left hastily.
A man in therapy.

Conclusions

Psychological problems don’t resolve passively on their own. This is why going to therapy consists of taking an active role in the problems. This role wasn’t exercised until recently. As you can imagine, being motivated to change, grow, or overcome certain circumstances is the first step towards recovery.

Change is impossible otherwise. Miller and Rollnick’s motivational interviewing can help in this regard. Especially for those patients whose problems strongly reinforce their addiction.

However, the patient is the one who’ll make the ultimate decision. But remember that certain personality variables or environmental reinforcers are difficult to control.

It isn’t until a person realizes they’re losing much more than they’re gaining that they might consider a change. At this point, the therapist just has to be attentive and encourage maximum adherence to therapy.

Change is likely with the proper motivation, flexibility, tolerance, and perseverance. The good news is that what’s on the other side is much more reinforcing than what the patient currently has.

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  • Vallejo, P, M.A. (2016). Manual de Terapia de Conducta. Editorial Dykinson-Psicología. Tomo I.