When to Use Motivational Interviewing with a Patient


Go to a 12-step meeting (e.g., Alcoholics Anonymous, Narcotics Anonymous, etc.) anywhere in the world, and one of the first things you will hear is an individual acknowledging that life has “become unmanageable.” In other words, the individual is acknowledging that they have a substance use problem—this is the first step in recovery.1

This first step, or the concept of admitting defeat and facing the fact that a real problem exists, is critical.

But what about individuals who won’t acknowledge that they use drugs and alcohol to excess? Individuals who feel that they still have a grip on their lives and aren’t so convinced that change is necessary?

This is called ambivalence, which is a common mindset for those who are considering professional help—be it therapy, counseling, outpatient treatment, or inpatient care. Ambivalent patients are those who go back and forth between reasons they should change or shouldn’t change: they aren’t sure they want to give up using substances of abuse or don’t believe that the effects of their abuse are damaging enough to warrant rehabilitation.1,2

Ambivalence may occur when someone is using substances to manage or solve problems and doesn’t know how else to cope, or when the person actually views the substance use as having a positive emotional payoff.1

What Is Motivational Interviewing?

Motivational interviewing principles can be a powerful tool used to strengthen motivation in someone who is ambivalent and build a plan for change.2

Therapists who use this technique help their clients by prompting them in an empathetic, non-confrontational manner to think about the negative consequences of their behaviors and to consider the positive effects of a healthier lifestyle.1

In the first phases of this type of therapy, the focus is on helping the client become motivated to engage in treatment. Larger issues of commitment to sobriety are not explored as deeply, as the therapy is primarily concerned with helping the person discover possible motivations for stopping drug or alcohol use.1,2

Motivational interviewing techniques can enhance a provider’s ability to address the patient’s readiness for change, helping them to:1,2

  • Recognize that they are suffering due to addiction.
  • See that there are coping mechanisms they can use in place of drugs and alcohol.
  • View a sober lifestyle as something positive.
  • Understand they have the power to break the cycle of addiction.

When Motivational Interviewing Doesn’t Help

Motivational interviewing is a journey where patients become motivated to change out of self-discovery. Patients arrive at the conclusion that sobriety is necessary in their lives.3

Motivational interviewing can be a powerful therapeutic model. Conversely, there are times when the technique may not be the best choice, such as when there’s limited opportunity to spend quality time in counseling.

If a patient has emotional or mental health problems that preclude them from being present and clearheaded, they may not be able to reach the decision that they need help.3

Patients with co-occurring disorders that occurs alongside addiction, such as bipolar disorder or depression, may have a hard time reaching the conclusions necessary for motivational interviewing to be effective.3

Motivational Interviewing can be an effective therapy choice for those patients who need to find personal motivation to change. It is sometimes used early in the recovery process as clients struggle to overcome ambivalence regarding recovery.1,2 It can also be used as part of a greater treatment plan that incorporates other therapeutic approaches.2,3

References

  1. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  2. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Motivational Enhancement Therapy.
  3. Miller, W. R., Rollnick, S. (2009). Ten Things that Motivational Interviewing is Not. Behavioural and Cognitive Psychotherapy, 37(2), 129–140.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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