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Go to a 12-Step meeting anywhere in the world, and one of the first things you will hear is that acknowledging that life has “become unmanageable” – or that the person has a problem – is the first step in recovery. This first step, or the concept of admitting defeat and facing the fact that a real problem exists, is critical. But what about those so-called highly functioning people who are using drugs and alcohol to excess, but feel that they still have a grip on their lives and aren’t so convinced that change is necessary?
This is called ambivalence, which the National Institute on Drug Abuse (NIDA) says is a common mindset for those who are considering professional help – be it therapy, counseling, outpatient treatment, or inpatient care. Ambivalent clients are those who are not sure they want to give up using their substances of abuse or who don’t believe that the effects of their abuse are damaging enough to warrant rehabilitation. Ambivalence occurs 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.
Motivational Interviewing (MI) can be a powerful tool for these types of people. According to the Center for Evidence-Based Practices (CEBP), therapists using this technique help their clients by prompting them to think about the negative consequences of their behaviors and to consider the positive effects of a healthier lifestyle.
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. According to NIDA, Motivational Interviewing is centered on helping clients to:
A study published in the Journal of Clinical Psychology explains some of the factors involved that make Motivational Interviewing a powerful therapeutic model. Conversely, there are times when MI may not be the best choice, such as when there is limited opportunity to spend quality time in counseling.
MI is a journey wherein clients become motivated to change out of self-discovery and arriving at the conclusion that sobriety is necessary in their lives.
If clients have 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. Clients with co-occurring disorders, such as bipolar disorder or depression that occurs alongside addiction, may have a hard time reaching the conclusions necessary for MI to be effective.
Motivational Interviewing can be an effective therapy choice for those clients who need to find personal motivation to change. Oftentimes, MI is used early in the recovery process as clients struggle to overcome ambivalence regarding recovery. It is often used as part of a greater treatment plan that incorporates other therapeutic approaches.