Motivational interviewing for substance use disorders
- Karen Ingersoll, PhD
Karen Ingersoll, PhD
- Associate Professor of Psychiatry and Neurobehavioral Sciences
- University of Virginia School of Medicine
Motivational interviewing is a directive, patient-centered counseling approach that aims to help people change problem behaviors. Motivational interviewing is used to enhance intrinsic motivation to change by exploring and resolving ambivalence . Motivational interviewing has been found to reduce substance use among individuals with DSM-IV substance abuse or dependence .
Substance abuse and substance dependence in DSM-IV-TR were replaced by one diagnosis, substance use disorder, in DSM-5 . Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, substance dependence is approximately comparable to substance use disorder, moderate to severe subtype, while substance abuse is similar to the mild subtype .
This topic describes the theoretical foundation, indications, assessment, practice, efficacy, and administration of motivational interviewing. Brief intervention for unhealthy alcohol and other drug use and other treatments for substance use disorder are described separately. (See "Brief intervention for unhealthy alcohol and other drug use" and "Psychosocial treatment of alcohol use disorder" and "Acute opioid intoxication in adults" and "Pharmacotherapy for opioid use disorder" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Pharmacotherapy for stimulant use disorders in adults" and "Psychosocial interventions for stimulant use disorder in adults".)
People with substance use problems and disorders often have mixed feelings and thoughts about their smoking, drug, and alcohol use. While they may perceive some negative consequences of smoking, drinking, or using drugs, they also enjoy positive experiences such as intoxication, disinhibition, socialization, and pleasure. They often remain in a conflicted or ambivalent state about changing unless their perception of these costs and benefits shifts. Understanding and resolving this ambivalence is a central goal of motivational interviewing and is accomplished through elicitation rather than persuasion.
Motivational interviewing is a counseling approach in which clinicians use a patient-centered stance paired with eliciting techniques to help patients explore and resolve their ambivalences about changing behaviors that are not healthy. It is characterized by a collaborative, autonomy-supporting, and evocative style in which clinicians seek to understand patients’ perspectives, while directing them toward considering changing one or more behaviors by building awareness of a discrepancy between the patient’s current and hoped-for self, avoiding confrontation, and supporting patients’ optimism about the possibility and methods for change.
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- THEORETICAL FOUNDATION
- Conceptual model
- Psychological theory
- Conceptualization of problem substance use
- Readiness to change
- Motivation enhancement therapy
- - Express empathy
- - Develop discrepancy
- - Roll with resistance
- - Support self-efficacy
- Specific techniques
- - Engaging
- - Focusing
- - Evoking
- - Planning
- Mechanisms of improvement
- SUMMARY AND RECOMMENDATIONS