Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Motivational interviewing for substance use disorders

Karen Ingersoll, PhD
Section Editor
Richard Saitz, MD, MPH, FACP, DFASAM
Deputy Editor
Richard Hermann, MD


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 [1]. Motivational interviewing has been found to reduce substance use among individuals with DSM-IV substance abuse or dependence [2].

Substance abuse and substance dependence in DSM-IV-TR were replaced by one diagnosis, substance use disorder, in DSM-5 [3]. 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 [4].

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.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Mar 02, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change, 2nd ed., Guilford Press, New York 2002.
  2. Smedslund G, Berg RC, Hammerstrøm KT, et al. Motivational interviewing for substance abuse. Cochrane Database Syst Rev 2011; :CD008063.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  4. Compton WM, Dawson DA, Goldstein RB, Grant BF. Crosswalk between DSM-IV dependence and DSM-5 substance use disorders for opioids, cannabis, cocaine and alcohol. Drug Alcohol Depend 2013; 132:387.
  5. Miller WR, Rollnick S. Motivational Interviewing, Guilford Press, New York 2012.
  6. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol 2009; 64:527.
  7. Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behavior, 1st ed., Guilford Press, New York 1991.
  8. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot 1997; 12:38.
  9. Markland D, Ryan RM, Tobin V, Rollnick S. Motivational interviewing and self-determination theory. J Soc Clin Psychol 2005; 24:811.
  10. Fredrickson BL. The broaden-and-build theory of positive emotions. Philos Trans R Soc Lond B Biol Sci 2004; 359:1367.
  11. Fredrickson BL, Losada MF. Positive affect and the complex dynamics of human flourishing. Am Psychol 2005; 60:678.
  12. Miller WR, Zweben A, DiClemente CC, et al. Motivational Enhancement Therapy Manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence, NIAAA/NIH, Rockville, MD 1999.
  13. Marlatt GA, Curry S, Gordon JR. A longitudinal analysis of unaided smoking cessation. J Consult Clin Psychol 1988; 56:715.
  14. Amrhein PC, Miller WR, Yahne CE, et al. Client commitment language during motivational interviewing predicts drug use outcomes. J Consult Clin Psychol 2003; 71:862.
  15. Bem DJ. Self-perception: An alternative interpretation of cognitive dissonance phenomena. Psychol Rev 1967; 74:183.
  16. Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: A meta-analysis of effects and processes. Adv Exp Soc Psychol 2006; 38:69.
  17. Bandura A. Human agency in social cognitive theory. Am Psychol 1989; 44:1175.
  18. Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol 2005; 1:91.
  19. Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother 1995; 23:325.
  20. Ball SA, Martino S, Nich C, et al. Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics. J Consult Clin Psychol 2007; 75:556.
  21. Stotts AL, Schmitz JM, Rhoades HM, Grabowski J. Motivational interviewing with cocaine-dependent patients: a pilot study. J Consult Clin Psychol 2001; 69:858.
  22. Tait RJ, Hulse GK. A systematic review of the effectiveness of brief interventions with substance using adolescents by type of drug. Drug Alcohol Rev 2003; 22:337.
  23. Carey KB, Scott-Sheldon LA, Carey MP, DeMartini KS. Individual-level interventions to reduce college student drinking: a meta-analytic review. Addict Behav 2007; 32:2469.
  24. Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010; :CD006936.
  25. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005; 55:305.
  26. Apodaca TR, Longabaugh R. Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidence. Addiction 2009; 104:705.
  27. Madson MB, Loignon AC, Lane C. Training in motivational interviewing: a systematic review. J Subst Abuse Treat 2009; 36:101.
  28. Söderlund LL, Madson MB, Rubak S, Nilsen P. A systematic review of motivational interviewing training for general health care practitioners. Patient Educ Couns 2011; 84:16.
  29. Martino S, Canning-Ball M, Carroll KM, Rounsaville BJ. A criterion-based stepwise approach for training counselors in motivational interviewing. J Subst Abuse Treat 2011; 40:357.
  30. Schwalbe CS, Oh HY, Zweben A. Sustaining motivational interviewing: a meta-analysis of training studies. Addiction 2014; 109:1287.
  31. Abramowitz SA, Flattery D, Franses K, Berry L. Linking a motivational interviewing curriculum to the chronic care model. J Gen Intern Med 2010; 25 Suppl 4:S620.
  32. Knight KM, Parr M, Walker D, Shalhoub J. Web-based training package for HEEADSSS assessment and motivational interviewing techniques: a multi-professional evaluation survey. Med Teach 2010; 32:790.
  33. Roman B, Borges N, Morrison AK. Teaching motivational interviewing skills to third-year psychiatry clerkship students. Acad Psychiatry 2011; 35:51.
  34. Cucciare MA, Ketroser N, Wilbourne P, et al. Teaching motivational interviewing to primary care staff in the Veterans Health Administration. J Gen Intern Med 2012; 27:953.
  35. Daeppen JB, Fortini C, Bertholet N, et al. Training medical students to conduct motivational interviewing: a randomized controlled trial. Patient Educ Couns 2012; 87:313.
  36. Triana AC, Olson MM, Trevino DB. A new paradigm for teaching behavior change: implications for residency training in family medicine and psychiatry. BMC Med Educ 2012; 12:64.
  37. Haeseler F, Fortin AH 6th, Pfeiffer C, et al. Assessment of a motivational interviewing curriculum for year 3 medical students using a standardized patient case. Patient Educ Couns 2011; 84:27.
  38. Rollnick S, Miller WR, Butler CC. Motivational interviewing in health care: helping patients change behavior., The Guilford Press, New York 2008.
  39. Rosengren DB. Building Motivational Interviewing Skills: A Practitioner Workbook, Guilford Press, New York 2009.