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Motivational Interviewing (MI) in Addiction Treatment

    Motivational Interviewing (MI) in Addiction Treatment

    Many people who are struggling with addiction may not feel positive about the idea of recovery. They know that their behaviour or substance use is unhealthy and causing damage to themselves and the people around them, but they are often unable to bring themselves to change their ways.

    Whether they believe they don’t have a problem, do not feel ready to give up drugs and alcohol or have little faith that the treatment methods will work for them, these conflicting feelings can make it difficult for people to fully engage in addiction recovery which can therefore hinder their progress and prevent them from achieving long-term sobriety. [1]

    Motivational interviewing helps people dealing with an addiction to find a reason to change their behaviour and motivates them towards sobriety. With the help of an experienced therapist, patients will begin to recognise the benefits of recovery and take concrete steps towards the future life that they wish to live.

    This form of therapy does not treat the underlying causes of the substance or behavioural addiction, so is most effective when used in combination with other treatment methods such as detoxification and counselling.

    What are the Stages of Change?

    The Stages of Change model was developed in the 1970s and is based around the idea that behaviour change is not an instant decision – instead, it is a slow and cyclical process that requires a large amount of decision making and personal realisations.

    Within motivational interviewing it is thought that each person enters addiction recovery at a different stage on the model, and the therapist must determine where their client stands in regards to the idea of change. It is possible to move backwards on the model, particularly in cases of relapse in which the patient becomes demoralised.

    The five Stages of Change include:

    1. Precontemplation

    The individual has not yet considered the idea of change. They are resigned to their lifestyle and behaviour and are not likely to take positive action in the near future.

    An example of this stage is a person who habitually smokes cannabis every morning, afternoon and evening but manages to live a functioning lifestyle despite this addiction.

    2. Contemplation

    The individual has recognised that there may be benefits to making a change but has no plans to take concrete action.

    This person may have received a warning at work regarding their cannabis use and has decided to smoke in their car during work hours instead of the office bathroom.

    3. Preparation

    The individual has committed to the idea of taking action and making a change and has started to make a plan for their recovery.

    The person has now decided that they would like to stop smoking cannabis and has started to look into rehabilitation centres and treatment programmes in their local area.

    4. Action

    The individual has started to take steps towards change, but these steps may fluctuate on a daily basis. They are beginning to try to recover.

    The person may have started a treatment programme to recover from their cannabis addiction, but often thinks about smoking cannabis and occasionally relapses.

    5. Maintenance

    The individual has made positive changes to their life and has taken concrete action over time, with the ability to maintain these new behaviours.

    The person has now completed the treatment programme and continues to follow the aftercare programme, attending ongoing counselling sessions and local support groups. [2]

    Which addictions can motivational interviewing help to treat?

    Motivational interviewing can be adapted to work with a number of substance and behavioural addictions, as it is designed to complement the existing treatment programme and help the patient to feel motivated and enthusiastic about recovery.

    In the cases of substance addiction, the goal is to help the patient to recognise that their substance use is hindering them and that recovery would lead to a happier and more fulfilled life, whereas in the case of a behavioural addiction the patient must recognise the impact of their behaviour on themselves and those around them and feel motivated to change. [3]

    Substance addictions that can be treated with motivational interviewing include:

    • Alcohol addiction
    • Heroin addiction
    • Cocaine addiction
    • Cannabis addiction
    • Ecstasy addiction
    • Methamphetamine addiction

    Behavioural addictions that can be treated with motivational interviewing include:

    • Gambling addiction
    • Shopping addiction
    • Video game addiction
    • Sex and love addiction
    • Exercise addiction

    If you are struggling with an addiction that is not listed above, give our friendly and non-judgemental team a call. We have connections to the most effective rehabilitation centres in the UK and will be able to find a motivational therapy treatment programme to suit your needs.

    What are the benefits of motivational interviewing?

    As an effective complementary therapy treatment, motivational interviewing comes with a number of benefits that can help patients achieve their recovery goals.

    Common benefits of motivational interviewing include:

    1. Can trigger change

    Discovering the benefits of recovery and finding reasons to modify their behaviour can be the most effective way to trigger a change in a person struggling with addiction. It can open their eyes to the negatives of the situation and show them that a better life is waiting on the other side, motivating them to take positive action.

    2. Reduces the risk of relapse

    A common reason for patients to relapse after completing a treatment programme is due to the fact that they have no concrete reasons to continue with the strategies that they learned during recovery. In short, they don’t know what they are fighting for. When they identify their goals and motivation they suddenly have a reason to change their behaviour.

    3. Increases treatment engagement

    When a patient attends an addiction treatment programme with no clear motivation to change, their progress may be hindered and they are less likely to engage with the treatment. Finding a reason to change can help the patient become more interested and enthusiastic about the recovery process, as they are now focused on their goals and celebrating their successes.

    4. Encourages patients to help themselves

    As this treatment is focused on open-ended questions that allow the patient to come to their own realisations and conclusions, it is an extremely effective way to allow patients to help themselves and find their own reasons for motivation as opposed to simply being told what to do.

    5. What are the limitations of motivational interviewing?

    While motivational interviewing has been proven to be an extremely effective form of treatment for many people seeking help for a substance or behavioural addiction, it is important to be aware of the potential downsides of this type of therapy.

    Some limitations of motivational interviewing include:

    6. Not effective as a stand-alone form of treatment

    As motivational therapy primarily focuses on the positives of behaviour change and the many reasons to take action towards recovery, it does not address the physical and psychological aspects of addiction.

    Many people begin using substances and repeating self-destructive behaviours as a way to cope with trauma and difficult emotions, and this will not be resolved by simply recognising the benefits of change. Others are physically dependent on a particular substance and require medical detoxification which is not part of the motivational interviewing programme.

    7. May not take into account co-occurring disorders

    This form of treatment does not address co-occurring disorders such as depression which can prevent people from taking the steps required to effect positive change in their lives. Others may be suffering from PTSD which can not be treated with motivational interviewing, and severe mental health disorders such as schizophrenia or bipolar disorder will likely not benefit from this type of therapy.

    What does a typical motivational interviewing session look like?

    Motivational interviewing is not typically utilised as an individual treatment for addiction and will usually be included at the beginning, middle and end of the treatment programme.

    Before the treatment can begin, a professional assessment must first be undertaken in order to determine the severity of the addiction and any underlying factors that may not have yet been addressed. This may involve physical tests such as blood tests and a general heath check as well as a psychological evaluation to examine any potential co-occurring mental health disorders.

    During subsequent sessions, the therapist and patient will discuss the results of the assessment along with the role that addiction has played in their life. The primary goal of these sessions is to help the patient recognise that changing their behaviour will have a positive impact on their life.

    The therapist may ask a number of open-ended questions in order to encourage the patient to lead the conversation. These may include:

    • If you had to change your behaviour, what would you do?
    • Why do you think you have a problem?
    • What do you like about using substances/repeating the behaviour?
    • Why are you here today?
    • What do you think about the recovery process?

    The therapist will listen closely to the patient’s answers and reflect their own words back at them, a strategy that can build trust and establish a connection.

    Motivational interviewing is generally comprised of four individual sessions that are spread throughout the course of the treatment programme. It is designed as a complementary form of therapy that helps to amplify other treatment methods during recovery, making them more effective.

    References

    [1] https://www.ncbi.nlm.nih.gov/books/NBK64964/

    [2] https://www.ncbi.nlm.nih.gov/books/NBK64942/table/A61041/

    [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193639/

    [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463134/

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