The Motivational Interviewing Approach

Motivational interviewing (MI) is a counseling technique which assists the interviewee in identifying the internal motivation to change the client’s behavior by resolving ambivalence and insecurities. The term holds similar meaning when it comes to interviewing an individual with substance abuse background. The main aim of Motivational interviewing is to facilitate the intrinsic motivation of the person with a substance use problem to change the behavior. It is a patient-centered approach which aims to help people change their problem behaviors. Similarly, it also facilitates movement towards achieving this goal by consolidating commitment to change.

Motivational interviewing is a process which might take weeks to months. In this process, the client verbalizes arguments of behavior change. Similarly, during this process, the client’s experience of the discrepancy between their behavior and present or future goals can be a significant motivating factor for change. In the past, traditional confrontation approach was used to deal with substance use problems, but this approach was not effective. Hence, in response to the concerns about this approach, Motivational interviewing was developed. There is a high prevalence of substance use and adverse effects in young population worldwide. Similarly, licit and illicit drugs like alcohol and cannabis are commonly used drugs among the youth population worldwide.

Furthermore, use of these substances co-occurs with various mental illnesses such as depression, anxiety and psychotic disorders. Substance use is a preventable cause of adverse events such as injury, disability, mental illness, social, legal and financial outcomes and death. Although with a high prevalence of substance use and the adverse effect, only twenty percent of the youth seek professional help. The reason behind it might be the stigma associated with the treatment and moreover, people with substance use disorder do not see it as a problem. MI helps such clients to get insight into the problem.

MI is considered as an effective treatment for alcohol use in adults compared with no treatment. Similarly, it has a solid impact on youth alcohol use and its adverse effect. Though there is the number of interventions available for the treatment of substance use; motivational interviewing has proven to be famous because of its effectiveness and simplicity. According to the Australian Department of Health (DoH), 2004, there basically are five principles surrounding the distinct interview technique, which is discussed further down. First of all, reflecting and accepting the aftermath of drug misuse is fundamental for change. Hence, an empathetic approach is the preliminary step of MI where the problems are identified. Secondly, clients are made aware of the costs their current behavior can have in their future. Once they are ready for change, they are taught the ways of modifying it, by setting goals and staying motivated onto it. When discussing strategies for a change it is not uncommon to meet resistance from clients during the process. As an interviewer, it is easy to lose ground and argue on the established misconception that substance abuse is detrimental and people need to be detoured from this path at any cost. Undoubtedly, this approach has the counter-effect on the clients.

The defending nature of the interview rather helps to generate the feeling of defensiveness among the clients. However, not all arguments lead to failure, because discussing on opinions also serves as a platform to give rationale and use the momentum as an advantage. It is absolutely necessary as an interviewer to understand that depriving the addiction out of an individual’s body and mind is not easy. Under such circumstances, the prime motive should be on listening and motivating them using their own strengths. This situation can be dealt by rolling over the resistance which helps to aid the change in perception without actually imposing one. Thus, approaching empathetically, developing discrepancies, avoiding disruptive arguments and focusing on calculated discussions and supporting self- efficacy is unique to MI.

Recent meta-analysis has shown that MI techniques are efficacious in decreasing alcohol, cigarette smoking and drug use in younger adults and adolescents and contributes to high treatment adherence rates. Likewise, an article by Sarpavaara (2015), overviews the importance of MI in identifying the importance of ‘significant others’ in the lives of a substance abuser in terms of their aspiration, motivation and hindrance for change. This article highlights the fact that the role these close ones play, in the lives of an abuser, should not be overlooked. Similarly, one article on smoking cessation suggests that higher rates of treatment success could be achieved if counselors promote client activation statements in favor of abstinence and often client’s utterances in terms of desire or perceived need to smoke. Additionally, counselors’ demonstration of the spirit of MI was a statistically significant predictor of outcome.

Similarly, a study carried out on Prisoners shows a positive effect of MI on their behavior. The study was carried out in three groups of prisoners where MI was provided to them, and at the end of the session and follow up, it was found that there was a reduction in the use of drugs as well as illegal activities and increased days working. Furthermore, a research done by Donna M et al. shows that BMI (Brief Motivational Intervention) is effective among mandated and volunteer students in decreasing consumption of substance use. Motivational interviewing reduces substance use in adolescents with one or more psychiatric disorder. It results in a delay in time to first use of any substance after discharge from the hospital. Similarly, it reduces a frequency of any substance use and of marijuana use reported during the first six-month post discharge from hospital.

MI empowers clients to overcome ambivalence regarding the positive change. The counselor uses an empathetic approach to help the client analyze the areas of ambivalence and furthermore, provides a client with the idea to change those areas. For example, a client who likes substance use might be aware of the negative effect. Clients like this usually have a mixed feeling about change in their behavior. MI supports them to come out of this confusion. It helps them to gain insight into the problem. Similarly, the therapist makes use of open-ended questions and elicits change talk from the client. This approach helps to engage clients in the therapy session leading to positive change in the behavior.

One of the greatest challenges in substance use patient is adherence to treatment. MI enhances client engagement and increases adherence to the treatment by bringing out their own motivation. The therapist explores and resolves ambivalence which helps in bringing out motivation in a patient. People with substance use generally have an ambivalent feeling regarding the substance use. This technique provides motivation through the gradual process of negotiation where the client explores the causes for his maladaptive behavior. Similarly, as this approach is not confrontational, so, it creates a friendly environment for the clients to express themselves which increases the rate of adherence to the treatment session. Last but not least, when a person understands the meaning of substance use, its effect on their physical body and mind and is ready for help, it is important for them to believe that change is possible for which staying motivated is quite essential.

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