Substance Abuse Treatment Utilizing Motivational Interviewing (MI)
Motivational Interviewing (MI) is a goal-directed, client-centered counseling style for eliciting behavioral change by helping clients to explore and resolve ambivalence. The operational assumption in MI is that ambivalent attitudes or lack of resolve is the primary obstacle to behavioral change, so that the examination and resolution of ambivalence becomes its key goal. MI has been applied to a wide range of problem behaviors related to alcohol and substance abuse as well as health promotion, medical treatment adherence, and mental health issues. Although many variations in technique exist, the MI counseling style generally includes the following elements:
- Establishing rapport with the client and listening reflectively.
- Asking open-ended questions to explore the client’s own motivations for change.
- Affirming the client’s change-related statements and efforts.
- Eliciting recognition of the gap between current behavior and desired life goals.
- Asking permission before providing information or advice.
- Responding to resistance without direct confrontation. (Resistance is used as a feedback signal to the therapist to adjust the approach.)
- Encouraging the client’s self-efficacy for change.
- Developing an action plan to which the client is willing to commit.
Adaptations of the MI counseling approach that are reviewed in this summary include a brief intervention for college-age youth visiting hospital emergency rooms after an alcohol-related event; a brief intervention for adult patients with histories of heavy drinking presenting to primary medical care settings for routine care; and a brief intervention for cocaine and heroin users presenting to urban walk-in medical clinics. Community-based substance abuse treatment clinics also have incorporated an MI counseling style into the initial intake/orientation session to improve program retention (also reviewed below).
Descriptive Information:
| Areas of Interest | Substance abuse treatment |
| Outcomes | 1: Alcohol use 2: Negative consequences/problems associated with alcohol use 3: Drinking and driving 4: Alcohol-related injuries 5: Drug use (cocaine and opiates) 6: Retention in treatment |
| Outcome Categories | Alcohol Crime/delinquency Drugs Family/relationships Social functioning Trauma/injuries Treatment/recovery |
| Ages | 18-25 (Young adult) 26-55 (Adult) 55+ (Older adult) |
| Genders | Male Female |
| Races/Ethnicities | Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified |
| Settings | Outpatient School Other community settings |
| Geographic Locations | Urban Suburban |
| Implementation History | MI has been implemented extensively at hundreds of sites worldwide since 1983. Thousands of participants have received the brief MI intervention described in this summary, which has been evaluated in at least 22 research studies for problem drinking alone. Outside the United States, MI has been implemented in Australia, Canada, France, Germany, Italy, Mexico, the Netherlands, New Zealand, Norway, South Africa, Spain, Sweden, and the United Kingdom. Translations of MI books are available in Bulgarian, Chinese, Czech, Danish, Dutch, Estonian, French, German, Greek, Italian, Japanese, Korean, Portuguese, Romanian, Spanish, and Swedish. |
| NIH Funding/CER Studies | Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes |
| Adaptations | Specific applications and adaptations of MI are described in detail in "Motivational Interviewing: Preparing People for Change (2nd Ed.)" by W. R. Miller and S. Rollnick (2002). Specific adaptations have been tailored to address a variety of health issues, such as diet and physical activity change, HIV risk prevention, smoking cessation, and medication compliance. The authors describe in detail how far MI can be adapted "before its goals, skills, and spirit are diluted beyond recognition." |
| Adverse Effects | No adverse effects, concerns, or unintended consequences were identified by the applicant. |