Introduction Motivational Interviewing

Introduction
Motivational Interviewing
The views expressed in this article are
those of the author and do not
reflect the official policy of the
Department of Army/Navy/Air Force,
Department of Defense
Course Objectives
• Learn about motivational
interviewing as it applies to
substance use disorders
• Learn some basic skills in the
principles and practice of
motivational interviewing
Definition
What is motivational interviewing?
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Definition
Motivational Interviewing is a patient focused
psychotherapy that seeks to resolve
ambivalence about changing behavior.
Ambivalence & Change
 Inertia: The resistance of any physical object
to any change in its state of motion.
 Behavioral change proceeds through
identifiable stages.
 Motivational Interviewing recognizes and
responds to this fundamental principle
Stages of Change
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Evidence: Motivational interviewing
for substance abuse*
Meta-analyses based on 59 studies with a total
of 13,342 participants.
The results show that people who have received
MI have reduced their use of substances more
than people who have not received any
treatment.
* Motivational interviewing for substance abuse (Review)
Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM, Karlsen K The Cochrane Collaboration. Published by
JohnWiley & Sons, Ltd. 2011, Issue 11
Evidence: Motivational
interviewing for smoking cessation*
• Meta-analysis based on 28 studies
involving over 16,000 participants.
• Interventions were delivered by
primary care physicians, hospital
clinicians, nurses or counsellors.
• Motivational interviewing appears to
help more people quit smoking than
brief advice or usual care when
provided by general practitioners and
by trained counsellors
*Motivational interviewing for smoking cessation. Lindson-Hawley N, Thompson TP, Begh R: The Cochrane Library. 2015, Issue 3
Clinical Considerations
In terms of substance use disorders – “as many
as 70% of patients are in the precontemplation
or contemplation stage when presented with
the diagnosis.”
Chapter 56. Substance Use Disorders
Robert Mallin, MD; Joseph J. Benich III, MD in CURRENT Diagnosis & Treatment in Family Medicine accessed
http://accessmedicine.mhmedical.com/content.aspx?sectionid=40349451&bookid=377&jumpsectionID=40356455&Resultclick=2
Clinical Considerations
Given the high degree of potential patient
resistance to a substance use disorder diagnosis
what can be done?
Chapter 56. Substance Use Disorders
Robert Mallin, MD; Joseph J. Benich III, MD in CURRENT Diagnosis & Treatment in Family Medicine accessed
http://accessmedicine.mhmedical.com/content.aspx?sectionid=40349451&bookid=377&jumpsectionID=40356455&Resultclick=2
Death Glossary: Pitfalls to Avoid When
Presenting the Diagnosis.
Drinking or drug use details are not relevant.
Etiology
Arguments
Threats:
Hedging
Hedging: Source: Modified, with permission, from Schulz JE, Parran T Jr: Principles of identification and intervention. In: Graham AW, Shultz TK, eds: Principles of
Addiction Medicine, 2nd ed. American Society of Addiction Medicine, 1998.
Chapter 56. Substance Use Disorders
Robert Mallin, MD; Joseph J. Benich III, MD in CURRENT Diagnosis & Treatment in Family Medicine accessed
http://accessmedicine.mhmedical.com/content.aspx?sectionid=40349451&bookid=377&jumpsectionID=40356455&Resultclick=2
Pitfalls in Discussing the Diagnosis
*Motivational interviewing for smoking cessation. Lindson-Hawley N, Thompson TP, Begh R: The Cochrane Library. 2015, Issue 3
Discussing the Diagnosis
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A Right Way
Available for FREE from
SAMHSA :
http://store.samhsa.gov/pr
oduct/TIP-35-EnhancingMotivation-for-Change-inSubstance-AbuseTreatment/SMA13-4212
Changes in Addiction Practice
based on Motivational Interviewing
• Focus on Client Competencies And Strengths
• Individualized and Client-Centered
Treatment
• A Shift Away From Labeling
• Therapeutic Partnerships For Change
• Use of Empathy, Not Authority and Power
• Focus on Earlier Interventions
• Focus on Less Intensive Treatments
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Instruments for Measuring
Readiness for Change
Readiness To Change Questionnaire
(Treatment Version)
Readiness To Change Questionnaire (Treatment Version)
(RCQ-TV) This instrument is copyrighted and may be
obtained by contacting: Professor Nick Heather
Consultant Clinical Psychologist Newcastle City Health
NHS Trust Northern Regional Drug and Alcohol Service
Newcastle upon Tyne United Kingdom
FRAMES
Elements of Effective Motivational Interventions
Tipping the Decisional Balance
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Questions to Tip the Balance
Emphasize Personal Choice
and Responsibility
• “It’s up to you what to do about
this.”
• “No one can decide this for you.”
• “No one can change your drug use
for you. Only you can.”
• “You can decide to go on drinking
or to change.”
Importance of Self-Efficacy
Motivational Strategy for
Precontemplation
Motivational Strategy for
Contemplation
Motivational Strategy for Moving
Towards the Action Stage
Motivational Strategy for Moving
Towards the Action Stage
Motivational Strategies: Relapse
Triggers
…One of my relapse
triggers is my social
circle
(1) go out with a different set of friends,
(2) go along with this group only for activities that do not
involve drinking,
(3) leave the group as soon as drinking seems imminent, (4)
(4) tell the supplier that she is trying to stay off cocaine and
would appreciate not being offered any,
(5) ask all her friends, or one especially close friend, to help
her out by not using when she is around or by telling the
supplier to stop offering it to her
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