Motivational interviewing, also known as Motivational Enhancement Therapy or MI, uses a stages-of-change approach that has been proven effective in treating alcohol addiction and substance abuse. It is a client-centered, goal-oriented approach to counseling, with the objective to increase a person’s intrinsic motivation for behavior change through the exploration and resolution of ambivalence, according to a report by the Substance Abuse and Mental Health Services Administration’s National GAINS Center. (1)

The aims of motivational interviewing are to increase a person’s motivation for behavior change and to strengthen that commitment to change. The spirit of this approach emphasizes collaboration over confrontation, evocation over education, and autonomy over authority.

That may sound a bit like “therapist speak,” but it is really nothing more than focusing on the client’s goals and achieving them one step at a time. Plans are individualized to the person, creating a personalized approach that is the opposite of other one-size-fits-all methods.

Motivational Interviewing allows therapists to embrace all the issues people bring to treatment and address them, meeting individuals where they are, and moving through the process with them.

The technique has four guiding principles (2):

  • Expressing empathy
  • Developing discrepancy
  • Rolling with resistance
  • Supporting self-efficacy

A History of MI

Motivational Interviewing was initially designed to reduce alcohol use, but it has since grown. The definition of Motivational Interviewing has been refined since it was first developed by William R. Miller in 1983. Today, the approach is often combined with other interventions and techniques; the methodologies together have been found to be more effective than alone.(3) Several systematic reviews of adaptations of motivational interviewing (where it is the core but not the sole technique used to enhance motivation for behavior change) have found support for its effectiveness addressing substance abuse, particularly where the intervention was focused on reduced use of drugs and/or alcohol and adherence with intensive substance abuse treatment.(3)

What Sets MI Apart

When it comes to Motivational Interviewing, the method is respectful, building upon a rapport between a patient and counselor. Trust is key, as a patient is encouraged to use identification, examination and resolution of ambivalence to change their own behavior.

In contrast to other methods, MI is not “coercive,” and there aren’t external forces imposing change on the patient. Instead, it’s change that comes from within. It’s collaborative, with motivational interviewing being used a guide to elicit and strengthen and individual’s own motivation for change.

A skillful MI practitioner is attuned to a patient’s level of ambivalence and can sense their readiness for change, thoughtfully utilizing techniques and strategies that will meet them where they are at the moment.

MI’s Proven Effectiveness

A meta-analysis of 30 controlled clinical trials of motivational interviewing found significant, small to moderate effect sizes of motivational interviewing in the areas of alcohol use, drug use, diet and exercise, and social impact (problems related to the target behaviors, for example the number of workdays missed because of substance use) when compared with control groups that received no treatment. Overall, motivational interviewing was found to be effective. (4)

Motivational interviewing is an effective approach for changing behavior related to substance use and promoting engagement with and adherence to treatment among people with mental and co-occurring substance use disorders. Essentially, MI is a collaborative conversation to strengthen a person’s own motivation for and commitment to change. It’s a tool, that when used properly can help those in treatment for co-occurring disorders see positive results.

If you or a loved one is struggling with an addiction and co-occurring disorder, call us today. We’re available 24 hours a day, seven days a week and can provide information on treatment programs, help with insurance and answer questions about the treatment process.

  1. SAMHSA’s National GAINS Center (2011). Motivational Interviewing. Substance Abuse and Mental Health Services Administration.
  2. Miller, W.R. (1996). Motivational interviewing: Research, practice, and puzzles. Addictive Behaviors, 21, 835- 842.
  3. Burke, B.L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta- analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843-861.
  4. Miller, W.R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford Press.
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