Adult Assessment & Intervention with Substance Abuse

3. Motivational Interviewing

Motivational interviewing is a counselling approach based on the principle that all human behaviour is motivated. It acknowledges that many people experience ambivalence when deciding to make changes – they both want and don’t want to change. It also acknowledges that people can perceive both the advantages and disadvantages of changing, or continuing, with their current drug use behaviour. The aim is not to immediately focus on the action of changing, but working to enhance motivation to change.

Brief motivational interviewing has two areas of exploration to assess the client’s motivation – the importance of the drug use and how confident they are that they can make the change.

The worker’s role in motivational interviewing is to:

• explore positive and negative consequences of drug use
• provide opportunity to explore the client’s specific concerns
• use reflective listening and summaries to understand and communicate understanding
• elicit self-motivational statements
• help the client decide whether to change

Avoid arguing with the client; imposing a label on them i.e. alcoholic, user; telling them what they must do; or trying to break down denial with confrontation.

It should never feel as though you are confronting the client but rather that you and the client are confronting the problem(s) together.

There are the five counselling techniques that are effective for this.

1. Express empathy – acceptance facilitates change
2. Avoid arguments – resistance is a signal to change strategies
3. Look for inconsistency – consequences that conflict with important goals will favour change
4. Roll with resistance – use this to look for solutions with the client
5. Support self responsibility - the client is responsible for choosing and carrying out change

To learn more about motivational interviewing, go the motivationalinterv.org web site.

To see slides with video clips explaining and demonstrating motivational interviewing/brief intervention techniques, go to the BNI-ART Institute (Brief Negotiated Interview and Active Referral to Treatment) web site maintained by the Boston University School of Public Health. Click on the Curriculum link on the left side of the page. Click on Brief intervention techniques when it drops down.