Motivational Interviewing for Drug Addiction

Motivational interviewing (MI) is a relatively new therapy designed to help patients through various mental illnesses and to resolve alcohol or drug addiction. It has met with mixed results. MI is only one type of drug counseling available. It works well with some patients, but not others. The goal of MI is to change a drug addict's motivation for using drugs, eliminating the need and inspiring her to become a productive member of society.

Principles

• The concept of motivational interviewing was first discussed by Professor William R Miller in a 1983 article in, "Behavioral Psychotherapy." Dr. David B. Rosengren, of the National Health Care for the Homeless Council, details the main principles of MI to be used in counseling. The meeting leader or counselor should be certified in MI techniques before attempting to help an alcoholic or drug addict. Dealing with drug addicts requires a firm grasp of MI principles.

Goals

• The first step in MI is for the meeting leader to interview the drug addict and gently attempt to detail the gap that exists between the client's view of himself, and his actions. For example, a therapist may ask a young man what his future goals are. He may say that he wants to be a doctor or athlete. The therapist would then ask how the client is doing in school or in team sports. The therapist would use questions to bring the patient to understand that use of drugs and a future in the medical profession or as a professional athlete cannot mix.

Details

• MI therapists ensure that questions are non-judgmental and do not use labels. The goal of MI is to get the patient to realize her problems from within, rather than having an authority figure tell her what is wrong. A good MI counselor is able to work around resistance. If the patient becomes defensive, the counselor will change the line of questioning. The therapist's goal is to instill a sense of "I can do it" to the client. The therapist may ask the client to describe times she overcame difficulties and challenges. This motivates the drug addict to believe she can change. The MI therapist expresses empathy for the client and creates an atmosphere of openness and honesty. When the patient trusts the therapist, he will be willing to be more descriptive of feelings and past behaviors, and understand that the therapist has his best interest at heart.

Weaknesses

• Some of the weaknesses of MI include not having a way to deal with drug addicts that are not ready for feedback. A client in denial will be unaffected by MI questions and advice. For example, a person that does not believe her cocaine addiction is affecting her career or personal life, may never be able to realize that it is. Even if she gets fired for missing a week of work, she will blame the boss and not the disease. Another drawback is that a drug addict may become motivated to change within a therapeutic environment, but once placed back within the "real world," friends and peer pressure may cause a relapse.

Study

• In a study by the University of New Mexico Center on Alcoholism, Substance Abuse and Addictions by William R. Miller, Paul Amrhein, Carolina E. Yahne, and J. Scott Tonigan, over 200 patients were given or not given MI. There was no significant effect on returning to addictive behavior between the two groups. Patients had been showing strong commitment to change until the therapist switched from empathizing with the client, to giving assessment feedback and pressing for an actual plan of change. At this point many of the clients became resistant.