The Basics of Alcohol Motivational Interviewing

Motivational interviewing (MI) to resolve alcohol addiction has had mixed success. MI is only one type of counseling available and works well with some patients but not others. The goal of MI is to change an alcoholic's motivation. The concept of MI was first discussed by Professor William R. Miller in a 1983 article in "Behavioral Psychotherapy."

Interviewing Techniques

• Dr. David B. Rosengren of the National Health Care for the Homeless Council details the five main principles of MI used in alcoholic counseling. The meeting leader or counselor should be certified in MI techniques before attempting to help an alcoholic. The first principle of MI is to explain the gap that exists between the patient's view of himself and his actions through the interview process. To attain their goal, therapists use non-judgmental questions in order to get the patient to realize their problems from within, rather than having an authority figure tell them what is wrong. For example, a therapist may ask a woman if she is a good mother, then what she thinks the qualities of a good mother are, then ask how much time she spends at a bar rather than at home. MI avoids the use of labels. If a man asks the MI therapist if she thinks that he is an alcoholic, the MI therapist will generally reply with a question such as, "Do you think of yourself as an alcoholic?"

Overcoming Trust Issues

• An MI alcohol therapist rolls with resistance. If the patient becomes defensive or argumentative, a good MI counselor will change the line of questioning. The therapist must instill a sense of "I can do it" to the client. The therapist may ask the client to describe accomplishments and times they overcame difficulty to inspire the client to believe she can change. The therapist must express empathy for the client and create an atmosphere of openness and honesty. When the client trusts the therapist, he will be willing to share feelings and past behaviors, and be willing to trust that the therapist has his best interest at heart.

Outcomes

• 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 counseling; some were offered MI, and others were not. There was no significant effect on returning to addictive behavior between the two groups. MI's success depends a great deal on the client not being in denial, being willing to change and the therapist being knowledgeable and effective in MI principles.