Motivational Interviewing Therapy for Substance Use By: Sara Polley, MD

“If you aren’t ready to change, then there is no point in seeking help for your substance use.”
“You need to hit rock-bottom, then you will know you have a problem and be ready for treatment.”

Did you know that the above statements are misconceptions about caring for individuals with substance use difficulties? Ambivalence, which is having mixed or contradicting feelings, about treatment is a normal part of substance use and recovery. The type of treatment that helps individuals recognize their need for behavioral change and supports them in making change is called Motivational Interviewing (MI) or Motivational Enhancement (ME).

MI/ME was created to be a patient-centered treatment, meaning that it is guided by the patient’s goals rather than what the clinician sees as a problem. A core principle of MI/ME is that change comes about when an individual is ready and makes the choice for themselves. The MI/ME clinician helps a patient to move toward change by joining with them, having respect for their opinions and beliefs, and helping them identify when their substance use may be holding them back from meeting their goals or living the life they would like.

There are specific terms and strategies used to identify a patient’s stage of change and a patient can receive effective treatment even before they recognize there is a problem, as long as they are willing to come to appointments to talk about their substance use.

Clinicians who practice MI/ME to help with substance use disorders work on helping patients identify the benefits and draw backs of their use, listen for and emphasize the patient’s own thoughts and feelings which may motivate change, and offer direct interventions when the patient is ready.  MI/ME explains that confronting a patient or attempting to convince them of their problem will only create defensiveness and drive them away from treatment.

In young people, MI/ME can be an ideal form of intervention. It provides the young patient with a sense of control and autonomy, which makes continued participation more likely. In addition to supporting individuals who have a substance use disorder, MI/ME can be helpful for those with at-risk substance use in that it promotes healthier choices and decreases the likelihood use will progress to an addiction.

Dr. Polley sees patients in the PrairieCare Brooklyn Park Medical Office Building in the Partial Hospital Program and the Dual Diagnosis Intensive Outpatient Program and Clinic.

Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.) Chapter 3—Motivational Interviewing as a Counseling Style. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64964/