Motivational Interviewing for Alcohol Addiction

Not everyone who enters treatment for substance use disorder is ready for change.1 That’s okay. Getting sober can be scary. You may fear the unexpected, dread withdrawal symptoms, and wonder how you will avoid relapse.

Licensed addiction specialists help you figure out internal motivations or reasons to stay in treatment and get sober. They do this using specially formed communication tools, like motivational interviewing.2

In this article:

What Is Motivational Interviewing?

Motivational interviewing is a collaboration with your licensed addiction therapist. It uses questions to help you explore your substance use disorder and work through resistance to change. You will create goals for working toward what you want to happen in your life. Your therapist plays a supportive role in this process, but does not decide which goals you should pursue—you are in control of the outcomes you want to see.2

Motivational interviewing consists of: 2

  • Collaborations rather than confrontations
  • Allowing you to talk rather than your therapist giving advice and education
  • Autonomy, or enabling you to be in charge of how you move towards recovery

Issues of control play a key role in the development of addiction and in recovery from it. Some therapeutic activities do not work for certain people because they consist of following the strict treatment plan established by a therapist or doctor with little personal input. While these treatment frameworks can help some individuals, such as those who do not know the next step to take or who are unable to make decisions without the direction and empowerment of their care team, especially in early recovery. For other individuals, this framework, can lead to a feeling that you have lost control over your treatment and are simply going with the flow, preventing you from fully engaging in recovery.2

Motivational interviewing helps you regain and maintain a sense of control, which motivates you to keep moving forward and making progress.2

Motivational interviewing is often used as a supplement to other therapies, like cognitive-behavioral therapy (CBT). Motivational interviewing techniques include:3

  • Engagement—This is when you and your therapist get to know one another and start to build trust.
  • Focus—This is when you and your therapist figure out the main areas of focus of your recovery.
  • Evoking—This is a powerful step. Here, you develop reasons and arguments for change.
  • Planning—With your therapist’s help, you envision change, set goals, and list resources you can use to help you reach those goals.

What Is OARS Motivational Interviewing?

Therapists can also use the OARS method to help you during any part of the motivational interviewing process.4

OARS is an acronym for:4

  • Open-ended questions—To get the most out of the OARS motivational interviewing technique, it is important not to ask yes or no questions. Asking open-ended questions helps you provide more profound, more thought-provoking answers. They allow you to dig deeper to figure out why change would be suitable for you.4
  • Affirmations— When struggling with a substance use disorder, you may not always see your strengths and positive qualities to help you recover. With affirmations, your therapist can bring these to light, pointing them out throughout treatment.4
  • Reflection— Reflections are an excellent tool for showing you that your therapist hears you and understands what you say. It keeps you engaged when you know your therapist gets it, can empathize with your situation and recognizes you are worth much more than your addiction. It also helps your therapist summarize everything they have learned from your conversation. Together, you can use this information to set goals for recovery.4
  • Summarizing—Therapists may summarize to help link two ideas or statements you had, wrap up a session or transition to another question, or collect information further.4

How Is Motivational Interviewing Used in Addiction Treatment?

Drug and alcohol use can trick you into thinking recovery is not possible, that you are not worthy of recovery, or that you cannot survive without using substances. Thoughts like this may make it difficult for you to see that you can succeed in recovery.

In the addiction setting, whether inpatient or outpatient, there is an order to motivational interviewing. The first step is to assess your readiness for change. Some use a readiness ruler. Some therapists may do this with an actual survey, and others may determine this through communication.

They may gauge your readiness for change as: 8

  • Not ready
  • Not as ready as you are to do other things
  • Equally important to other goals
  • More important than most goals
  • The most important thing right now

Your therapist will then ask you to reflect on your answer. If you are not ready, your therapist may want to explore the other goals more critical than sobriety. The therapist may ask you other questions to help you explore reasons change could be a good thing in your life. The goal is to help you recognize what getting sober could mean for you.8

Communication continues in examining how current behaviors make it impossible to achieve goals. Therapists may want to assess your level of confidence in yourself to make changes. Some with a substance use disorder do not feel they have the skills to make changes, while others are confident in their abilities to change.8

Motivational interviewing works best for those who are reluctant to change. If you are unmotivated or unprepared for change, motivational interviewing can be beneficial. It can also help those who are defensive, angry, or hostile about the possibility of getting sober.10

Motivational interviewers will ask questions to eliminate ambivalence to change. They want you to see the advantages of change, become more aware of the problem, and increase your intent to change.7

It does this by: 8

  • Building your self-confidence
  • Helping you learn to trust yourself and the process of recovery
  • Helping you take responsibility for your actions
  • Showing you that you have the power to make positive changes
  • Helping you realize you can get sober
  • Working through the reasons why you are resistant to addiction treatment

Motivational interviewing is designed for anyone reluctant to behavioral changes.8

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Motivational Interviewing Questions

When implementing the OARS components, motivational interviewing questions like the following may be used by your therapist:7

You can expect your therapist to respond with affirmations like:7

  • I’m grateful you are willing to share that with me.
  • You’ve accomplished a lot.
  • You’ve tried hard to quit.
  • You’ve done well at keeping up with your responsibilities.

Reflective and summarizing statements may start with:7

  • Let me tell you what I heard you say.
  • Did I hear this correctly?
  • This is what I understand so far.
  • So, you feel…

Other methods used in motivational interviewing include developing discrepancy, expressing empathy, amplifying ambivalence, rolling with resistance, and supporting self-efficacy. The way these work in an addiction setting, your therapist will ask questions or make statements geared to help you connect your thoughts to your behavior patterns.9

  • Developing discrepancy helps your therapist point out differences heard during conversations, like how current behaviors prevent you from accomplishing goals.9
  • Expressing empathy allows your therapist to try and put themselves in your shoes to understand better what you are going through and why it may be hard for you to be motivated for change.9
  • Amplifying ambivalence helps you verbalize why change is so hard. Getting it out in the open can often help you move past it.9
  • Rolling with resistance is mainly for the motivational interviewer. When they are met with resistance to a question or statement, it tells them they need to change directions and avoid becoming confrontational or authoritative. It’s important they let you remain in control.9
  • Supporting self-efficacy is your therapist’s way of showing you there is no one way or “proper way” to change. Allowing you to find your format to change can be powerful.9

Is Motivational Interviewing Right for Me?

Motivational interviewing can benefit anyone who needs help finding their “why” to continue in substance use recovery. Motivational interviewing is often recommended for individuals who have mental health conditions, physical health issues, or life circumstances that complicate their addiction, such as attending a “party school.”

Motivational interviewing can help people who need to manage these additional issues by staying on track with recovery. For example, it can be difficult to make dietary changes to manage the symptoms of health issues such as diabetes, especially when working through the challenges of giving up substance use. With motivational interviewing, you can develop concrete personal reasons to make the recommended dietary changes and set goals to do so in an achievable way over time that does not threaten your ability to focus on recovery. 10 Motivational interviewing can also be used to help individuals who acknowledge the need to form new social networks, but find the idea of making new friends overwhelming, such as teenagers with alcohol use disorder.

When seeking motivational interviewing to help you become more ready for entering or progressing through the recovery process, look for a clinician who is trained and licensed in the field of mental health or addiction-related disorders with experience and education in this therapeutic modality.11 Don’t be afraid to ask them if they are familiar with motivational interviewing.

You can also contact us at 800-839-1686Who Answers? to be connected with a treatment facility that implements motivational interviewing and can meet you wherever you are in the process of recovery, even if you are not sure how ready you are to stop using alcohol or other substances. Motivational interviewing is a way to start the conversation about getting addiction treatment.

Resources

  1. Lussier, M. T., & Richard, C. (2007). The motivational interview: in practice. Canadian family physician Medecin de famille canadien, 53(12), 2117–2118.
  2. Resnicow, K., & McMaster, F. (2012). Motivational Interviewing: moving from why to how with autonomy support. The international journal of behavioral nutrition and physical activity, 9, 19.
  3. Randall, C. L., & McNeil, D. W. (2017). Motivational interviewing as an adjunct to cognitive behavior therapy for anxiety disorders: A critical review of the literature. Cognitive and behavioral practice, 24(3), 296–311
  4. Substance Abuse and Mental Health Services Administration. (2019). Enhancing Motivation for Change in Substance Use Disorder Treatment. TIP 35.
  5. Hesse M. (2006). The Readiness Ruler as a measure of readiness to change poly-drug use in drug abusers. Harm reduction journal, 3, 3.
  6. Hardcastle, S. J., Hancox, J., Hattar, A., 7. Maxwell-Smith, C., Thøgersen-Ntoumani, C., & Hagger, M. S. (2015). Motivating the unmotivated: how can health behavior be changed in those unwilling to change? Frontiers in psychology, 6, 835.
  7. Washington State Department of Health. (2012). OARS Practice.
  8. S. Department of Health and Human Services. (2001). Substance Abuse and Mental Health Services Administration. Quick Guide for Clinicians Based on TIP 35 Enhancing Motivation for Change in Substance Use Disorder Treatment.
  9. Center for Substance Abuse Treatment. (2005). Substance Abuse Treatment for Persons With Co-Occurring Disorders. (Treatment Improvement Protocol (TIP) Series, No. 42.) [Table], Guiding Principles of Motivational Interviewing.
  10. Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. Annals of family medicine, 12(3), 270–275.
  11. Madson MB, Villarosa-Hurlocker MC, Schumacher JA, Williams DC, Gauthier JM. (2019). Motivational interviewing training of substance use treatment professionals: A systematic review. Substance Abuse, 40(1), 43-51.

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