The University of Arizona
 

Illicit Drug Screening, Brief Intervention, and Treatment Placement
Brief Interventions:
Use of Motivational Interviewing

One of the key methods associated with brief interventions is motivational interviewing, which is an empathic, respectful philosophy and set of techniques for promoting behavior change. Motivational interviewing was originally developed by William Miller to increase the likelihood that heavy drinkers would reduce their drinking[1], and has been slightly adapted in other clinical trials and settings.  Motivational interviewing incorporates strategies that are designed to enhance clients’ motivation for change, address ambivalence about change, and emphasize client responsibility and ability to make choices.[2]

Principles:  Motivational interviewing incorporates the following principles:

  • Empathy, reflective listening
  • Respect and acceptance
  • Nonjudgmental, collaborative relationship
  • Supportive, knowledgeable consulting
  • Positive focus
  • Listening, not telling
  • Change is up to the client
  • Support
  • Helping the client recognize discrepancies between goals and behavior
  • Avoiding confrontation
  • Adjusting to client resistance
  • Supporting the client’s self-efficacy and optimism

Skills:  Five of the key skills used in motivational interviewing are:

  • Open-ended questions
  • Reflective listening
  • Affirmations
  • Summarizing
  • Eliciting self-motivational statements

Open-ended questions are useful because they call on clients to provide a breadth of information.  An example of such a question is: “How do you feel about your methamphetamine use?” This question communicates that you really want to understand the client rather than just push for a decision. It may also garner more important information about positive and negative aspects of substance use.

Reflective listening merely mirrors what the client says without adding any further meaning. Reflective listening says: “I hear you; I’m not judging you; this is important; please tell me more.” An example of reflective listening is: Client’s statement: “My boyfriend gets really angry when I get high and pass out.” Reflective listening: “So, he gets mad when you get high.” This simply restates and encourages the client to say more and avoids passing judgment.

Affirmations convey respect and understanding. They gently encourage more progress. Also, when clients feel respected, they feel freer to reveal less positive information about themselves. Examples of affirmations are: “You are very courageous to be so revealing about this.”

Summarizing involves reflecting back to the client the essence of what the practitioner has heard over some period of time. Example of summarization: “What you said was important to me, and here’s what I heard; did I get that right?” If so, “great, let’s move on.”

Eliciting self-motivational statements is a critical skill for clients who are not committed to change. There are four areas of questioning that can help elicit these concerns:

  • Problem recognition: “How has your drug use created problems for you?” and “How do you think you’ve been hurt by your drug use?”
  • Concerns: “What worries do you have about smoking crack?” and “What are you afraid might happen if you continue to use heroin?”
  • Intention to change: “Using a scale of 1 to 10, with 10 being the highest, how important is it for you to stop using meth?” If an individual responds "6", ask why he or she did not say "7" or "5." This may help elicit the reasons why an individual would want to change.
  • Optimism: “What difficult goals have you achieved in the past?” Clients can also rate their confidence in their ability to change. Their responses will help uncover the strengths they can bring to their attempts at behavior change.

 

References

  • (1) Miller WR. Motivational interviewing with problem drinkers. Behavioral Psychotherapy 1993;11:147-72.
  • (2) SAMHSA. TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment. Rockville, MD: U.S. Department of Health and Human Services; 1999.