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Types of Evidenced-Based (Effective) Treatments for Addiction: Motivational Interviewing

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

We have already discussed how a treatment approach is determined to be effective. Here we review and describe some of the most well-known, effective treatment approaches for addiction.

Motivational Interviewing

Motivational Interviewing (MI) is a brief psychological intervention. It assists prospective therapy participants to sort through their ambivalence toward change. This type of ambivalence is characteristic of the pre-contemplation and contemplation stages of change.

therapist and patientAs the name implies, the goal of motivational interviewing is to strengthen the motivation to change. We accomplish this by encouraging an accurate appraisal of the costs and benefits of change. Unlike some types of addiction treatment that attempt to coerce people to change, motional interviewing honors and respects ambivalence. Motivational interviewing recognizes there are valid reasons not to change, just as there are valid reasons to change. Through a structured sequence of inquiry, the therapist works directly with a person's ambivalence. Therapists guide therapy participants to make their own decision about whether or not they wish to change. In a sense, MI allows therapy participants to convince themselves of the need to change. This approach avoids the so-called "resistance to change."

MI therapists encourage therapy participants to explore their ambivalent (conflicting) feelings regarding change. For example, a therapy participant may be reluctant to give up cocaine. The therapist would explore this. Through this exploration, the therapist may learn he fears he'll no longer have fun with his friends. An MI therapist would agree this is a valid concern. The therapist then encourages a more thorough and accurate exploration of this concern. Were there times before cocaine use when he had "good times?" Do the people called "friends" have anything else in common with each other besides using cocaine? This concern about lost friendships, when considered by itself, would suggest that discontinuation of cocaine is not worthwhile. But, the MI therapist will ask the participant to weigh this valid concern alongside his desire to change. Perhaps the therapy participant is aware his wife will leave him if he continues his cocaine use. In this case, it might be useful for him to compare the value of his marriage to the value of good times with friends. During MI, the therapist would try to help the client resolve these ambivalent feelings. This resolution will strengthen the motivation for the preparation and action stages of change.