Motivational Interviewing (MI) in the Field of Addiction Medicine

    

Ruwan M Jayatunge M.D. PhD 

Motivational interviewing (MI) helps to change longstanding behaviors that pose significant health risks, and MI is considered an important tool in addiction treatment. Moreover, MI is a tool designed to facilitate behavioral change in the patient by resolving the ambivalence to change (Miller & Rollnick, 2002). MI is facilitating health-related behavioral change in substance abuse, such as tobacco, alcohol and others (Dunn et al., 2001). Sim and team (2009) state that MI is about creating a climate that facilitates change, and can help build motivation, commitment and confidence to change.  

As described by Hall and colleagues (2012), Motivational interviewing is a patient-centered counseling method that involves enhancing a patient’s motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient’s own motivations; Listen with empathy; and empower the patient. MI can be described as a collaborative and evocative process that honors patient autonomy (Miller & Rollnick, 2002). It is focused on patient coaching rather than instructing the patient and is described as a non-confrontational, non-judgmental and supportive type of counseling (Al Ubaidi ,2017). MI helps to promote and increase patient motivation towards positive behavioral change, as well as to explore and then resolve any negative issue(s) or experience(s) of conflict. 

 

MI focuses on client desires, thoughts and feelings as a way to encourage clients to express their own barriers to change and to explore and resolve ambivalence toward behavioral change (Wu & Lin 2009). The patient's motivation cannot be imposed by an external entity; it is the patient's task to resolve their ambivalence, and the counselor should not concentrate on persuading the patient to change their behavior.  (Al Ubaidi ,2017). Readiness to change is a dynamic process, and ambivalence is hindering positive change. Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual. Ambivalence is evident in substance abuse.

 

MI strategies reduce the paternalistic therapeutic style, and the practitioner avoids an authoritarian stance. During the sessions, a partnership between the patient and practitioner is formed. Joint decision-making occurs. The practitioner acknowledges the patient’s expertise about themselves. The practitioner activates the patient’s own motivation for change by evoking their reasons for change. It is the patient’s own reasons for change, rather than the practitioner’s, that will ultimately result in behavior change. The therapist is using reflective listening skills and accurate empathy, where the practitioner seeks to understand the patient’s perspective, thoughts and feelings without judging, criticizing or blaming. Assisting patients to identify discrepancies between their current behavior and future goals or values about themselves as a person, partner, parent, or worker is a powerful motivator that helps ‘tip the balance’ toward change.

 

MI activates motivation for change. It uses a guiding communication style that invites people to consider their own situation and find their own solutions to situations that they identify as problematic and that are preventing change (Christie & Channon, 2014). The counselor adopts a "goal-directed approach" with a "patient-centered counseling style" that may enhance the patient's desire to change and decrease resistance (Miller & Rollnick ,2002). Research indicates that MI is equivalent to or better than other treatments such as cognitive behavioral therapy (CBT) or pharmacotherapy (Burke et al., 2003).

References

Al Ubaidi BA (2017) Motivational Interviewing Skills: A Tool for Healthy Behavioral Changes. J Fam Med Dis Prev 3:069.

Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled trials. J Consult Clin Psychol 2003;71:843–61.

Christie D, Channon S. The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review. Diabetes Obes Metab. 2014 May;16(5):381-7. doi: 10.1111/dom.12195. Epub 2013 Sep 1. PMID: 23927612; PMCID: PMC4237607.

Dunn, C,. Deroo ,L., Rivara, F.P.(2001). Addiction. 96(12):1725-42.

Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques - facilitating behaviour change in the general practice setting. Aust Fam Physician. 2012 Sep;41(9):660-7. PMID: 22962639.

Miller, W.R., Rollnick, S. (2002).Motivational Interviewing: Preparing People for Change. 2nd ed. New York: Guilford Press.

Sim MG, Wain T, Khong E. Influencing behaviour change in general practice - Part 2 - motivational interviewing approaches. Aust Fam Physician. 2009 Dec;38(12):986-9. PMID: 20369152.

Wu CC, Lin CC. [The application of motivational interviewing in nursing practice]. Hu Li Za Zhi. 2009 Apr;56(2):89-93. Chinese. PMID: 1931