Bringing it Up: Addressing Addiction with Motivational Interviewing

When a loved one is misusing substances, it can be difficult to stand by without making demands that they change their lifestyle. Watching someone hurt themselves often evokes a strong reaction, leading to people saying things like “You have to stop!”

Making broad demands for people to stop doing something or change their life is rarely effective, though. People typically need to understand why change is needed for themselves in order to attempt a real transformation. Simply being told one needs to alter their lifestyle is not the same as confronting the topic and arriving at that conclusion for themselves.

What is Motivational Interviewing?

The idea that people need to be personally motivated to affect change in their life is central to the practice of motivational interviewing. Many things could fall under the umbrella of motivational interviewing, but put simply, it is a conversational counseling approach that’s built around empathy and putting the client first. It asserts that the individual is the expert in their own life and must be at the center of change.

For addiction recovery, motivational interviewing encourages change in an individual by helping them alter their perspective and resolve their ambivalence. By asking open-ended questions and letting the individual steer the conversation towards what matters to them, therapists can gently guide clients to their own conclusions.

OARS: The Techniques of Motivational Interviewing

There are four common techniques used by therapists in motivational interviewing. They are often abbreviated by the term OARS:

Open-Ended Questions – Asking open-ended questions—as in questions that can’t be answered by “yes” or “no”—allows the client rather than the therapist to steer the conversation. A therapist may ask “What worries you about using substances?” rather than “Aren’t you worried about using substances?” By asking these questions, the therapist can better understand what about their client’s situation really matters to them.

Affirmations – Offering affirmations enriches the individual’s perspective. To provide affirmations, a therapist may highlight the strengths their client has shown, or the steps they’ve already taken towards recovery. It is helpful for individuals misusing substances to recognize their own achievements as it empowers them to make further change.

Reflective Listening – Reflective listening involves restating, rephrasing, or paraphrasing what the individual has revealed. This inspires deeper trust as it shows the client that the therapist is listening intently to them. It also helps the client see the details of their life more objectively and allows them to correct misunderstandings or inconsistencies.

Summaries – Similar to reflective listening, summarizing is the process of collecting the points a client has made about their life and repeating them back to the client. This can help the client see a broader perspective of their situation, linking and articulating issues they may not have seen as connected.

The Readiness Ruler

Another practical device used by therapists in motivational interviewing involves asking the client to rate or measure the importance of specific issues in their life. A therapist may ask, “On a scale of 1-10, how important is it for you to change your behavior?” If the client answers “6,” the therapist may respond by asking why it wasn’t a “2.” The answer will often provide reasons why the individual does want to change. The therapist can help them recognize this, shifting the conversation towards plans to support change.

Change Comes from Within

Motivational interviewing recognizes that recovery is contingent on states of change. This theory observes that ambivalence is common with any change. Even when someone is struggling with addiction and may be desperate for change, there is still ambivalence and doubt regarding their ability to make progress. Dealing with things like shame, guilt, trauma, and co-occurring disorders can deepen this ambivalence.

With motivational interviewing for addiction, therapists can not only help clients see the reality of their circumstances, but also encourage them to reclaim their own agency in the matter. By acknowledging themselves as a resource in their own life rather than a mere recipient of services, individuals can find the perspective and strength they need to leverage real change.

If you or a loved one are struggling with addiction, call the New England Recovery Center today at 1-877-MyRehab.