Motivational Interviewing: A Counseling Style That Can Keep You Committed to Recovery

If you’re healing from a substance use disorder, you already know that it isn’t a linear process. The recovery journey is full of ups and downs. And it’s normal to have mixed feelings when you’re trying to break any habit, especially one as powerful as addiction.

Although these feelings are normal, being uncertain can get in the way of healing. If you’re not sure whether you want to recover, it can be hard to commit to treatment. For patients in this position, motivational interviewing (MI) may be a helpful way to approach rehab. This counseling style is specifically designed to help patients resolve internal conflict.

What Is Motivational Interviewing?

Motivational interviewing, or MI, is a framework for having conversations about change.¹ It’s based on the idea that motivation needs to come from within the person changing. It can’t be pushed or forced by someone on the outside. At its core, MI highlights each person’s own reasons for wanting to make a change—and in the case of substance use, their reasons for wanting to quit using.

Although MI was created as an intervention for people with alcohol addiction, it’s successfully used to help patients make all sorts of positive behavior changes, from eating well to taking their medications as prescribed.

The Uses of Motivational Interviewing for Substance Use Disorder

Dr. Bill Miller first started defining motivational interviewing in the 1970s, and its first description was published in 1983. Research has proven it to be an effective intervention for people with substance use disorders (SUDs). Some of the ways motivational interviewing can help include:

• Helping people with alcohol use disorder stop drinking.²
• Protecting against relapse.³
• Helping people heal from cannabis use disorders.⁴
• Reducing HIV risk due to substance use-related and other behaviors.⁵
• Improving treatment engagement during recovery from substance use or mental health concerns.⁶
• Helping adolescents recover from substance use disorder.⁷

The Principles of Motivational Interviewing

Unlike many other modalities, MI is not a psychotherapy method. Because of this, it has some unique benefits and limitations. Anyone can use a motivational interviewing style, including medical practitioners, therapists, recovery coaches, and addiction counselors. It’s simply a framework for having conversations about change.

This framework can help you stay engaged with recovery. Research has found that people who receive an MI intervention before attending a treatment program are more likely to complete it. The basic principles of MI set it apart from more traditional addiction counseling frameworks.

Ambivalence

Ambivalence is the internal tug-of-war that many people experience when facing a major transition, such as recovering from addiction. One part of you wants to stop using, and another part of you doesn’t want to change. While some treatment providers may see ambivalence as a sign that you’re not ready for recovery, MI treats this conflict as a normal part of healing. This model is designed to help people resolve ambivalence instead of fighting against it.

Unlike some other therapeutic frameworks, MI never labels patients as “resistant.” Instead, your provider will respect your point of view, trusting that you know what’s best for yourself.

Partnership and Autonomy

When talking to a treatment provider who uses an MI approach, think of them as your partner in the journey of recovery. Their job is to respect that you’re the expert on your own life, and that you already have a lot of wisdom about what does and doesn’t work for you. They know you have irrevocable autonomy. You’re the only person in control of your actions.

Within an MI framework, your provider will never give you unsolicited advice. Instead, they may ask your permission before suggesting an idea, or wait for you to ask their opinion. This empowers patients to collaborate with their providers, giving you room to decide what’s best for your own healing process.

Change Talk

Most patients experience ambivalence during recovery. But having a provider push you to overcome that ambivalence can just intensify it. In MI, practitioners help patients uncover their personal reasons for wanting to make a change. These reasons are called change talk.

To elicit change talk, MI providers ask targeted questions that encourage you to consider what life would be like without substances. For example, they might ask you to reflect on how substance use has caused problems in your life, or interfered with your goals.

You may also reflect on why recovery is important to you. MI practitioners understand that your reasons for wanting to recover from addiction may be different from those of your partner, family, or friends. And ultimately, your reasons are the ones that matter.

Developing Discrepancy

MI providers may also help you resolve ambivalence through a practice called developing discrepancy. During this process, you’ll start to define your values.

Every person has core values that they live by, or would like to live by. Often, addiction keeps us from living a life that’s aligned with those values. MI practitioners invite you to consider how your behavior reflects your unique values. This is intended to increase your motivation and commitment to recovery.

For example, imagine that a patient considers family as a core value. But they lie to their family about their addiction. This not only hurts the people around them; it also undermines their commitment to their own values. It’s all too easy to harm yourself and your loved ones by disregarding your own values, even if you’re doing so unintentionally.

During an MI intervention, your provider will help you see any discrepancies between your values and the way substance use makes you behave. This is done in a non-judgmental way. The goal isn’t to make you feel guilty, but to help you commit to living a life that aligns with your own values.

Affirmations

MI is a strengths-based approach. This means that MI providers don’t see you as an “addict.” Instead, they see you as a whole person who already has strengths and resources to help you recover from addiction. They’ll always put your strengths at the forefront of the recovery process.

As you go through MI, your provider will also make sure that you are aware of your own strengths. They do this through the use of affirmations. It’s important that you know what your strengths and resources are, so you know what you can rely on for support during recovery.

The Stages of MI

Like most treatment models, MI doesn’t proceed in a strictly linear fashion. But there are some key stages of MI that you’ll often experience when you’re receiving an MI intervention:

Engagement

The provider will first work to develop a trusting relationship with you. If you feel attacked or judged by your provider, then no intervention (including MI) is likely to work. MI practitioners will build engagement with you by using a collaborative approach, which includes reflective listening techniques.

Focusing

MI is designed to help patients make a change. To do that, you and your provider need to agree about what change you actually want to make. Focusing is a collaborative process in which you will decide on a goal together. You might have other goals that you want to work on, in addition to overcoming addiction, and these goals will always be honored.

Evoking

Evoking is at the heart of motivational interviewing. In this process, your MI provider will draw out change talk, or your reasons for wanting to quit using a substance. Evoking involves asking you questions and reflecting your answers back to you in a meaningful way. However, your provider won’t give you unsolicited advice or try to pressure you into a particular course of action.

Planning

Planning is the only stage of MI that’s optional, meaning you may or may not ever get here. In this stage, you collaborate with your provider to create a plan for how to maintain your commitment in the future. While some patients find this helpful, others prefer to create a plan without the provider’s help.

It’s important to note that there is a manualized version of MI, called Motivation Enhancement Therapy (MET). This is a more rigid version of MI, in which patients go through these stages in a more linear and orderly fashion.

Benefits of Motivational Interviewing

Like any treatment model, MI has both benefits and limitations. It’s not a miracle cure, and it’s not intended to be. But it can be a good fit for people who feel ambivalent about recovery. This framework has several noteworthy benefits:

• It saves time. MI is a time-limited, cost-effective intervention. Practitioners don’t typically need a lot of time to help people make changes. In fact, just one MI intervention before treatment has been found to improve engagement.⁸
• It works. Hundreds of studies have been published about the use of MI to treat substance use disorders. One literature review found that motivational interviewing is more effective than traditional advice-giving approximately 80% of the time.⁸
• It can help you commit. Unlike most other treatments, MI helps patients resolve their indecisiveness about substance misuse. This may be especially helpful for patients who want to make a change but are unsure of how to commit to that process.
• It increases your self-efficacy. MI helps you build the confidence you need to stay committed to recovery, rather than depending on outside sources.
• It respects your agency. MI is a good treatment option for people who don’t like being told what to do. MI practitioners respect your autonomy. They understand that pushing patients too hard isn’t likely to work, and it may even intensify their resistance to change.
• It helps you get in touch with your reason for recovering. Often, people in recovery never take the time to pinpoint their personal “why” of substance use recovery. They may have a vague notion that they “should” quit using drugs and alcohol, but sometimes, that isn’t enough to see them through. MI can help you to discover and remember your reasons for doing so.

Limitations of Motivational Interviewing

Like any intervention, MI also has some limitations. This model may not be a good fit for every person, and isn’t meant to be used as a treatment for every issue.

• Motivational interviewing is not a comprehensive psychotherapy model, so it’s not the right fit for every condition.⁹ For example, it may not be an appropriate way to approach depression or PTSD. However, research has found that MI may be an effective component of treatment for patients with dual diagnoses.¹⁰
• The effectiveness of motivational interviewing depends on who delivers it.⁹ This isn’t unique to MI; the therapeutic relationship is key to the success of most mental health interventions. However, since people who aren’t licensed therapists can use MI, their levels of training and competency may differ more widely than it does in other models of psychotherapy. If you decide to pursue MI, you may want to consider working with a counselor who has been trained by a member of the Motivational Interviewing Network of Trainers (MINT).
• Motivational interviewing may or may not be an appropriate intervention for every type of substance use disorder.¹¹ For example, more research is needed into MI for people with a history of opiate or methamphetamine misuse. If you have an opiate or methamphetamine addiction, there are other treatments specifically designed for you that may be more effective.

Committing to Change with Motivational Interviewing

Motivational interviewing can be extremely helpful for some patients, but it’s just one aspect of recovery. Because this framework can be integrated with other treatment models, it may be a good fit for people with a wide variety of mental health concerns.

Remember that no intervention, including MI, is a quick fix for healing from addiction. While this approach may help you resolve ambivalence, it won’t resolve all the underlying reasons you began misusing substances. If you’re interested in pursuing MI, talk to your team of providers about whether it would fit with the other treatments you’re engaged in.

If this approach interests you, visit our directory of rehabs offering MI to browse centers near you and see photos, pricing, reviews, and more.