Practice Profile: Motivational Interviewing for Substance Abuse

Evidence Rating for Outcomes

Drugs & Substance Abuse | Multiple substances

Date: This profile was posted on September 11, 2014

A client-centered, semidirective psychological treatment approach that concentrates on improving and strengthening individuals’ motivations to change. The practice is rated Effective. Individuals in the treatment groups significantly reduced their use of substances compared to those in the no-treatment control groups.

Practice Goals

Motivational Interviewing (MI) is a brief client-centered, semidirective psychological treatment approach that concentrates on improving and strengthening individuals’ motivations to change. MI aims to increase an individual’s perspective on the importance of change. When provided to those who abuse substances, the long-term goal is to help them reduce or stop using drugs and alcohol.

Target Population

MI targets individuals who are less motivated or ready to change, and who may show more anger or opposition. MI can target a wide range of problem behaviors, such as smoking, gambling, or eating disorders. But it was originally developed to change substance abuse behaviors (Dunn, Deroo, and Rivara 2001). Substance abuse generally refers to the overindulgence in and dependence on a drug or other substance (such as alcohol) that leads to detrimental effects on an individual’s physical and mental health or the welfare of others (Smedslund et al. 2011). MI can target those who abuse substances who may be ambivalent about changing their behavior.

Practice Theory

The practice involves a form of supportive and empathic counseling style put forth by Rogers (1951). He described a client-centered counseling approach that takes a specific form of reflective listening (or accurate empathy), which is one of the basic principles of MI (discussed below) [Burke, Arkowitz, and Menchola 2003]. Miller and Rollnick (1991) developed the foundation of MI as a way to help people work through their ambivalence about changing their problem behavior, to increase their motivation and commitment to change.

Practice Components

MI is a brief intervention. The person abusing a substance and the MI counselor will typically meet from one to four times, for about 1 hour each session. The settings of delivery can vary and consist of aftercare/outpatient clinics, inpatient facilities, correctional facilities, halfway houses, and other community-based settings.

MI incorporates four basic principles into treatment: 1) expressing empathy, 2) developing discrepancy, 3) rolling with resistance, and 4) developing self-efficacy.

Expressing empathy takes a form of reflective listening in MI (Rogers 1951). Part of this principle consists of viewing an individual’s reluctance to change as a normal part of the human process, rather than as a mode of defensiveness (Smedslund et al. 2011).

With the second principle, developing discrepancy, the MI counselor works to help an individual understand the discrepancy between where he or she is and where that individual wishes to be. Individuals are guided by specific types of questions to help them examine and recognize the discrepancies between their current problem behaviors and future goals, to become motivated to make important life changes.

The third principle, rolling with resistance, guides the MI counselor to not oppose an individual’s resistance to change, but to accept and flow with it, using reflective listening skills (Burke, Arkowitz, and Menchola 2003). The counselor doesn’t challenge the resistance but further explores an individual’s views on change.

Finally, an essential part of MI is developing an individual’s self-efficacy. This involves enhancing the person’s ability to handle obstacles and succeed in changing (Burke, Arkowitz, and Menchola 2003).

MI can be delivered as a standalone intervention or as a prelude to another type of treatment. However, MI is usually not delivered alone; it is typically combined with feedback or other forms of treatment (Hettema, Steele, and Miller 2005). For example, adaptations of motivational interviewing (AMIs) combine the clinical method of MI with other intervention components. AMIs incorporate the core principles of MI with additional non–Motivational Interviewing techniques, such as feedback. Feedback, often provided to those abusing a substance, is provided based on an individual’s results from a standardized assessment tool, such as the Drinker’s Check-Up. Feedback focuses on the severity level of the individual’s problem behavior (i.e., alcohol or drug use) compared with norms, and is delivered in a style of MI that elicits possibilities for change in a nonthreatening manner (Burke, Arkowitz, and Menchola 2003).

Meta-Analysis Snapshot
	Literature Coverage Dates	Number of Studies	Number of Study Participants
Meta Analysis 1	2001-2010	12	2326

Meta Analysis 1

Smedslund and colleagues (2011) assessed the effectiveness of motivational interviewing (MI), as a primary or support intervention for substance abuse. Substance abuse included drugs, medications, toxins, and alcohol but excluded nicotine. Individuals receiving MI had to be dependent or addicted to substances. Substance misusers were excluded. The MI intervention could be offered in three ways: 1) as a standalone therapy, 2) integrated with another therapy, or 3) as a prelude to another therapy (such as cognitive–behavioral therapy). Studies had to include checks of audiotapes or videotapes of sessions to assess fidelity of treatment. The control groups could include no intervention, wait-list control, placebo psychotherapy, or other active therapy.

A comprehensive search of electronic databases, Web sites, mailing lists, and references of primary studies was conducted to locate eligible studies. Fifty-nine studies were identified and eligible for inclusion in the meta-analysis. Comparisons were divided into 1) MI versus no treatment/intervention, 2) MI versus treatment as usual, 3) MI versus assessment and feedback, and 4) MI versus other active intervention. In addition, the comparisons were also divided according to follow-up periods: postintervention; short follow-up until 6 months; medium follow-up at 6–12 months; and long follow-up of 12 months or more. For this review, the emphasis was on the comparison of MI versus no intervention at the medium follow-up at 6–12 months. Of the 59 studies eligible for the review, 12 fell into this category.

The 12 studies include more than 2,300 study participants. All of the studies were randomized controlled trials, except for one that was quasi-experimental. Seven of the studies included individuals receiving MI for alcohol abuse, including alcoholism, problem drinking, heavy or episodic drinking, and high-risk drinking. The other studies included individuals who abused drugs, including cocaine, cannabis, stimulants, and club drugs. More than half of the studies took place in the United States, while the remainder of the studies took place in Australia, Canada, Germany, Netherlands, and the United Kingdom.

The primary outcome of interest was cease and/or reduction of substance use measured by self-report, urine analysis, blood samples, or other methods of data collection. The effect sizes were calculated as standardized mean differences. The optimal information size was used to assess whether there was a sufficient sample size for concluding there was a statistically significant effect in the meta-analysis. Statistically significant heterogeneity among primary outcome studies was assessed with Chi-squared (Q) test and I-squared. A significant Q and I-squared of at least 50 percent was considered a statistical heterogeneity. The results from the 12 studies did vary somewhat but did not exceed the criteria for significant heterogeneity.