Mastering Motivational Interviewing to Overcome Substance Use Disorders

Posted by The Carey Group on
<span id="hs_cos_wrapper_name" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="text" >Mastering Motivational Interviewing to Overcome Substance Use Disorders</span>

According to the 2020 National Survey on Drug Use and Health, nearly 59 percent of the United States population, age 12 and older, were current users (within the past 30 days of completing the survey) of tobacco, alcohol, or an illicit drug. For years, the primary substance of choice in the U.S. has been and continues to be alcohol. Tobacco is the second most commonly used substance, followed by illicit drugs, with the most commonly used illicit drug being marijuana.  

Of those in the study who reported alcohol use, 22 percent reported binge alcohol use in the past month. Young adults, ages 18–25, had the highest binge alcohol use, followed by adults ages 26 or older. Many of these individuals were also heavy drinkers within the month of the survey. For marijuana use, young adults, again, had the greatest use rates, followed by adults aged 26 or older.  

The survey also asked questions about risk perception because, historically, if one perceives there are high risks involved in using substances, they are less likely to use them. The majority of respondents perceived a great risk of harm related to tobacco use and risk from consuming four to five alcoholic beverages nearly daily. Perceived risks related to cocaine and heroin use were also high; however, less than 28 percent of people perceived great risk from smoking marijuana once or twice a week.  

Other factors assessed in the survey were major depressive episodes, suicide risk, any mental illness, and severe mental illness. Findings show that Illicit drug, tobacco, and binge alcohol use occurs at a much greater rate for people with severe mental illness. For example, 47.8 percent of adults with severe mental illness and 39.8 percent of adults with any mental illness used illicit drugs, compared to 17 percent of adults with no mental illness who used drugs.  

The year of this study, 2020, provided an additional stressor: COVID-19. Of those surveyed, one in five adults perceived the COVID-19 pandemic to negatively impact their mental health “quite a bit or a lot.” This perception could and likely did contribute to substance use rates during and since that year.  

All of these details matter because they can predict the manner in which some people respond to life experiences and challenges and at what ages and times in their life they may be at greater risk and, subsequently, need greater support. As justice system and behavioral health professionals, this knowledge informs and enhances our ability to facilitate improved outcomes for those with substance use disorder.

With the proper intervention and support, individuals who are aware there is a problem with their substance use will be able to recognize that addressing the problem is better than continuing to use it. For justice system and behavioral health professionals, an evidence-based practice that is proven to inspire, instead of dictate, change is Motivational Interviewing. Motivational Interviewing involves a collaborative, person-centered approach that, through interactive conversations, identifies the change needed, helps determine readiness for change, and allows the individual the autonomy and motivation needed to follow through with the change.  

Motivational interviewing actions that foster change includes:
  • Asking open-ended questions.
  • Active, reflective listening and empathy.
  • Ability to share an understanding of what you heard.
  • Willingness to help discover why change is important.
  • Recognizing change isn’t easy, and understanding there are often setbacks. 
  • Optimistically support plans to move forward when setbacks occur. 
  • Actively involve clients in the decisions specific to change, as well as in the alternative. solutions that will be implemented if they struggle. 
  • Affirming strengths and behaviors that will lead to positive change.
  • Summarizing the conversation to clarify statements and goals.
Examples of open-ended questions and statements that keep the conversation active require more than a “yes” or “no” response and inspire self-reflection and change include: 
  • How can this program best support you?  
  • Help me understand… 
  • If you decided to quit, how could you do it?  
  • What makes you think you might need to change?  
  • What or who makes you want to change?  
  • Tell me more about… 
  • What are you afraid of losing if you change?  
  • How is that working out for you?  
  • What’s getting in your way?  
  • How would you like your life to be?  
  • What change do you believe is most possible in the next month?  
  • What are some of your strengths, and how can they help you make positive change? 
  • I’m interested in hearing about… 
  • What do you want to do differently?  
  • How can I help?  
  • When did you feel most successful, and why?  

Change is not easy for any of us and can be even more difficult for people experiencing mental illness and/or substance use disorder. Regular affirmation/recognition of a person’s ability to make positive change, especially when setbacks or relapses happen, is important because it builds and maintains rapport, increases self-confidence, and empowers them to actively identify solutions. Examples of affirmations include:  

  • You handled that situation really well.  
  • That’s a great suggestion.  
  • You’re getting so close to your goal… 
  • We’ll get through this. 
  • Change takes time.  
  • You really excel at… 
  • I’m confident that you… 
  • You have a lot of strengths.  
  • Keep up the great work! 
  • You’re not alone. 
  • Congratulations on xxxx days/weeks/months of sobriety—that’s a huge accomplishment.  

By using motivational interviewing, both justice system and behavioral health professionals are better able to help frame their clients' change in a way that focuses on the advantages of healthy behaviors and actions, as opposed to the disadvantages of staying the same. Most importantly, motivational interviewing can and does result in measurable, positive change. 

For assistance with motivational interviewing, encouraging prosocial behavior, and preventing non-compliant behavior, contact a Carey Group consultant who can connect you with effective, research-based policies, practices, and behavioral intervention tools 

Decades of experience demonstrate that aligning justice systems and behavioral health organizations around evidence-based policies and practices offers the greatest promise of success. Carey Group offers services and products for staff in these fields, from evidence-based consulting to interactive workbooks and guides 

Carey Group’s evidence-based training and consulting services address the needs of the justice system and behavioral health professionals. Training is an essential tool for keeping staff, supervisors, leadership, and stakeholders updated with emerging knowledge and expectations for improved outcomes. Carey Group offers in-person, online, and self-directed courses on evidence-based practices, motivational interviewing, core professional competencies, case planning and management, continuous quality improvement, coaching, and the use of behavior-change tools and supervisor resources.