Motivational interviewing practice for drug use and problem drinking
3 ways to motivate addiction clients toward a healthy recovery
As a therapist providing addiction treatment, one must always grapple with level of motivation for change. The nature of addiction is ambivalence. As treatment providers, we are always looking for ways to avoid getting into the argument about change. We want to circumvent the traditional discussion where the therapist outlines all the reasons for change and the client elucidates all the reasons why they cannot. It is important to think about what motivates the client, how the client sees change, and tailor treatments accordingly. Below I have identified 3 ways to motivate clients with addiction problems that may be helpful to treatment providers in getting clients to give voice to the reasons for change.
1. Chart patient values to motivate change.
One can download a useful structured exercises for charting addiction patient values to accomplish this assessment of patient values task and / or you can choose to have a structured discussion with clients regarding their core values. The important piece in motivating individuals is to have the client give voice to his/her values and have them make the comparison to how they are currently living their life. Most likely they will be able to cite some ways in which they are not living up to their own expectations. It is important to ask how the client perceives the impact of drugs/alcohol use on living according to their values. In this way, the client comes up with the reasons for change and the client defines how drugs and alcohol are inconsistent with living life the way they would like.
Good follow-up would include inquiring about what the client sees as necessary for things to change to live more consistently with one’s values. In addition, asking how likely the client is to make those changes and what do they see as roadblocks or supports for making change are integral to moving the discussion forward. Using this exercise will give the treatment provider lots of good information about what motivates the client and how they define the problem with drugs or alcohol.
2. Get a baseline for alcohol or drug use and provide feedback.
One of the simplest ways of helping motivate clients is to give them unbiased feedback related to their drug and alcohol use. The first step is to collect a baseline level of use. Having them fill out a Timeline Followback calendar (Sobell, L.C. & Sobell, M.B., 1996) can be a structured way of getting baseline information that later can be summarized and presented in the course of treatment. Likewise you can ask detailed quantity/frequency questions related to alcohol or drug use that will yield similar information that may include patterns of use, usual amount of money spent on use, highest levels of use, lowest levels of use, average levels of use, precipitates of use, etc. The important part is to take all of the information the client provides and aggregate this information for them so they can identify where their drinking or drug use fits in. Usual feedback will show where their responses fit in to the general population.
For example, clients who are exploring drinking use can be given the feedback that on average they drink 8 standard drinks on any drinking occasion and then be asked to identify where they fit in on a chart of Americans who drink. They would need to identify that only 7% of Americans drink at that same level. Resources for this type of feedback include Drinker’s Check Up [dot] com and CAMH [dot] net Alcohol Use Feedback questionnaire. What is motivating about this type of exercise is the self-identification of where one fits in to the norms. For some, it is relatively shocking that a small amount of individuals share their drinking or drug habits because they spend so much time with others using drugs/alcohol in similar ways. For others, it is the amount of money they spend, the amount of calories they imbibe, or the increased health risks related to their use that is most motivating. The important part is that all of the feedback is based on their self-report. Therefore, it is the client being able to identify the problem and determine what aspects of their use motivate change.
3. Use decisional balancing as a cognitive exercise.
This is a basic cognitive exercise designed to evaluate the costs and benefits of changing. It is important to discuss with clients that people do not engage in behavior repeatedly without some sort of payoff. This exercise will assist them in identifying the payoff of drug and alcohol use and identifying the negative consequences. Again, clients can be sent home with a structured exercise like a Decision Balance Sheet to fill out and return to discuss or the therapist can use time in session to cover the costs of change, the benefits of change, the benefits of staying the same, and the costs of staying the same. This allows the client to self-identify the payoff from using drugs/alcohol and the negatives without being judged. This cognitive exercise has the added benefit of allowing clients to make informed decisions about change. The client knows going into making change what they will have to give up making change easier to for which to plan and the positive results of change are made equally as clear.