Motivational Interviewing in Addiction Treatment

By Team RehabAid

Last Updated March 26, 2024

Treatment Types

Recovery is hard, and sometimes it can feel like addiction is a trap that you can’t get out of. There’s a part of you that desperately wants to live an addiction-free life, and you know that’s the best thing for you. But another part of you keeps going back to drugs and alcohol: for comfort, to cope with life, or for an escape.

Sound familiar? If so, then Motivational Interviewing might be helpful for you. This evidence-based treatment helps people to move towards making healthy lifestyle changes, including (and especially) quitting drugs and alcohol.

What Is Motivational Interviewing?

Motivational Interviewing is a specific style for interacting with someone who is trying to make a lifestyle change, but hasn’t been able to, for whatever reason. This evidence-based treatment method for addiction is widely used in rehab centers, and is one of the most effective and rapid methods for helping someone quit using.

The History of Motivational Interviewing

Motivational Interviewing, more commonly referred to in the field as MI, is a behavior change model that was designed in the 1980s to help people battling substance abuse. At that time, addiction treatment was heavily based on the medical model; by that, we mean that treatment practitioners saw people battling addiction as “sick,” and worked only to “fix” them.

Of course, we now know that addiction is a disease, primarily of the brain. However, especially in those days, physicians and counselors treated people with addiction as if they had no free will or self-awareness whatsoever. The general philosophy toward people with addiction was: You’re an addict, and you need my help. I’ll tell you what to do, and all you need to do is to just do what I tell you. The treatment practitioner was seen as the expert who had all the answers.

A physician named Dr. William Miller realized that this treatment model wasn’t working. Most of the patients he observed relapsed. Often, he observed that patients pushed back even harder against quitting drugs and alcohol when they were told by their doctors that they had to quit. In other words, this model of treatment not only wasn’t helpful, but it was possibly leading patients even farther away from the possibility of recovery.

Dr. Miller, a psychologist, based his therapy practice on Carl Rogers’ humanistic model, which advocated for the inherent worth of every human being. Rogers taught the practices of active listening and unconditional positive regard: deeply empathizing with the person in front of you, without judgment, and while holding them in the highest esteem.

Main Concepts of Motivational Interviewing

Motivational Interviewing, which Dr. Miller designed with his colleague Dr. Stephen Rollnick in the 1980s, gathers the best of humanistic therapy and takes it one step further. Yes, every human being has inherent worth and wisdom that we need to respect, and simply listening can be a powerful tool in itself.

But MI goes deeper than just respect and empathy. It actually helps people to make measurable changes in their lives —changes like quitting drugs and alcohol. It takes every person’s inherent wisdom and uses it to help the person develop their own reasons and ways for recovery.

Instead of pushing clients to quit drugs and alcohol, Miller and his colleagues taught practitioners to pull from them their own reasons for wanting to quit. This empowers clients to work through the internal battle that has kept them locked into addiction for so long, and increases their motivation for wanting to break free from addiction.

Some of the main principles of Motivational Interviewing include:

Ambivalence

MI accepts that it’s normal to have second thoughts about making any big change in your life, and that ambivalence (both wanting to quit and not wanting to quit, at the same time) is an inherent part of addiction recovery. All of us are ambivalent about health behaviors that they know are good for them: for example, how many of us really floss our teeth every day?

Acceptance

In the spirit of its foundation in Carl Rogers’ work, MI believes that each person has inherent worth, and that practitioners must show empathy for clients’ unique experiences and feelings that have led to addiction. The general philosophy of MI is in tune with: “People don’t change until they’re accepted fully for who they are now.”

Autonomy

MI accepts that when it comes to a personal change, like quitting drugs or alcohol, only the person themselves can make that decision. Threatening them or trying to force them to change simply doesn’t work. In fact, you’ve probably felt before that when someone’s told you that you must stop doing something, it made you even more likely to want to do it.

Evocation of Change Talk

MI respects that every person has a deep well of wisdom inside of them, and that they are the experts on their own lives. Instead of telling you the reasons why you must quit, an MI practitioner will ask you about your own reasons for quitting. How do you think your life would be better without drugs and alcohol? This, at the end of the day, is the only reason that matters. When you, and not your counselor, are the one who voices the reasons for quitting, you’re more likely to stick to recovery.

Collaboration

In an MI session, the practitioner (or counselor) doesn’t take on the role of the “expert.” The practitioner and the client are more like partners in the MI process; sometimes, the counselor takes the lead, and sometimes, the client does. Most of the time, it’s an equal partnership. They are working together to help the client make healthy changes.

Dancing With Discord

In MI, the client is never viewed as “resistant” or “in denial” for not wanting to quit —which is very different from most other addiction treatments. Instead, MI counselors understand that: 1) Feeling ambivalent about change is a normal part of the process; and 2) If the client is feeling “resistant,” it’s probably because the therapist is pushing them too hard.

Developing Discrepancy

MI helps people to realize what a big gap there is between the life they want to be living and the life they’re living in reality. It’s likely that your life with drugs and alcohol isn’t completely in-line with your true values. This isn’t who you really are, but who drugs and alcohol turn you into. MI practitioners lean into this gap, and then help you walk over the bridge between who you are and who you want to be into an addiction-free life.

Of course, this isn’t a comprehensive list of MI principles, but it is a basic overview to give you a sense of what you would experience through an MI intervention.

Unlike some other substance abuse treatments, Motivational Interviewing isn’t designed to be a comprehensive psychotherapy model. There isn’t a set amount of time for which MI interventions last; MI has been successfully used for anything from a single 15-minute session to multiple sessions over long periods of time. In general, MI (as well as its nephew, MET, which we’ll talk about in the next section) are designed to be brief interventions.

Dr. Miller describes Motivational Interviewing as, simply, “A conversation about change.” It isn’t a specific therapeutic model or method; rather, it’s a way to have a conversation with somebody about unhealthy behaviors.

What Is Motivation Enhancement Therapy?

Sometimes, Motivational Interviewing is referred to as “Motivation Enhancement Therapy,” or MET. This is technically incorrect —MI and MET are not the same thing— but MET is based on MI principles.

MET is, in essence, a manualized version of MI. While MI is the broader theoretical framework of how to talk with people about behavioral change, MET is a 4-session interview plan for evoking change talk and increasing motivation. Each session is designed for a purpose, like assessment, feedback, and creating change plans.

Both MI and MET are commonly used, and they are both evidence-based treatments for substance use disorder.

What Is Motivational Interviewing Used For?

Motivational Interviewing has the uncommon honor of being an evidence-based practice that was specifically designed to treat substance use disorder. We described the birth of MI (in response to faltering addiction treatment at the time) above; since then, it has been approved as an evidence-based practice for the treatment of substance use disorder.

On top of helping people to break away from drug and alcohol addiction, MI has also been shown to be beneficial for a number of different areas. Basically, MI can have a positive effect on anyone and anything that requires a personal change in behavior. Most research has been conducted on the use of MI in health behaviors, but MI can be used for other kinds of changes, too.

Some specific unhealthy behaviors that an MI intervention can help people to change are:

• Addiction to drugs and alcohol
• Sugar intake for diabetics
• Medication adherence
• Weight loss (exercise and diet)
• Smoking cessation
• Treatment follow-through
• Problem gambling
• Unhealthy parenting behaviors
• HIV risk behaviors
• Lifestyle changes for people at risk for heart disease
• Better self-care

Because MI is designed to help people change specific behaviors, it’s not considered a treatment method for any specific mental illness. The exceptions to this are addiction (both substances and gambling) and eating disorders, which are inherently behavioral —if the person is able to stop engaging in substance use, they no longer qualify for the disorder.

For example, MI alone won’t help someone recover from depression. However, it can help people make the behavioral changes needed to bring them closer to recovery, like staying on medication, attending therapy, and exercising. MI has also been used alongside treatment methods that do help with depression recovery, like cognitive behavioral therapy (CBT), and has been shown to make the primary treatment (in this case, CBT) even more effective.

How Effective Is Motivational Interviewing for Addiction?

Decades of research have shown us that Motivational Interviewing is incredibly effective for helping people recover from substance use disorder. Knowing what we have now learned about how Motivational Interviewing works, it isn’t hard to see why. During an MI intervention, people are empowered to quit drugs or alcohol for reasons that are personal to them, not just because their counselor told them to.

MI Effectiveness: Research Outcomes

There is a large body of research that supports MI’s effectiveness in treating substance abuse problems. One meta-analysis found that MI is more effective than traditional advice-giving in 80 percent of research studies —an impressive number. Most studies have found that MI is effective in helping people to recover from drug and alcohol addiction, including in studies measuring treatment retention, adherence, and outcomes. There is research that shows that MI is up to 20 percent more effective than other treatments for substance use disorder.

Another benefit of MI for drug and alcohol addiction is that it is a brief intervention, and it doesn’t need months or even weeks to be effective. Even a single 15-minute MI session, when focused on the problem behavior (drug and alcohol use), has been found to be effective in helping people recover from addiction. Naturally, more sessions of MI increases its effectiveness.

Interestingly, the effect size (an academic term that refers to exactly how statistically effective something is) of MI varies quite widely, essentially from “not effective at all” to “extremely effective.” It’s becoming more and more apparent that who provides the MI intervention is almost as important as the intervention itself. Since so many people are trained in MI, the quality of training and how well they’re actually using MI might be factors here.

Keep in mind that there are many treatment methods that have been found to be effective for the treatment of substance use disorder. MI is at least as effective as many of these treatments. What may make it stand out as a treatment for some providers, though, is its cost-efficiency: MI accomplishes in only a few sessions what takes other treatment models much longer to achieve.

MI and Alcohol Addiction

MI has been shown to be particularly helpful for alcohol addiction. A large, multi-site research study called Project MATCH proved that MI (specifically, MET) is an effective treatment for alcohol use disorder.

This is likely because people who are addicted to alcohol are very ambivalent about quitting. Alcohol is a legal drug, after all, and many people drink without any problems whatsoever. This can lead people with alcohol addiction to feel unsure if they really want to quit altogether, or to convince themselves that their relationship with alcohol is healthy.

In comparison, someone with a heroin addiction, for example, is less likely to be ambivalent about wanting to stop. Of course, ambivalence is still present, and it’s still extremely difficult to walk away from a heroin addiction —but the desire to quit heroin is usually there.

MI, at its core, helps people to resolve their own ambivalence about making changes in their lives. This could explain why it’s been so helpful for people with alcohol addiction —it helps people resolve their own ambivalence about drinking, instead of telling people that they need to quit.

Is Motivational Interviewing for Me?

There is a wide array of effective treatment options out there for addiction treatment, and the sheer breadth of choices can sometimes feel overwhelming. The good thing is, like we discussed earlier, Motivational Interviewing isn’t a comprehensive method on its own. It’s very often combined with other treatments —which means that you don’t need to choose between MI and another intervention. You can have both!

MI is safe, and there have been no negative consequences reported after MI intervention. Combining it with other treatments is safe, too; in fact, combining MI and another evidence-based treatment is usually found to make both the MI and the other intervention even more effective than they are on their own.

If you still aren’t sure if Motivational Interviewing is for you, the following might be signs that you’re a good candidate for MI intervention.

You’re Tired of Being Told What to Do

Your family members, your partner, and endless counselors have told you that you need to quit using —that it isn’t good for you— and you’re getting tired of it. You, obviously, know that your addiction is harming your health and you’d like to live an addiction-free life, but it isn’t that simple. You’d wish they’d stop bothering you and just understand your situation.

If you’ve ever felt this way, then MI may be right for you. An MI practitioner will inherently understand that there are two sides to every coin, and help you strengthen your own motivation for quitting (instead of telling you what you “have to” do).

There Is a Part of You That Really Wants to Recover From Addiction

If you see no problem with your drug or alcohol use, then you might be a few steps away from being ready for treatment in general. MI can and does, however, help people like this by developing discrepancy, like we discussed before.

Most people, though, have at least a tiny voice inside of them that whispers: You are better than this. You’ve probably thought about quitting before, and maybe you’ve even made actual attempts. If you’re feeling conflicted between the side of you who wants to keep using and the side of you who wants to recover, then MI can help you to resolve that ambivalence.

Past Attempts to Recover Haven’t Been Successful, or You’ve Relapsed

Staying on the path of recovery requires willpower and motivation. And that’s exactly what MI helps with; it empowers you to voice your own reasons for wanting to live an addiction-free life. That way, when you’re tempted to go back to a life of drugs and alcohol, you are more likely to remember why you stopped in the first place.

If you’ve been trying for a long time to achieve recovery but haven’t been successful, don’t give up. Relapse is, unfortunately, a normal part of the recovery process, and MI might be the intervention that will finally help.

Limitations of Motivational Interviewing

On the other hand, MI may not be for you if you’re facing a dual diagnosis condition or if your priority is to get to the root of what caused your addiction. Certainly, MI alone will not help you address anything other than behavior.

Of course, that doesn’t mean that your MI practitioner won’t listen to you empathetically; active listening is one of the core skills of MI. But if you’re looking to explore deeper and heal from the traumas and pain that led you to use in the first place, then MI alone won’t help you do that. This is the main limitation of this practice.

What MI will do, however, is increase your motivation to recover from addiction. And remember, MI can be (and is often) used alongside other treatment methods. That means that if you’ve started another treatment to explore trauma (like Eye Movement Desensitization and Reprocessing, or “EMDR”) before, but haven’t been able to stay committed to it, receiving MI sessions may help increase the likelihood that you keep going to treatment.

MI can’t cure you of everything, but it was never intended to. It can help you recover from substance use disorder and to stay in treatment.

How to Get Started With Motivational Interviewing

Many substance abuse providers are trained in Motivational Interviewing because of the large body of research supporting its effectiveness. The only way to know for sure whether the counselors at a specific rehab are trained in MI is to call and ask.

It’s worth noting that anybody can be trained in using Motivational Interviewing, including substance abuse counselors, nurses, and correctional officers. This is in contrast to psychotherapy methods like dialectical behavior therapy (DBT), which require a therapy license to practice. That means that even if a treatment center only offers group therapy run by a peer counselor, it’s possible that the counselor has been trained in the use of MI.

If you’re ready to get started on the road to recovery with the help of Motivational Interviewing, find a rehab or counselor that provides it. You can start by searching through reputable rehab centers in your area on RehabAid; we give you the information you need to make the rehab choice that’s right for you and your family.

Resources

If you or a loved one are struggling with narcissistic personality disorder and substance abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Medical Disclaimer

At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment. With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website. Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on RehabAid.com.

Key Sources

Lundahl, B., & Burke, B. L. (2009). The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses. Journal of clinical psychology, 65(11), 1232–1245.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Press.

Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. The American psychologist, 64(6), 527–537.

Rosengren, D. B. (2009). Applications of motivational interviewing. Building motivational interviewing skills: A practitioner workbook. Guilford Press.

Rubak, S., Sandbaek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: a systematic review and meta-analysis. The British journal of general practice: the journal of the Royal College of General Practitioners, 55(513), 305–312.

No Authors Listed (1997). Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of studies on alcohol, 58(1), 7–29.