1. Running head: MOTIVATIONAL INTERVIEWING 1
Motivational Interview
Opiate Addiction
Cassandra Erickson
Saint Cloud State University

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In the field of clinical psychology, it is becoming ever more important to allow clients to
make their own choices. Using motivational interviewing (MI), a person centered skill designed
to illicit change, a client becomes in charge of their own health. MI is a tool that is often used in
addiction, with this paper focusing specifically on opioid addiction. Opioid use can be
prescription forms of codeine, oxycodone, and hydrocodone, or the non-prescription heroin.
Oftentimes in the case of prescription opiates opioid addiction stems from needing to relieve
pain. People will use heroin to obtain a euphoric high. According to SAMSHA, approximately
1.9 million Americans met criteria for prescription painkillers use disorder based on their use of
prescription painkillers, and 4.8 million people have used heroin at some point in their lives
(SAMSHA 2016). People who are regular users of prescription pain killers will turn at some
point in their life to heroin due to being a more inexpensive option, as well as being more widely
available. MI has shown to be an effective tool and should become standard in the counseling of
opioid addicts.
Motivational Interviewing
MI is a collaborative conversation used to illicit change by strengthening personal
motivation and creating attainable goals through exploration of needed change. Being a person
centered approach to counseling, MI collaborates between client and counselor in an effort to
create change talk. Change talk occurs after ambivalence, when the client realizes why they
want to change. A counselor trained in MI will know how to draw out and encourage change
talk in an effort to proceed with a plan on how to implement the change.
MI is focused on four key concepts; partnership, acceptance, compassion, and evocation.
These constitute the spirit of MI and what a counselor invokes when practicing the skill.
Partnership or collaboration happens when the counselor is working with a client. MI is not a

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superiority skill but rather an active partnership between two people with no one person more
knowledgeable than the other (Miller, Rollnick, 2013). This concept is important in MI because
it helps to build trust between the counselor and client. Acceptance does not mean as the
counselor approval of the clients behavior is necessary but rather understand and realize the
worth of every client as well as affirming the strengths and efforts of the client. It means taking
an active interest in the client’s life, and respecting a client’s wishes and honoring their
autonomy (Miller, Rollnick, 2013). Compassion is a relatively new element for MI, but is
extremely relevant for any counselor. When compassionate the counselor will actively seek to
enhance the client’s welfare, and give priority to the client’s needs. A counselor does not
necessarily need to have suffered alongside the client (Miller, Rollnick, 2013). Evocation is
probably the most fundamental portion of MI. It is the realization that clients have what they
need to survive, counselors only assist in the realization (Miller, Rollnick, 2013). When the
counselor evokes change talk, it becomes the point at which a client can take charge of their own
life, and will often proceed to creating the change the client desires.
MI follows a specific set of principles which are required for the therapy style to work.
The counselor can remember these principles using the acronym RULE. This acronym stands
for resisting the righting reflex, understanding the client motivation, listen with empathy, and
empower the client. When employing MI the counselor should never give advice. The change
must come from within the client with the counselor there to put the client in the right position.
Even if the counselor doesn’t agree with the motivations of the client they must not give advice,
by doing this they are listening with empathy. Oftentimes the client needs someone to show
care, at which point empathetic listening evokes the clients trust. When the client has reached
the point of change the counselor should empower the client to make those changes. If the

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counselor follows these principles and concepts of MI, the technique will be invaluable to
clients, and further increase rehabilitation.
Skill Sets for Opioid Addiction
MI revolves around many different skill sets used to evoke change talk. The change talk
desired in an Opiate Addict is to stop using and maintain sobriety. Determining if the client is
still in pain after going through detox is important as well as pain can drive the addiction. How
the counselor does this is important on whether the client will actually change. They key is not
to push too fast, if the client is still ambivalent about change the counselor must get the client to
begin thinking of change. The best way to do this is using MI micro-skills and other skill sets.
The micro-skills consist of open ended questions, affirmation, reflection, and summarization or
OARS. Perhaps the most important skill set is asking open ended questions. By asking these
questions it is possible to lead the client to change talk. By affirming this process it encourages
the client to think more about change and what it would mean for them.
The next skill set of importance to use in Opiate Addiction is confrontation. While the
counselor does not want to yell at the client it is preferable to push. When the client states
something which isn’t true, or in direct violation of their stated values it is important. Sometimes
the client may not recognize the importance or inconsistencies of what they are saying. For an
opiate addict who values their family the counselor could confront them with, “How can you
value your family if you are taking money from your kid’s piggy bank to pay for your heroin”.
This will encourage the client to either reevaluate their values or bring about change talk.
Oftentimes the client will stick to their perceived values and begin to question their activities
instead.

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Why MI for Opiate Addiction
Opioid is a complex issue requiring treatment. The increase in availability of narcotic
pain killers has caused an increase in the amount of people using. Often times the treatment of
Opioid Addiction will need to look at why the client began using the drug. If the client started
using prescription pain killers because they were in pain and then transitioned to heroin, or if
they are still only using pills, would be different if the client began using heroin. MI is effective
for Opioid Addiction because it allows the client to question the value of continued addiction and
if life would be different without the use of opiates.
MI for an Opioid Addict is useful as a treatment plan as shown in brief episodes of MI
therapy in treatment. In a study done by Saunders, Wilkinson, and Phillips (1995), they looked
at the intensity of using MI in short segments for opioid users at a methadone clinic. Saunders,
Wilkinson, and Phillips found a positive link between opioid users and a positive shift towards
change, even if it was a brief one (Saunders, Wilkinson, and Phillips, 1995). The overall effect
of MI on opioid users is positive, especially if able to continue treatment over a long period of
time.
When a debating what kind of treatment to pursue when the client is diagnosed as an
Opioid Addict it is better to pursue MI than to not pursue any kind of follow up therapy at all.
When MI is shown to be strongest immediately following intervention with it dwindling over
time if not continued (Smedslund, et al., 2011). To achieve long standing results of MI, the
counselor must continually enforce the principles. In this study it seems they did brief sessions.
Overall MI is an effective strategy for treatment. It would be beneficial to pair MI with another
form of therapy when considering Opioid Addiction, such as relapse prevention or goal setting.

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By teaching life skills and inviting change talk the counselor creates a positive environment
where the client is able to grow.
Weaknesses resulting from MI is the time table. Not every client will open up to the
counselor in the amount of time. Without the client – rapport it is unlikely for change talk to
happen. Another weakness is follow up. With MI being a behavioral change there is no follow
up to encourage following through on goals. When a client runs out of insurance reimbursement
they are often left without the affirmations. These weaknesses in MI can be circumvented given
an increase in counseling sessions as needed, and making an effort to provide follow ups as
needed for the client.
Acknowledging the strengths of MI is the change model. Recognizing when the client is
ready to change is important otherwise the client and counselor never get anywhere as they are
always fighting each other. MI is a strength based model. It encourages clients to look within
themselves to change because they already know how, they just have not fully realized it. This is
encouraging when most counseling techniques focus on the inability of the client to choose and
require the knowledge of the counselor to proceed. Focusing on the clients strengths allows
them proceed the stages of change at a much quicker pace.
Despite the limitations of MI in my future career as a rehabilitation counselor I see
myself continuing to explore and learn more about MI. The treatment shows to be effective in
the treatment of addiction with letting people set their own pace for change. This is important
because each individual has the right to know and understand how influential they are in their
own recovery.

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References
Miller, R. W., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd
ed.). New York, London: The Guilford Press.
Saunders, B., Wilkinson, C., & Phillips, M. (1995). The impact of a brief motivational
intervention with opiate users attending a methadone programme. Addiction, 90(3), 415.
doi:https://doi.org/10.1080/09652149542382
Smedslund, G., Berg, R. C., Hammerstrøm, K. T., Steiro, A., Leiknes, K. A., Dahl, H. M., &
Karlsen, K. (2011). Motivational interviewing for substance abuse. Cochrane Database
of Systematic Reviews, doi:10.1002/14651858.CD008063.pub2
Substance Abuse and Mental Health Services Administration (SAMSHA). (2016). Opioids.
Retrieved from http://www.samhsa.gov/atod/opioids