Addiction: A Pathology of Motivation and the Role of Motivational Interviewing in Substance Abuse Treatment


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Final presentation for the Scaife Advanced Student Medical Seminar by Angela Condo

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Addiction: A Pathology of Motivation and the Role of Motivational Interviewing in Substance Abuse Treatment

  1. 1. Primary Chronic DiseaseMotivation Choice
  2. 2. What is Motivational Interviewing?
  3. 3. Transtheoretical Model of Change
  4. 4. I can control my behavior. I know my triggers and how to handle them. I am making changes. I avoid people, places, and things. I want to change. I can… Yeah, I have a problem; but it’s too hard to change or I don’t want to change.I don’t have a problem.I can stop if I want to.
  5. 5. Principles of Motivational Interviewing• Express Empathy – “Put yourself in my shoes.”• Support Self Efficacy – Previous successes not failures• Roll with Resistance – “dancing, rather than wrestling”• Develop Discrepancy – Current Behavior and Values – Current Circumstances and Future Goals
  6. 6. Spirit of Motivational Interviewing• Collaboration • Not hierarchy• Evocation • Not imposing or externally driven• Client Autonomy • Not authority or coercion
  7. 7. MI: Progression through the Stages of Change Open ended questions Affirmations Reflections Summaries
  8. 8. Role of Motivational InterviewingIncrease Change Talk & Readiness to ChangeIncrease Client Exp. Of Discrepancy Increase Client Engagement Decrease Resistance Improve Retention, Motivation, and Outcomes
  9. 9. Role of Primary Care PhysiciansMotivational interviewing is an effective substance abuseintervention when used by clinicians such as primary carephysicians who are non-specialists in substance abusetreatment; it can enhance entry to and engagement in moreintensive substance abuse treatments. (Dunn et al, 2001)Form a Therapeutic AllianceAdhere to the spirit of MIBegin a discussion of change
  10. 10. ReferencesAmerican Society of Addiction Medicine [ASAM]. (2011). Definition of addiction. Retrieved from, T. R., & Longabaugh, R. (2009). Mechanisms of change in motivational interviewing: areview and preliminary evaluation of the evidence. Addiction, 104, 705-715.Britt, E., Hudson, S. M., & Blampied, N. M. (2003). Motivational interviewing in health settings: areview. Patient Education and Counseling, 53, 147-155.DiClemente, C.C., Nidecker, M., & Bellack, A. S. (2008). Motivation and the stages of change amongindividuals with severe mental illness and substance abuse disorders. Journal of SubstanceAbuse Treatment, 34, 25-35.DiClemente, C. C., Schlundt, D., & Gemmell, L. (2004). Readiness and stages of change in addictiontreatment. The American Journal on Addiction, 13, 103-119.Dunn, C., Deroo, L., & Rivara, F. P. (2001). The use of brief interventions adapted from motivationalinterviewing across behavioral domains: a systematic review. Addiction, 96, 1725-1742.Jensen, C. D., Cushing, C. C., Aylward, B. S., Craig, J. T., Sorell, D. M., & Steele, R. G. (2011).Effectiveness of motivational interviewing interventions for adolescent substance use behaviorchange: a meta-analytic review. Journal of Counseling and Clinical Pyschology, 79, 433-440.Kalivas, P. W., Volkow, N. D. (2005). The neural basis of addiction: a pathology of motivation andchoice. American Journal of Psychiatry, 162, 1403-1413.
  11. 11. Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy: Methodological issues and research recommendations. Journal of Child Psychology and Psychiatry, 44, 1116-1129.Miller, W. (2004). Toward a theory of motivational interviewing. Retrieved fromhttp://www.motivationalinterview.orgMiller, W. R., Baca, C., Compton, W. M., Ernst, D., Manuel, J. K., Pringle, B., Schermer, C. R.,Weiss, R. D., Willenbring, M. L., and Zweben, A. (2006). Addressing substance abuse in health care settings. Alcoholism: Clinical and Experimental Research, 30, 292-302.Miller, W. & Rollnick, W. (2010). What’s new since MI-2? Retrieved fromhttp://www.motivationalinterview.orgMiller, W. R., Yahne, C. E., & Tonigan, S. (2003). Motivational interviewing in drug abuse services: a randomized trial, Journal of Consulting and Clinical Psychology, 71, 754-763.Motivational Interviewing. (2012). Overview of motivational interviewing. Retrieved from http://www.motivationalinterview.orgMoyers, T. B., Miller, W. R., & Hendrickson, S. M. L. (2005). How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Journal of Consulting and Clinical Psychology, 73, 590-598.Velicer, W. F, Prochaska, J. O., Fava, J. L., Norman, G. J., & Redding, C. A. (1998). Smokingcessation and stress management: Applications of the Transtheoretical Model of behavior change. Homeostasis, 38, 216-233.