Motivation plays an important role in alcoholism treatment. Researchers have shown interest in how motivation impacts recovery. Patients can be classified into stages of change regarding their readiness to change drinking behavior. Motivational treatment approaches like brief motivational intervention, motivational interviewing, and motivational enhancement therapy are designed to enhance a patient's intrinsic motivation to change. These approaches provide feedback, support self-efficacy, and help patients explore the pros and cons of change to increase motivation and commitment to reducing or stopping drinking. Internal motivation generally leads to better long-term outcomes than external motivation.

1. MOTIVATIONAL
ENHANCEMENT
BY Dr Ajay Kumar-MD
1Dr Ajay Kumar - PGIMER-CHD

2. Motivation plays an important role in alcoholism treatment
by influencing patients to seek, complete, and comply with
treatment as well as make successful long-term changes in
their drinking.
Researchers and clinicians have shown increased interest in
the concept of motivation and the role that motivation plays
in recovery from alcohol problems.
Alcohol-abusing and alcohol-dependent people can be
classified into different "stages of change" in terms of their
readiness to alter their drinking behavior.
2Dr Ajay Kumar - PGIMER-CHD

3. STAGES OF MOTIVATION
DiClemente and Prochaska 1998; Prochaska et al. 1992
 Pre-contemplation (i.e., not yet considering change)
 Contemplation (i.e., considering change but not taking
action)
 Preparation (i.e., planning to change)
 Action (i.e., making changes in one's behavior
 Maintenance (i.e,changing one's lifestyle to maintain
new
behavior)
3Dr Ajay Kumar - PGIMER-CHD

4. External influences and pressures, as well as internal
thoughts and feelings, contribute to a persons motivation
both to consider and implement a change in behavior
(Cunningham et al. 1994)
Programs to recruit and motivate unmotivated patients are
designed to address specific tasks and obstacles that arise at
the different stages of change.
4Dr Ajay Kumar - PGIMER-CHD

5. SOURCES OF MOTIVATION
Intrinsic sources of motivation (e.g., feeling a sense of
accomplishment)
Extrinsic sources of motivation (e.g., financial incentives) (Deci
and Ryan 1987).
5Dr Ajay Kumar - PGIMER-CHD

6.  Internal motivation is associated with greater long-
term change than external motivation (Deci and
Ryan 1985)
 Internal motivation appears to be more effective for
long-term success
 External motivation seems to promote short-term
abstinence from alcohol and other drugs.
6Dr Ajay Kumar - PGIMER-CHD

7. Ryan and colleagues (1995) found that people who received
outpatient alcohol treatment, internal motivation (as assessed by
a treatment motivation questionnaire) was related positively to
both treatment involvement and retention.
Irrespective of their level of external motivation, outpatients
with low internal motivation had the worst treatment outcomes.
The severity of the patient's alcohol problems enhances internal
motivation, presumably because the problem severity increases
distress and thus influences decisionmaking.
7Dr Ajay Kumar - PGIMER-CHD

8. A study of 263 inpatients in alcohol treatment
Patients whose motivations to enter treatment
were related to current external threats
(e.g.,threatened loss of lob, driver's license, or
spouse) experienced better treatment outcomes
8Dr Ajay Kumar - PGIMER-CHD

9. TRADITIONAL APPROACHES
 Aggressive and confrontational strategies used in
response to the patients' denial
 A team of family members, friends, and colleagues
unite to confront the drinker and convince him or her
that alcoholism treatment is necessary
 Clinicians who work with unmotivated patients must
implement less confrontational and more motivation-
generating treatment approaches - Miller (1985) .
9Dr Ajay Kumar - PGIMER-CHD

10. MOTIVATIONAL TREATMENT APPROACHES
(MTA)
Designed to enhance patients' intrinsic motivation
Brief Motivational Intervention (BMI)
Motivational Interviewing (MI) and
Motivational Enhancement Therapy (MET)
10Dr Ajay Kumar - PGIMER-CHD

11. Brief Motivational Intervention (BMI)
vary in duration from one to four sessions (10 to
60 minutes)
straightforward advice and information on the
negative consequences of alcohol abuse
minimal motivational interventions for alcohol-
dependent patients
relevant for problem drinkers who are not yet
alcohol dependent
Goal
Reduce drinking rather than abstinence
11Dr Ajay Kumar - PGIMER-CHD

12. • Treatment provider’s advice patients on the need to reduce their alcohol
consumption and offer feedback on the effects of the patients' drinking.
• Feedback is designed to increase patient motivation to reduce or stop
drinking
• Technique does not involve overtly confrontational tactics - to reduce
patients' defensiveness
• A respected professional giving the patient advice and providing
personally motivating information
• BMI patients tend not to be self-referred
• Increasing self-awareness of problematic drinking patterns by itself
may be a motivating factor in changing drinking patterns.
12Dr Ajay Kumar - PGIMER-CHD

13. Specific training, does increase the frequency and
effectiveness of brief motivational interventions.
Variable affecting the outcome evaluation of brief-
intervention
• Patient's level of motivation also may contribute to
the effectiveness of brief interventions
• Pre-treatment level of motivation
• Rate of attrition
• Participants tend to be younger (i.e., in their twenties
and thirties), less educated, and heavier drinkers may
have less motivation, fewer resources, and additional
complicating problems.
13Dr Ajay Kumar - PGIMER-CHD

14. Motivational Interviewing (MI)
MI focuses on enhancing and facilitating the patient's
internal motivation to change (Miller and Rollnick 1991)
Patient is responsible for changing his or her addictive
behavior
Recognizes ambivalence as a natural part of the process
MI is designed to assist patients in working through their
ambivalence and in moving toward positive behavioral
change.
14Dr Ajay Kumar - PGIMER-CHD

15. Various techniques to help increase the patient's motivation
Reflective listening - a form of paraphrasing that enables patients to more
fully tell their stories and to feel that they are being heard by the
empathetic MI therapist
Exploring the pros and cons of change - which may help patients
realistically evaluate their behavior and current situation and, ideally,
determine whether the pros of change outweigh the cons.
Support patient's self-efficacy or confidence - that he or she can change,
can help bridge the gap between a patient's desire to change and concrete
behavioral change
Interview and assessment data - to provide patients with personalized
feedback regarding the problem behavior (e.g., comparing the patient's
level of alcohol use with national drinking norms) as a means of increasing
self-awareness and of highlighting the discrepancy between th e patient's
current behavior and the target behavior.
15Dr Ajay Kumar - PGIMER-CHD

16. Eliciting self-motivational statements from the patients - such
as recognition of the problem and concern for one's own welfare
Propel patients to change - as they reflect the topics of greatest
concern to themselves
The MI therapist emphasizes -
 The patient's personal choice regarding change,
 De-emphasizes diagnostic labels and
 Avoids arguing with and confronting the patient.
16Dr Ajay Kumar - PGIMER-CHD

17. Motivational Enhancement Therapy (MET)
Developed for Project MATCH - initiated in 1989
MET combines MI techniques with the brevity of a less intensive
intervention
Four treatment sessions over 12 weeks preceded by an extensive
assessment
1. Therapist provides the patient with clear, structured, personalized
feedback concerning his or her:
• drinking frequency (number of drinking days per month),
• drinking intensity (number of drinks per drinking occasion)
• typical level of intoxication
• risk for negative consequences of alcohol use
• results of liver function and neurological tests
• risk factors for alcohol problems (e.g., familial risk and tolerance symptoms).
17Dr Ajay Kumar - PGIMER-CHD

18. 2. The therapist concentrates on strengthening the patient's
commitment to change by using MI techniques that are
appropriate for the patient's stage in the change process and on
helping the patient develop a specific plan for change (e.g., what
he or she will do, how he or she will do it, and who can help).
3. In the third and fourth session the therapist focuses on reviewing
patient progress and renewing motivation and commitment by
exploring remaining ambivalent feelings that the patient might
have about changing the targeted behavior
4. Termination of the treatment and future plans are also discussed
at the end of session 4, which involves a summary of the
treatment progress
18Dr Ajay Kumar - PGIMER-CHD

19. In general, motivated patients enter and attend treatment at
higher rates than do less motivated patients. However, some extr
in the insically motivated patients may attend treatment regularly
but be reluctant to participate treatment program. Other
minimally motivated patients may attend and participate to some
degree but tail to make substantial changes or sustain changes
made in treatment. Both the type and intensity of the patient's
motivation for change are important potential moderators of
treatment participation and recovery success.
19Dr Ajay Kumar - PGIMER-CHD

20. REFERENCE
http://findarticles.com/p/articles/mi_m0cxh/is_2_23/ai_59246571/
Motivational Enhancement Therapy with Drug Abusers
William R. Miller, Ph.D. Department of Psychology and
Center on Alcoholism, Substance Abuse, and Addictions
(CASAA) The University of New Mexico
20Dr Ajay Kumar - PGIMER-CHD