Motivational Therapy in Addiction Treatment

Substance use disorder [1], also referred to as substance addiction, drug addiction, alcohol use disorder, and more is a serious brain disease which not only ruins the lives of the addicted person and their family but can cause serious physical and psychological harm.

When cases of substance use disorder are severe enough, it can kill the addicted person.

Addiction has a history of being stigmatised, and its severity has been downplayed by many who are fortunate enough not to have experienced its effects.

However, neuroscientists and neuroscientific models are continuing to develop in a way which is highlighting the psychological and physical effects that addiction has on people.

Understanding Substance Use Disorder Treatment

To treat substance use disorder, there needs to be a range of treatments incorporated to optimise a patient’s treatment programme.

A fully comprehensive treatment programme designed by addiction specialists – and tailored to the individual and their specific requirements – will maximise their responsiveness to recovery methods and their chances of recovery.

When a patient enters a drug and alcohol rehab, they will be required to undergo a medical detox if they are suffering from any physical withdrawal symptoms.

Following a successful detox, they will proceed to undergo a vast range of therapeutic methods and relapse prevention planning strategies.

Therapeutic approaches include but are not limited to Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, holistic therapy, and Motivational Interviewing.

What is Motivational Interviewing?

Motivational interviewing [2] is a form of motivational therapy which is used to increase the patient’s likelihood of recovering from their drug or alcohol addiction.

Motivational Interviewing was developed in the 1980s – by two people named William Miller and Stephen Rollnick – to treat alcohol addiction [3].

While it was initially developed to treat alcohol addiction, it is employed to treat a wide range of addictions (substance and behavioural), such as:

• Alcohol addiction
• Drug addiction
• Gambling addiction
• Sex addiction
• Porn addiction

How Does Motivational Interviewing Differ from Other Forms of Therapy?

Forms of therapy such as Cognitive Behavioural Therapy and Dialectical Behavioural Therapy may attempt to get to the root cause of someone’s addiction.

For example, a licensed counsellor leading these sessions may discuss varying topics related to the patient’s addiction and personal life to understand what is causing their addiction and how they can address these issues and overcome it.

However, motivational interviewing does not attempt to address these root causes.

Instead, the purpose of motivational interviewing (and motivational therapy in general) is to increase the patient’s level of motivation – and thus their participation – throughout the recovery process and addiction treatment.

It is not necessarily a form of therapy which should be employed by itself, but instead, it is a form of therapy which will highly complement and increase the effectiveness of other forms of therapy within the addiction treatment programme.

Motivational Interviewing, when used correctly and appropriately, can have a significant impact on a patient’s recovery progress.

This is because, after attending a few motivational interviewing sessions, the patient will have a new perspective on their recovery and their motivation – or drive – towards recovery will be thoroughly reinforced.

Why Motivational Interviewing?

Motivational therapy and motivational interviewing are not only necessary but highly influential for some patients.

Each patient is different; their case of addiction is different, their personal lives vary tremendously, and their commitment to recovery will vary to the next patient.

Because of this, some patients require motivational therapy to help them achieve recovery.

While some patients may associate addiction treatment at a drug and alcohol rehab as the solution to their problems, other patients may associate rehabilitation facilities with negative connotations.

They may associate these places with struggle, confinement, pain, and more, which means that they will be reluctant to enter rehab and undergo a comprehensive recovery plan.

Motivational interviewing can help these patients transform their perspective.

Instead of viewing addiction treatment as something overwhelming, daunting, and requiring high levels of commitment and sacrifice, motivational interviewing can help them reshape their perspective to view addiction treatment as an opportunity full of positive connotations.

What are the Benefits of Motivational Interviewing Techniques?

There is a vast range of benefits to be had from attending motivational interviewing sessions with a licensed counsellor.

Each patient is different, and the licensed counsellor will be able to tailor these sessions to cater to the patient’s unique needs and find new methods to motivate and sustain their commitment towards recovery methods:

• Increase in participation throughout addiction treatment: Many people who undergo addiction treatment may suffer from a lack of motivation. While they want to get better, addiction recovery seems like a monumental task, especially when they are suffering from discomforting psychological and physical symptoms. Motivational interviewing will incite and reinforce the motivational factors towards recovery, and the patient will then become more committed to their addiction treatment programme.
• Overcoming passivity: One thing that motivational interviewing does is help patients realise that they are the ones that have the power to recover. They will learn to understand that, while incredibly pivotal to one’s recovery, licensed counsellors and addiction specialists are not the only ones that have the tools to help them recover. Once they realise that recovery is ultimately down to them, they will become more proactive.
• Activation of self-efficacy: In realising that they are the ones that have the tools to recover, the patient will experience a huge increase in self-efficacy. By understanding that they have the pre-requisite tools and abilities to recover and return to a life of health and sobriety, the patient will develop self-efficacy, which is the belief in their capabilities to reach a desired outcome – in this case, addiction recovery.
• Increased benefits in other forms of therapy: Motivational interviewing is most optimal when used along with other forms of behavioural therapy, communication therapy, holistic therapy, and so on. When someone is undergoing motivational interviewing and experiencing its benefits, they will also realise that the benefits from other forms of therapy are increasing. This is because they will be more committed and engaged in these forms of therapy, whether it be Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, or else.
• Priority Changes: Motivational interviewing helps the patient realise and emphasise what drives them to recovery, whether it be intrinsic motivations (improving one’s health) or extrinsic motivations (family’s wishes or job performance etc.). By placing more emphasis on these motivations, patients will employ better habits in other aspects of their life, not only addiction, because they will have a better understanding of their priorities.
• Increased longevity: Patients will have developed a healthier perspective, and they will be more aware of what is driving them towards recovery. Not only will this help them overcome addiction, but it will help them sustain their sobriety in the long run. This will also lead to other healthy lifestyle changes, like disassociating oneself from negative people or places, which may act as relapse triggers.
• Improved physical and psychological health: Now understanding that they need to be proactive to achieve things, patients will be more active in their pursuits of other achievements in life. Overcoming addiction will increase their self-efficacy immeasurably, and this will lead to them aspiring and achieving other personal goals which will improve their life.

Are There Any Drawbacks to Motivational Interviewing?

While Motivational Interviewing presents a range of significant benefits to patients, it is not the only solution to drug and alcohol addiction.

Since Motivational Interviewing does not attempt to address the root cause of someone’s addiction, which could be due to biological factors, social issues, or psychological disorders, it cannot be used by itself to help a patient overcome addiction.

Instead, Motivational Interviewing is more effective when used concurrently and in addition to other forms of therapy.

It can even increase the effectiveness of other forms of therapy. By increasing the motivation levels of patients, they can expect to experience greater benefits from other forms of therapy.

What Happens During Motivational Interviewing?

Patients who are undergoing addiction treatment will need to be assessed and evaluated by licensed counsellors and addiction specialists.

This will help these health professionals to understand how the patient is suffering, and they can then proceed to implement the necessary treatment approaches which are catered to their unique needs.

The licensed counsellors will assess their addiction severity, the substance of choice, social and economic factors, and so on. Then they can then proceed to undergo motivational interviewing with these factors taken into consideration.

When the patient starts and attends these sessions of motivational interviewing, it will be conducted in a 1-1 format.

The licensed counsellor will assume the role of an interviewer, and they will proceed to ask a range of questions which are thought-provoking and evocative to get the patient to think about their addiction and why they want to recover from their condition.

Along with the evaluated information provided by the patient during the health and pre-admission assessment, the counsellor and patient will engage in a range of in-depth discussions.

These discussions will not only allow the licensed therapist to gain more insight into the patient’s addiction, root cause, and so on, but they can also become insightful for the patient.

Motivational interviewing can benefit the patient by helping them develop self-awareness and improving their emotional intelligence.

This helps the patient become more active rather than a mere participant undergoing therapy. Rather than letting the licensed counsellor control the session, the patient will learn to express themselves and become proactive in their recovery journey.

With the help of a range of intrinsic and extrinsic motivational factors, the patient will learn how to sustain their commitment towards recovery.

Some of the questions which may be asked during a session of motivational interviewing may include but are not limited to:

• In what ways have addictive substances had an impact on your life? This will allow the patient to go into great detail about the ways that drugs and alcohol are hurting their life. Externalising these problems and communicating them with a health professional will also reinforce to the patient how drugs and alcohol are negatively impacting their life.
• What are some indicators that you have a problem with drugs and alcohol? The patient will explain what some signs are that made them consider that they may have a drug or alcohol addiction.
• Do you think there are benefits to consuming addictive, toxic substances? The patient will decide whether there are benefits to be had by taking drugs or alcoholic substances. While some people may justify that it relaxes them or makes them more sociable, the licensed counsellor will also reiterate that these are unsustainable solutions to deeper-rooted problems.
• What made you decide to reach out to us? Answering this question will help reinforce why the patient decided that they needed to change their habits and seek help. This will help reinforce their motivation by reiterating what problems are caused by drugs and alcohol in their life.
• Has your addiction affected the lives of others? If so, how? Talking about how your substance addiction has affected others can be tough because people tend to feel worse when their addiction affects others as opposed to how it affects themselves because they must take some accountability for other people’s suffering.
• What are some intrinsic motivations to recover? The patient will discuss their internal reasons for wanting to change with the licensed counsellor.
• What are some extrinsic motivations for recovery? The patient will discuss and list external factors which are motivating them to change. These factors can include friends and families wanting them to change, their employment and occupational performances requiring them to be sober, and so on.

The Stages of Change Throughout Addiction and Recovery

The Stages of Change Model was developed in the 1970s and can help us understand the patterns of motivation in a patient who is suffering from addiction but desires change.

Throughout various stages of life and stages of recovery, the patient’s motivation will change. Motivation is never static; it will change just as the patient’s perspective changes.

The stages of change include:

• Precontemplation: During this stage, the addicted person has not yet thought about changing their habits or confronting their drug or alcohol dependency. This is because they may not seek to change, or they may not even think that they have a problem. This stage is when addiction can be at its worst because the addicted person is unaware of their problem and continues to consume these toxic substances.
• Contemplation: Following contemplation, the patient may then consider changing some of their habits to confront their dependence. However, many addicted people understand that they have a problem with drugs or alcohol but are unwilling (due to fear or reluctance) to change. Patients will vary in their commitment during the contemplation stage; some people may seriously contemplate changing their life, whereas others may know that they need to change but fail to act.
• Preparation: At this stage, the addicted person has acknowledged that they do have a problem. It is often said that the first step of recovery is admitting that you have a problem, and this is true in many ways. Only once you recognise that you have a serious problem can you proceed to not only undergo therapy and addiction treatment but to take it seriously.
• Action: Following preparation in action. At this stage, the addicted person will have taken action, in whatever form, to improve their lives and overcome addiction. The addicted person will have begun abstaining, tapering, or will have reached out to a drug and alcohol treatment provider to improve their lives and overcome substance addiction. At a drug and alcohol rehab, they will undergo a comprehensive addiction treatment programme, as an inpatient or an outpatient, to overcome their addiction.
• Maintenance: The maintenance stage refers to the patient or addicted person having overcome their withdrawal symptoms and cravings associated with their drugs and alcohol. Although they are sober at this stage, it is possible (and sometimes even expected) that the patient will relapse. Their time spent at a drug and alcohol rehab will have taught them a range of relapse prevention planning strategies, and they may undergo an aftercare programme to help them sustain their newfound life of sobriety.

Other Examples of Motivational Therapy

Motivational interviewing is not the only form of treatment which falls under the branch of motivational therapy.

There are other forms which are similar to motivational interviewing but stress different techniques to reach the same objective – to increase the patient’s motivation and commitment towards addiction treatment.

1. Contingency Management

Contingency Management [4] is not only different to motivational interviewing but different to most forms of treatment traditionally used in a drug and alcohol rehabilitation facility.

While its purpose is to increase the motivation of the patient to stick towards their newfound healthy lifestyle, it aims to achieve this in a very different way.

Additionally, one could argue that it is not a form of ‘therapy’ or ‘treatment’. Contingency Management does not involve the use of therapists or 1-1 sessions which rely on communication.

Instead, Contingency Management includes the use of incentives to help patients remain committed towards their targets.

The idea of incentivising addiction treatment for patients can improve the level of commitment towards therapy.

Although addiction recovery should – in theory – be a big enough incentive to attend therapy sessions and undergo addiction treatment, patients may remain more committed if their goals are broken down into smaller steps.

Contingency Management can make use of gifts, vouchers, and other items which are deemed valuable to the patient.

These incentives can be awarded to patients once they reach targets, such as remaining sober for a week, month, or year or having completed so many therapy sessions in succession without missing a session.

Additionally, Contingency Management provides patients with tangible evidence of their hard work. This can further encourage them to keep working because each goal that they reach is manifested in the form of a physical gift.

2. Motivational Enhancement Therapy

Motivational Enhancement Therapy [5] may be used synonymously with motivational interviewing. However, there are some differences which should be noted to differentiate the two.

While both are utilised to encourage and facilitate change, the biggest difference between Motivational Interviewing andMotivational Enhancement Therapy is their method of achieving these goals.

Motivational Interviewing is more beneficial towards patients who are reluctant to change, whereas Motivational Enhancement Therapy is aimed more towards patients who are ambivalent towards change.

Motivational Interviewing encourages the patient to become a more active participant in their drug and alcohol addiction recovery journey.

The licensed therapist takes a secondary role, asking questions to the patient, who is encouraged to become more active.

On the other hand, Motivational Enhancement Therapy requires the therapist to be more active, educating the patient on why therapy and treatment will benefit them and using a range of science and evidence-based research to reinforce these changes.

Other Therapy Patients Undergo at a Drug and Alcohol Rehab

As previously mentioned, Motivational Interviewing, by itself, is not enough to ensure that someone overcomes addiction.

Patients must undergo a personalised and thorough drug and alcohol addiction treatment programme to ensure that they recover optimally.

Some of the other forms of therapy included throughout addiction treatment include but are not limited to:

• Cognitive Behavioural Therapy: Cognitive Behavioural Therapy [6], also commonly referred to as CBT, is a highly effective form of therapy which is frequently used to treat not only patients of substance addiction but also patients suffering from mental health disorders such as anxiety, depression, and so on. The purpose of CBT is to help patients identify and overcome cognitive and behavioural issues. These issues include cognitive distortion, self-hatred, suicide ideation, and more. CBT can help patients improve all facets of their life, not only addiction.
• Dialectical Behavioural Therapy: Dialectical Behavioural Therapy, also referred to as DBT, is similar to CBT. However, the purpose of DBT is to help patients overcome strong feelings and emotions which can make them irrational and turn towards self-destructive coping mechanisms, such as consuming drugs or alcohol. DBT places a lot of emphasis on mindfulness and stress management to help patients develop healthier coping mechanisms.
• Family Therapy: Family Therapy [7] can help improve relationships and communication between family members. Whether the patient has a positive or negative relationship with family members, this will benefit both parties because it will create a healthier relationship, a recovery environment, and a reinforced support system. Family Therapy also offers counselling support as well as education about addiction for family members.
• Holistic Therapy: Holistic therapy embodies the theory of holism, which believes that people are one entity and should be treated as such. How this is implemented into addiction treatment is that holistic therapy emphasises therapies and treatments which benefit patients physically, mentally, and spiritually. Examples of activities which can benefit patients on a holism level are yoga, acupuncture, massages, adventure therapy, and more.

Contact Rehab 4 Alcoholism Today Beat Addiction

At Rehab 4 Alcoholism, our priorities are to help you or your loved one recover from drug and alcohol addiction and return to a life of health and normalcy.

We understand the extent to which addiction can affect people and their families. With your motivation and our expertise, we can help you overcome addiction.

You can reach out to us by dialling the number 0800 111 4108 from the UK, or you can dial +44 345 222 3509 if you are based internationally. Once you reach out to us, we can initiate your recovery journey together.

References

[1] Substance Use Disorder https://www.ncbi.nlm.nih.gov/books/NBK570642/

[2] Motivational Interviewing https://www.ncbi.nlm.nih.gov/books/NBK589705/

[3] A Definition of Motivational Interviewing https://www.umass.edu/studentlife/sites/default/files/documents/pdf/Motivational_Interviewing_Definition_Principles_Approach.pdf

[4] Contingency Management in Addiction Treatment – Rehab 4 Alcoholism https://www.rehab4alcoholism.com/alcohol-treatments/contingency-management

[5] Effects of Motivational Enhancement Therapy (MET) on the self-efficacy of individuals with alcohol dependence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132760/

[6] Cognitive Behavioural Therapy for Alcoholism – Rehab 4 Alcoholism https://www.rehab4alcoholism.com/alcohol-treatments/cbt

[7] Family Therapy for Addiction – Rehab 4 Alcoholism https://www.rehab4alcoholism.com/alcohol-treatments/family-therapy

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