Motivational Interviewing (MI) for Addiction Treatment

Motivational interviewing is an evidence-based counseling approach that is patient-centered and aims to help people change problem behaviors. MI’s main principle is that motivation to change must be drawn out of people, not imposed on them. It is used to strengthen a person’s basic motivation to change by exploring and clearing up their hesitation to do so. MI then makes the most of their readiness to change their behavior. 

It has been found that motivational interviewing can reduce substance use   among people who have been diagnosed with substance abuse or substance use disorder (SUD). Motivational Interviewing was originally developed by William Miller and Stephen Rollnick to treat alcohol addiction. It’s exceptional in the way it gives individuals the power to take responsibility for their own recovery.

How Does Motivational Interviewing Work?

It’s no surprise that people with substance use problems and disorders frequently have mixed feelings and ideas about their smoking, drug, and alcohol use. Although they may recognize some negative consequences of smoking, using drugs, or drinking, they also experience some enjoyable  experiences such as:

Motivational interviewing is a technique of discussing an issue in a way that brings out a person’s own reasons for changing, instead of confronting them with your own opinions about why they should change, even if your reasons are correct. MI understands that having mixed feelings or not being sure about making a change is a typical part of the process of recovery.

Talking about this uncertainty includes empathizing with the part of the individual that doesn’t want to change. But this can help to draw out the person’s reasons for making a change. MI targets finding and strengthening the person’s own motivation for change in accordance with their own:

Costs vs. Benefits

Because of the enjoyable experiences, individuals often remain in a conflicted or undecided state about changing unless their concept of the costs vs. benefits changes. Understanding and working out  this confusion is a main goal of motivational interviewing. And it is accomplished by helping the individual recognize their problem, rather than persuading them that they have one.

Motivational interviewing is a process where the individual and counselor work together to understand the person’s outlook, while directing them toward considering changing one or more behaviors. This is done by building their awareness of the difference between the person’s current self and their hoped-for self. This is done without confrontation while encouraging the person’s optimism about the opportunity to change.

Essential Processes in Motivational Interviewing for Substance Use Disorder

The key processes in motivational interviewing include:


Counselors using MI build a relationship and engage the person with a friendly, non-judgmental attitude. They will bring out the person’s ideas and feelings about a variety of current behaviors. Then they will explore how they fit with the person’s hopes and values and whether the person can envision better choices than the current behaviors.


They will focus on particular changes that the individual wants to make and match the plan to the person’s priorities. 


The therapist will obtain the person’s own reasons and justification for possible changes. This is referred to as “change talk.” After a person is determined to change, they can usually do it on their own.


Although it’s not essential, motivational interviewing may include the process of planning for and putting changes into action. Generally speaking, MI is more focused on discussing the “whether” and “why” to change rather than the “how.”

The Motivation for Recovery from Addiction

In the framework of motivational interviewing, whether the person has a SUD or not is less important than the person’s understanding that they should make some changes in their life. Counselors using MI with people with a history of dependence might choose to advise the person not to drink or use drugs but, using a MI approach, the person’s viewpoint on their addictive behaviors is more important than the counselor’s.

Instead of seeing the person as having an SUD, they would be viewed as being stuck in unhealthy behaviors. Therefore, they can be “unstuck.” Behavior patterns that are seen as being unhealthy are the result of competing motivations to make changes or to stay the same. Once the benefits of changing are greater than the costs, and when staying the same is less attractive than changing, people generally proceed with changing.

Who Can Benefit from Motivational Interviewing?

Candidates for motivational interviewing include:

There is nobody that can’t benefit from motivational interviewing. However, individuals with cognitive impairments or reduced abilities to think about ideas or concepts may have a problem imagining benefits of change.

MI is suitable for a range of health settings because it can be applied in briefer encounters with people who need to change. In addition, it works well when combined with other therapies such as in group settings. Its skills are valuable in any situation where resistance to change is faced.

What Are the Benefits of MI for Recovery from Addiction?

There are many reasons why motivational interviewing is an extensively used form of mental health therapy. 

Some of them are:

Motivational interviewing is particularly beneficial to people who are resistant to starting a treatment program or who are not prepared to make the changes necessary.

How Effective is Motivational Interviewing?

Since it was first developed in the 1980s, studies have shown that it can be used to effectively treat a variety of psychological and physical health issues including addiction treatment. Research revealed that of 39 students interviewed, two-thirds found that motivational interviewing was linked to substantial reductions in adolescent substance use. Furthermore, another review showed that MI can effectively reduce binge drinking along with the frequency and amount of alcohol consumed.

A review of 72 clinical controlled trials revealed that 75% of the studies do get an effect, regardless of whether the problems were physical or psychological. The analysis led to the conclusion that MI in a scientific setting outperforms traditional advice-giving. Also, when you consider that there aren’t any harmful effects of MI, there is a suggestion that this method has important potential to benefit patients.

Motivational Interviewing Guidelines You Can Use

Medical professionals are often trained in motivational interviewing. But family and friends of people struggling from a SUD can use these methods of talking to their loved ones about making changes, getting treatment, and staying on their path to recovery.

At first, some of the techniques of MI may seem surprising. MI can be particularly difficult when discussing opioid use with a loved one. It can become emotionally charged and cause conflict. Friends and families of someone with an opioid use disorder may want to get help from a trained addiction counselor.  But still, these guidelines can be a helpful beginning in encouraging a loved one to make a change. 

Collaboration vs. Confrontation

MI encourages the idea of working together to find a solution instead of arguing. In discussions, one person is not the “expert” and the other is not the “student.” The point is mutual understanding, not one or the other proving that they’re “right.”

Drawing out vs. Forcing Ideas About Changing

In MI, the goal is to draw out a person’s own motivations and skills for change. It’s not to tell them what to do or why they should do it. Generally, it doesn’t matter how good another person’s reasons for change are, change that lasts is more likely to happen when an individual finds their own reasons to change. It’s common to want to give someone advice and try to persuade them to change. But this is more likely to end up in arguments than change. 

Autonomy vs. Authority

The real power for change is with the individual (autonomy) who is suffering from addiction. It isn’t with their friends, family, or doctor (authority). In the end, it is up to the individual to make things happen. The person with the addiction should be encouraged to lead in coming up with ideas about how to achieve the change they want.

Roll with Resistance

This is a hard principle to follow. When talking about change, a person with an addiction might often resist suggestions for treatment and ideas from other people. In motivational interviewing, you go along with the resistance. Don’t try to challenge or argue with them. It’s more effective to let the person come up with their own ideas for change. Different points or ideas can be suggested, but don’t force them.

Support Self-Efficacy

The individual’s belief or confidence in their ability to carry out a certain behavior is self-efficacy. You can help reinforce the person’s power to make the changes they want by helping to guide them through the process and encourage them along the way.


OARS stands for the basic principles of motivational interviewing. These principles help make the discussions more successful in stimulating change.

Open-ended questions–Ask questions that can’t be answered with yes or no.

Affirmations–Identify and encourage the individual’s strengths.

Reflections–React in ways that make it obvious that you’ve been listening to them. Allow them to make corrections if they didn’t fully express themselves. This also allows you to show empathy (the ability to share in their feelings and experiences and see the world through their eyes). This helps make the person feel heard and understood. For example, you may say “I hear that you’re upset.” or “What I hear you saying is…” 

Summarize–This allows you to recap what has been discussed. It can highlight the other person’s strengths and reasons for change.

Let Sana Lake Show You the Path to Recovery

At Sana Lake Behavioral Wellness Center we understand what you’re going through. Whether it is you or a loved one struggling with substance use disorder, we know you have questions and we are happy to answer them. And we are available to you 24/7 so don’t sit and wonder what to do. Nothing happens unless you make that step. Contact us today.

From a medical detox center to residential and outpatient treatment, to recovery housing, Sana Lake is prepared to meet your needs. Our experienced and caring staff of professionals will design a program specifically to help you meet your goals. You make contact, and we will do the rest.