Introduction Motivational Interviewing

Introduction Motivational Interviewing

The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense

Course Objectives • Learn about motivational interviewing as it applies to substance use disorders • Learn some basic skills in the principles and practice of motivational interviewing

Definition

What is motivational interviewing?

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Definition Motivational Interviewing is a patient focused psychotherapy that seeks to resolve ambivalence about changing behavior.

Ambivalence & Change  Inertia: The resistance of any physical object to any change in its state of motion.  Behavioral change proceeds through identifiable stages.  Motivational Interviewing recognizes and responds to this fundamental principle

Stages of Change

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Evidence: Motivational interviewing for substance abuse* Meta-analyses based on 59 studies with a total of 13,342 participants. The results show that people who have received MI have reduced their use of substances more than people who have not received any treatment.

* Motivational interviewing for substance abuse (Review) Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM, Karlsen K The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. 2011, Issue 11

Evidence: Motivational interviewing for smoking cessation* • Meta-analysis based on 28 studies involving over 16,000 participants. • Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. • Motivational interviewing appears to help more people quit smoking than brief advice or usual care when provided by general practitioners and by trained counsellors *Motivational interviewing for smoking cessation. Lindson-Hawley N, Thompson TP, Begh R: The Cochrane Library. 2015, Issue 3

Clinical Considerations In terms of substance use disorders – “as many as 70% of patients are in the precontemplation or contemplation stage when presented with the diagnosis.”

Chapter 56. Substance Use Disorders Robert Mallin, MD; Joseph J. Benich III, MD in CURRENT Diagnosis & Treatment in Family Medicine accessed http://accessmedicine.mhmedical.com/content.aspx?sectionid=40349451&bookid=377&jumpsectionID=40356455&Resultclick=2

Clinical Considerations Given the high degree of potential patient resistance to a substance use disorder diagnosis what can be done?

Chapter 56. Substance Use Disorders Robert Mallin, MD; Joseph J. Benich III, MD in CURRENT Diagnosis & Treatment in Family Medicine accessed http://accessmedicine.mhmedical.com/content.aspx?sectionid=40349451&bookid=377&jumpsectionID=40356455&Resultclick=2

Death Glossary: Pitfalls to Avoid When Presenting the Diagnosis. Drinking or drug use details are not relevant. Etiology Arguments Threats: Hedging Hedging: Source: Modified, with permission, from Schulz JE, Parran T Jr: Principles of identification and intervention. In: Graham AW, Shultz TK, eds: Principles of Addiction Medicine, 2nd ed. American Society of Addiction Medicine, 1998.

Chapter 56. Substance Use Disorders Robert Mallin, MD; Joseph J. Benich III, MD in CURRENT Diagnosis & Treatment in Family Medicine accessed http://accessmedicine.mhmedical.com/content.aspx?sectionid=40349451&bookid=377&jumpsectionID=40356455&Resultclick=2

Pitfalls in Discussing the Diagnosis

*Motivational interviewing for smoking cessation. Lindson-Hawley N, Thompson TP, Begh R: The Cochrane Library. 2015, Issue 3

Discussing the Diagnosis

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A Right Way Available for FREE from SAMHSA : http://store.samhsa.gov/pr oduct/TIP-35-EnhancingMotivation-for-Change-inSubstance-AbuseTreatment/SMA13-4212

Changes in Addiction Practice based on Motivational Interviewing • Focus on Client Competencies And Strengths • Individualized and Client-Centered Treatment • A Shift Away From Labeling • Therapeutic Partnerships For Change • Use of Empathy, Not Authority and Power • Focus on Earlier Interventions • Focus on Less Intensive Treatments

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Instruments for Measuring Readiness for Change

Readiness To Change Questionnaire (Treatment Version)

Readiness To Change Questionnaire (Treatment Version) (RCQ-TV) This instrument is copyrighted and may be obtained by contacting: Professor Nick Heather Consultant Clinical Psychologist Newcastle City Health NHS Trust Northern Regional Drug and Alcohol Service Newcastle upon Tyne United Kingdom

FRAMES Elements of Effective Motivational Interventions

Tipping the Decisional Balance

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Questions to Tip the Balance

Emphasize Personal Choice and Responsibility • “It’s up to you what to do about this.” • “No one can decide this for you.” • “No one can change your drug use for you. Only you can.” • “You can decide to go on drinking or to change.”

Importance of Self-Efficacy

Motivational Strategy for Precontemplation

Motivational Strategy for Contemplation

Motivational Strategy for Moving Towards the Action Stage

Motivational Strategy for Moving Towards the Action Stage

Motivational Strategies: Relapse Triggers …One of my relapse triggers is my social circle

(1) go out with a different set of friends, (2) go along with this group only for activities that do not involve drinking, (3) leave the group as soon as drinking seems imminent, (4) (4) tell the supplier that she is trying to stay off cocaine and would appreciate not being offered any, (5) ask all her friends, or one especially close friend, to help her out by not using when she is around or by telling the supplier to stop offering it to her

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