More than 95 percent of the nearly 23 million American adults who struggled with substance abuse and addiction in 2013 did not feel they needed treatment for the disease, the National Survey on Drug Use and Health (NSDUH) publishes. A huge treatment gap exists between those who need help and those who actually get it in a specialized treatment program. The American Society of Addiction Medicine (ASAM) reports that only one out of every 10 people in the United States who need care for addiction actually get the treatment they require.
A huge barrier to treatment is a person’s motivation and their belief that a problem exists. In the early 1990s, William Miller and Stephen Rollnick publicized a type of therapy modality that focuses on helping a person overcome their ambivalence to treatment. Essentially, the therapy helps the person to perceive a need for positive change. This is called motivational therapy, which is person-centered and goal-directed. Motivational therapy seeks to help a person recognize that a problem exists and to come to their own conclusions that things need to change.
A component of motivational therapy, Motivational Interviewing (MI), is a counseling approach often used in treatment for substance abuse and addiction. It is frequently used to reduce other potentially self-destructive and risky behaviors, and to improve a person’s engagement and retention in a treatment program. The Journal of Clinical Psychology reports that MI was 10-20 percent more effective than no treatment at all and was also similarly effective when compared to other treatments and therapeutic methods.
The concept of Motivational Interviewing originated from the treatment of alcohol addiction as a form of non-directive counseling inspired by Carl Rogers in the 1950s. MI has also been used to treat asthma, diabetes, and weight loss as well as to help people stop smoking, to enhance fitness programs, and to treat drug addiction.
Motivational Interviewing is fairly risk-free, and the British Journal of General Practice publishes that MI led to improvements in behavior as much as 80 percent of the time. Motivational therapy lets the person decide that they need to change while offering empathy and support to illicit positive self-directed improvement.
Motivational Therapy and the Stages of Change
Several years after motivational therapy gained public attention, Carlo DiClemente, PhD, a professor out of Maryland, presented that motivation is a process that people go through, and it is both behavior- and substance-specific. As motivation is commonly a key factor that is missing in getting a person into addiction treatment in general, it should also therefore be a focus of the treatment. Dr. DiClemente provided a framework for the Stages of Change model, explaining that all behavior change goes through this process, not just the behaviors that need to change surrounding addiction. By better understanding what it takes to change a behavior, a person can learn how to make these changes and also how to sustain them into recovery.
As published by Medscape, the Stages of Change model is as follows:
- Pre-contemplation: not yet ready to change
- Contemplation: starting to think about change
- Preparation: planning, commitment, and readying oneself for change
- Action: implementing the plan and making the change
- Maintenance: working on maintaining the change while learning how to integrate it into one’s lifestyle
- Relapse/cycling: going back into the previous behavior and starting the cycle of change again
- Termination: completing the cycle of change
A person may go through the stages and cycle of change many times during addiction treatment, as it can take time for new habits and healthy coping mechanisms to be formed and ingrained. Patience and commitment are reaffirmed throughout a treatment program as personal motivation is strengthened. Motivational therapy can help people to work through these stages to make positive and lasting changes, which can include less, or a complete cessation of, drinking and drug use.
Motivational Therapy in Addiction Treatment
Motivational Enhancement Therapy (MET) is considered a brief intervention, often used for the treatment of addiction and problematic substance abuse. MET is a rapid motivational therapy model during which a person undergoes a comprehensive assessment, which can take up to eight hours. The assessment is then followed with 2-4 individual sessions. Family members and spouses may be included in the first few MET sessions.
In the first session, the therapist and client go over the assessment together to better understand problematic behaviors and patterns of substance abuse. Future sessions will help a person to find the motivation to change these negative actions, indentify and manage potential relapse triggers, and learn how to cope without using substances. Goals are set, and the individual will develop a plan on how to reach these goals, which often includes complete abstinence. Relapse prevention strategies are discussed and worked through. During motivational therapy sessions, a therapist will avoid direct confrontation and argument. They will work to point out discrepancies in an individual’s goals and current actions in an empathetic manner. Gentle persuasion, support, and encouragement help to enhance self-efficacy and positivity.
Motivational therapy sessions are nonjudgmental and work to form a therapeutic alliance between the provider and the person seeking treatment. Instead of labeling a person as an “alcoholic,” the therapist may instead use personal information garnered from the detailed assessment to point out how much and how often a person drinks. The therapist will help the client to decide what their goals are going forward and determine how alcohol is impacting their life. The client can then decide that they are drinking too much, and it might be a good idea to cut back.
Therapists form a collaborative bond with their clients during motivational therapy, listening and respecting them rather than telling them what to do. Reflective listening is a tool commonly used during motivational therapy sessions; the therapist will repeat back to client what they have said in their own words. In so doing, a person may gain personal insight and be better able to see how others see them and what may be problematic in their life.
The National Institute on Drug Abuse (NIDA) publishes that Motivational Enhancement Therapy has been shown to be successful in treating addiction involving alcohol and marijuana and may be best when used as part of a comprehensive treatment program that includes other therapeutic models, such as Cognitive Behavioral Therapy (CBT). MET seems to be best suited to help a person find the motivation to stay in treatment and be more engaged in a treatment program rather than changing patterns of drug use on its own.
The National Institute on Alcohol Abuse and Alcoholism’s Project MATCH reports that motivational therapeutic techniques help to get people struggling with addiction involving alcohol into treatment, aid in reducing alcohol abuse long-term, and help to reduce problems and health concerns related to alcohol abuse and addiction.
Motivational therapy may be done in a group or individual setting and as part of an inpatient or outpatient addiction treatment program. It is likely most beneficial when both group and individual sessions are included in the treatment plan as both can enhance each other. Ultimately, motivational therapy may be a useful tool for helping people to recognize that their substance use is problematic, and this can motivate them to engage in treatment.