What is Motivational Interviewing?

Motivational interviewing is the concept of regularly rewarding desirable behavior to reinforce and encourage it. It is one of the oldest motivational techniques and is now understood to be a type of operant conditioning. In the context of mental health treatment, motivational interviewing (MI) is also known by the terms carrot and stick, contingency management (CM), and prize method, among other names.^1,3

How Is Motivational Interviewing Used to Treat SUD?

Motivational interviewing is not a type of therapy, but an approach to increasing the success and buy-in of other mainstream and complementary interventions such as psychotherapy and medication-assisted therapy, as well as improved diet and exercise. MI is not appropriate as a primary method for addressing substance use disorder (SUD) or co-occurring mental health disorders.^3,4

Regardless of how and where MI is used, in the context of SUD, it is associated with small rewards for positive behavior. For instance, group therapy participants could be given parlor prizes like candy bars for being on time or for showing up continuously for a number of sessions. In some cases, a small amount of cash could be given for participating in therapy sessions or for making breakthroughs in treatment.^1,2,3,4,5

What are The Benefits of MI in SUD Treatment?

Motivational interviewing has been shown in multiple studies to improve the effectiveness of SUD treatment and rehab programs. Apart from its effectiveness, the key benefits include the following:^1,3,4

1.) Ease of Implementation

It’s extremely simple for the therapists, caregivers, and recovering individuals themselves to implement MI. The only real requisite is that there should be a small, consistent reward for desirable actions. In the context of a rehab program, this could be as easy as a cash reward for participation. In essence, MI “gamifies” the recovery process so that the participants have something concrete to look forward to, reinforcing desired behavior.

2.) Big Rewards are Not Unnecessary

The main goal of MI is to help the participant associate desirable actions with positive feelings, which are created through the reward. What is interesting is that, past a certain point, rewards do not have to be especially valuable.

Though relatively large rewards are not unheard of, decades of studies demonstrate that modest rewards or tokens are all that’s needed to make MI work. As with regular operant conditioning, consistency is more important than the size of the reward. With time, the participant will begin to have positive feelings about the action even without the presence of the reward.

3.) Highly Flexible

MI is easily adaptable to a wide variety of group and individual therapy scenarios. This is important as SUD treatment and rehabilitation is a highly-personalized process where no single approach will work for everyone. Along with its relatively low cost and simplicity, this makes MI a favorite of treatment and rehab programs with limited resources.

Along with MI’s success rate, this combination of benefits has led it to become a common tool used by SUD clinicians and other caregivers today.

Why Is Motivational Interviewing Controversial?

Even though motivational interviewing has been shown to be effective in different studies, there is still significant opposition to it. Below are the two major criticisms of MI.^2,5

1.) It’s Seen as “Rewarding” Drug Use

For people who don’t yet understand SUD or how MI works, it can appear that participants are being rewarded for drug or alcohol misuse. For this reason, MI and other counterintuitive evidence-based approaches can be unpopular with the general public in some areas. For this reason, motivational interviewing is not often used in facilities that receive state funding, as it may be politically unpopular.

2.) Some People Consider Operant Conditioning an Attack on “Free Will”

Operant conditioning, the basis of MI, remains controversial decades after it was described by pioneering psychologist B.F. Skinner. In essence, some people may be wary of operant conditioning for the same reason they are wary about drugs and alcohol — they invite difficult questions about free will and responsibility. This could be compared with contemporary criticism of psychology and psychiatry.

Despite these criticisms, motivational interviewing is increasing in popularity even in states where it was not previously a common option. Its use is especially welcomed for types of SUD that do not yet have an approved medication-based treatment, such as methamphetamine use disorder.

Find Programs that offer Motivational Interviewing in North Texas

Dallas Drug Treatment Centers gives you access to drug and alcohol treatment programs that offer evidence-based approaches in the Dallas-Fort Worth metro and beyond. Call our team at +1(214) 935-2287 to discuss your options.

Resources:

1. National Institute on Drug Abuse. (2020, June 1). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine).
2. Hall, K., Staiger, P. K., Simpson, A., Best, D., & Lubman, D. I. (2016). After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing?. Addiction, 111(7), 1144-1150.
3. Schwalbe, C. S., Oh, H. Y., & Zweben, A. (2014). Sustaining motivational interviewing: A meta‐analysis of training studies.Addiction, 109(8), 1287-1294.
4. Smedslund, G., Berg, R. C., Hammerstrøm, K. T., Steiro, A., Leiknes, K. A., Dahl, H. M., & Karlsen, K. (2011). Motivational interviewing for substance abuse. Campbell Systematic Reviews, 7(1), 1-126.
5. Feldstein Ewing, S. W., Apodaca, T. R., & Gaume, J. (2016). Ambivalence: Prerequisite for success in motivational interviewing with adolescents?. Addiction (Abingdon, England), 111(11), 1900–1907. https://doi.org/10.1111/add.13286