Motivational Interviewing for Substance Use: How It Supports Addiction Treatment

When people are considering seeking professional assistance for an addiction problem, they are likely to have mixed emotions. A person may want to change their life but still feel afraid of stopping alcohol or drug use. They may be aware of the potential damage that results from substance abuse, yet be unclear as to whether a treatment program will actually be successful. 

These conflicting views about how to address a substance use disorder are a major reason why a motivational interviewing (MI) strategy can be helpful.

Motivational interviewing (MI) is a form of counseling that can help a person identify and work through ambivalence about changing their behavior and identify actions consistent with their personal values. Unlike other forms of counseling that rely on pressure, confrontation, or shame, MI uses principles such as empathy, mutual respect, and self-determination.

In substance use disorder treatment, MI can help people listen to themselves as they consider what recovery should mean to them. However, MI does not require a person to take action. Instead, it helps people identify their own reasons for beginning the recovery process.

What Is Motivational Interviewing?

Motivational interviewing (MI) is a client-centered counseling method that helps clients resolve ambivalence and increase intrinsic motivation for changing behaviors.[1] It was developed by William Miller, professor emeritus of psychology and psychiatry at the University of New Mexico, and Stephen Rollnick, a clinical psychologist and co-founder of the modern MI approach.

MI was initially developed in the context of alcohol use treatment and has since been used in many areas of health care, including substance use disorders, mental health treatment, primary care settings, and chronic disease management [2]. In addiction treatment, MI gives people the opportunity to engage in honest discussions about both sides of change: wanting to recover while also feeling afraid of withdrawal symptoms, cravings, changing relationships, shame, or life without substances.

This matters because most patients do not enter treatment with perfect motivation. Many people want the pain of addiction to stop, but they may also worry about withdrawal, cravings, relationships, shame, or life without substances. MI treats that ambivalence as part of the recovery process, not as resistance or failure.

Why Ambivalence Is Common in Substance Use Disorder

Addiction can affect motivation, judgment, habit formation, stress responses, and decision-making. A person may acknowledge that substance use is creating problems in their life but still feel pulled toward continued use because substances can temporarily relieve discomfort, numb emotional distress, or simply feel familiar.

This is why motivational interviewing can be useful for addressing substance use disorders. Rather than arguing with the person, the counselor engages them in conversations around questions like:

• What do you enjoy about your use?
• What concerns you about continuing?
• How much has your substance use cost you?
• How would your life change if you were to make some changes?
• What is most important to you currently?

Through these types of discussions, people use their own voices to articulate their reasons for making changes. This is significant because intrinsic motivation tends to be stronger when it is based on a person’s own values rather than on someone else lecturing them.

How Motivational Interviewing Works

The four processes in motivational interviewing are engaging, focusing, evoking, and planning [3].

Engaging is the relationship-building phase of treatment. The counselor uses active listening and empathy to create a safe space where the client feels respected.

Focusing helps identify what the conversation is actually about. This may include decreasing alcohol consumption, addressing addiction, or rebuilding trust with loved ones.

Evoking occurs when the counselor elicits change talk. Change talk consists of statements that indicate desire, ability, reasons, need, or commitment to change. Example statements may include: “I do not want to continue disappointing my family,” or “I think I could stop if I had more support.”

Planning happens after the client is ready to discuss next steps. Planning may involve entering addiction treatment, attending more sessions, joining a support group, or using coping skills when experiencing cravings.

MI is not a script. It is an active intervention that adapts to the person, setting, and stage of change.

Motivational Interviewing Techniques

Techniques used in motivational interviewing are commonly referred to as OARS.[4] The letters represent open questions, affirmations, reflections, and summaries.

Open questions allow clients to explore their own thoughts and feelings rather than providing yes-or-no answers. Examples may include: “What worries you most about your drinking?” or “What would you want to be different six months from now?”

Affirmations acknowledge effort, strengths, and values. An affirmation might sound like: “You care a great deal about being present for your children,” or “It took courage to come to this first session.”

Reflections show empathy and help clients hear their own thoughts more clearly. A counselor may say something such as: “A part of you is tired of using drugs, and another part of you is scared of what will happen if you stop.”

Summaries bring important points together. They can highlight change talk, help clarify mixed feelings, and provide the client with direction on where to go next.

Using motivational interviewing effectively requires much more than asking questions. It includes demonstrating empathy, listening closely, respecting autonomy, and avoiding the urge to argue with or persuade the client.

Change Talk and Sustain Talk

There are two important concepts in MI: change talk and sustain talk.

Change talk points toward recovery. Examples include:

• “I want to stop feeling this way.”
• “I need to be healthier.”
• “I could call someone before I use again.”
• “I am tired of the consequences.”

Sustain talk points toward staying the same. Examples include:

• “I do not think my drinking is that bad.”
• “Treatment hasn’t worked for me before.”
• “I need drugs to manage stress.”
• “I am not ready yet.”

In motivational interviewing, the counselor does not shame sustain talk. Instead, they listen to both sides and help the client identify the difference between current behavior and future goals. Over time, this can help inspire change without creating a power struggle in treatment.

How MI Supports Addiction Treatment

MI is often used early in treatment when the client is unsure about receiving treatment. It can also be used throughout the recovery process when motivation varies.

MI may help with:

• Increasing client involvement in treatment
• Decreasing client defensiveness
• Increasing client self-efficacy
• Helping clients discuss their alcohol or drug use openly
• Supporting harm reduction or abstinence goals
• Preparing clients for relapse prevention strategies
• Encouraging clients to follow through with other treatments

The length and frequency of an MI intervention will depend on the specific needs of the client. An MI intervention could be completed within one visit to a health care provider, such as a primary care physician, or it could be an integral component of ongoing addiction treatment. MI interventions can be provided by health professionals who have received training in MI in both individual and group settings.

Several systematic reviews and meta-analyses have concluded that MI can reduce substance use compared with no intervention.[5] However, findings suggest that many factors contribute to its effectiveness across different populations, substances, numbers of sessions, and lengths of follow-up. MI can be effective, but it cannot guarantee success and works best as part of a broader treatment plan. 

Motivational Enhancement Therapy and Other Treatments

Motivational enhancement therapy (MET) is a structured method developed using the foundational elements of motivational interviewing. MET is most often offered to clients for a short period, with the purpose of establishing and maintaining motivation for positive change. MET has primarily been studied among people with alcohol use disorders and may be used alongside other empirically supported treatments [6].

In addition to MET, motivational interviewing can complement several other established treatments, including:

• Cognitive behavioral therapy
• Dialectical behavior therapy
• Contingency management
• Medication-assisted treatment
• Family therapy
• Group therapy
• Relapse prevention plans

For example, a client with opioid use disorder might use MI to review their reasons for participating in medication-assisted treatment. A person recovering from alcohol use disorder might use MI to weigh the advantages and disadvantages of stopping drinking completely, reducing their alcohol use, or seeking greater structure and support. A client struggling with mental health and substance use might use MI to connect their recovery goals with emotional stability, better relationships, or personal values.

Who Can Benefit From Motivational Interviewing?

MI can help people who feel stuck, ambivalent, resistant, ashamed, or overwhelmed. It can also be helpful for people who wish to get treatment voluntarily and for those whose family members, courts, employers, or health care providers encourage them to seek treatment.

MI may be particularly advantageous when someone:

• Wants to make changes but fears making those changes
• Denies or downplays substance use
• Has attempted treatment previously
• Is being pressured by friends or loved ones
• Misuses alcohol, drugs, or prescription medications
• Experiences co-occurring mental health conditions
• Needs help developing confidence before initiating change

Motivational interviewing respects that change is personal. The goal is not to tell clients what to do. The goal is to help them identify what matters, what is getting in the way, and what steps they feel ready to take.

Motivational Interviewing at SOBA New Jersey

Addiction treatment professionals at SOBA New Jersey recognize that many patients come into treatment with uncertainty, fear, or mixed feelings about sobriety. The goal is to meet each patient where they are and support them in moving toward recovery without judgment. Our staff uses a compassionate, empathetic, supportive, and validating approach with all patients.

MI can serve as a key element of a person’s overall treatment plan by helping clients identify their personal goals and values. When clients connect those goals and values to their struggles with addiction, they can build motivation to engage in treatment and take the next steps in the recovery process.

If you or a loved one is struggling with substance use, SOBA New Jersey can help. Contact us today to learn more about our addiction treatment programs and how we support people through the recovery process.