Addiction treatment is there to ensure that you or someone you care about gets the necessary help. Whether you are looking for help for yourself, or for a member of your family or a close friend, understanding Brief Intervention (BI) and Motivational Interviewing (MI) could improve the recovery process.
Table of Contents
- 1. Stages of Brief Intervention
- 2. The FRAMES model
- 3. Common values
- 4. Motivational Interviewing
- 5. How is MI different?
- 6. When should MI be used?
- 7. Rolling with resistance
- 8. 5 Principles of MI
- 9. Avoiding confrontation
- 10. The role of an MI therapist
- 11. What is OARS?
- 12. Examples of MI questions
- 13. Limitations of MI
- 14. How effective is BI?
- 15. References
Brief Intervention is used to determine if a person has an issue with substance use. It then encourages motivation for that person to change their behaviour around their addictive habits.
BI can take anywhere from five minutes to thirty minutes with a longer session involving some form of brief counselling to assist the person.
These BI sessions are not meant to treat someone who has serious substance dependence. Instead, it is a tool that can assist someone who is displaying risky or problematic behaviour under the influence of drugs or alcohol.
BI sessions are meant to be highly personalised, with support being offered in a manner that does not convey judgment.
What is Motivational Interviewing and how is it used in a Brief Intervention?
Motivational Interviewing (MI) is a way to interview a person and empower them to solve their own issues. The process of MI is more like an interview than a confrontational setting with a therapist.
The patient is encouraged to set goals for themselves, giving them a choice, rather than a therapist imposing sobriety on them or telling them what they think they need. When a person feels in control of their own steps toward recovery, they are able to set reachable goals and take steps toward them.
They also become self-motivated and the therapy sessions do not strip them of their autonomy. If a patient feels in control of their recovery and the steps they take to achieve it, they have a higher likelihood of remaining sober without relapse once treatment is completed.
During a brief intervention, the patient is empowered by offering them choices rather than imposing treatment on them and giving them a gloomy picture of their future.
Why is Motivational Interviewing Different Than Other Methods?
Motivational Interviewing (MI) is a different approach to treatments for substance users because it relies on the patient being the change. The clinician speaks to the patient in a way that offers room for them to have an opinion.
This then allows them to make a choice in changing their behaviour when they are ready, not by being forced to make that change. Many treatments focus on forcing a patient into certain behaviours, and when someone is forced to do something against their will, they will stop doing that thing as soon as they possibly can.
MI offers options and puts the ideas into the patient’s head, allowing them choices and changing their behaviours when they feel ready. MI gives the power to the patient and that is what makes it effective.
The Stages Of Brief Intervention
There are 4 stages that a user goes through when they are faced with BI. These stages are:
When the user does not accept that they have a problem with substance use, they feel happy and do not want to make any changes.
When the user finally sees both the good and the bad things that are associated with their use of a substance. They are aware that there may be some pros and cons with their current pattern of usage. If they are willing to make a change they do not know how or they may lack confidence about their ability to make the changes required.
At this stage, a substance user has made a solid decision that their use of a substance needs to change. They may be cutting back on their substance use or cutting down, having made a solid decision to make a change to their behaviour.
The substance user is trying to maintain their behavioural changes and their success means staying in maintenance. This stage requires a lot of reinforcement and encouragement from support people and groups.
Relapse is often experienced with substance users when they try to make changes to their behaviours. This may be for a short time and is something that should be expected.
After a relapse a substance user will return to one of the four stages listed above. For many people, changing their substance use gets easier each time they try until they are eventually successful. [1]
When Should Motivational Interviewing be Utilised?
Motivational Interviewing is most effective when it is used together with a treatment program. If a person does come to treatment as a result of a court order resulting from a crime, then a person may not be happy to be at a session.
One of the most imperative aspects of Motivational Interviewing is establishing a strong and trusting relationship with a client. [2] A clinician needs to ensure that the environment is comfortable for the client so that they are motivated to discuss changes.
Where possible, MI should be used the most as an interviewing technique because it puts the patient into a position where they have control.
The FRAMES Model in Brief Intervention
FRAMES is an abbreviation for a model that is used in Brief Intervention to assist substance users. There are several key elements and those include:
It is up to a medical professional/therapist/counsellor to offer the user feedback after they have presented with a complaint that could relate to substance use.
At this point, there might be a comparison between the substance use patterns of the patient and the average patterns and related problems experienced by people who have similar issues.
One of the key elements of successful intervention procedures is for a substance user to take responsibility for their behaviour and make choices about their use of substances.
The main message is that no one can make a change or a decision for a substance user except for them and they must take control over how they behave. Once the user has a sense of control it will help them with the motivation for change and they will also stop resisting the help that they need.
Substance users are generally oblivious to the end result of their substance use whether that be health issues or putting themselves at risk. By providing advice that clearly sets out how stopping the use of a substance can change those potential health issues and risks, the clinician is increasing the awareness of the patient.
The patient is provided with strategies that will assist them in reducing or quitting using a substance. This provides the patient with the option to choose strategies giving them the feeling that they are personally in control.
This responsibility to be the change helps to strengthen a patient’s motivation which then drives the change. A couple of examples of some strategies include keeping a diary of their substance use and putting away money in a separate bank account that they would have otherwise spent on substances.
When an intervention is being delivered, it is important for the person who is doing the delivery to be warm, empathetic and reflective. These factors all play into the response of the patient to intervention and reduced substance abuse.
Screening is a way to determine if a substance use problem exists, it is not a complete assessment nor is it a diagnosis. Screening can assist a clinician to make a determination as to the severity of the issue and whether an intervention is needed. Screening can be the process of asking some basic questions or it can be a thorough process utilizing screening tools.
Providing advice to a substance user should be short and evidence-based. This does not mean, however, that the patient should be provided with a pamphlet and sent on their way.
The way that the content is delivered is crucial because it is meant to trigger the person’s motivation to make a change in their life.
The Importance of “Rolling with Resistance”
To ‘Roll with Resistance’ approach is a key factor in motivational interviewing. This approach helps people to change the behaviours that are causing issues for themselves and for other people.
This approach involves avoiding head-on arguments, acknowledging that the therapist has heard what the patient has said and encouraging them to come up with their own solutions.
Motivational Interview – Five Main Principles
The clinician practices motivational interviewing with five general principles in mind:
- Express empathy through reflective listening
- Develop discrepancy between clients’ goals or values and their current behavior
- Avoid argument and direct confrontation
- Adjust to client resistance rather than opposing it directly
- Support self-efficacy and optimism [3]
Expressing empathy is a special skill that can be learned. It requires keen attention to every statement made by a client to understand the meaning behind it. When this skill is mastered it is a way to effectively communicate with a client that they are respected and accepted and their feelings are validated.
The interviewer can listen and provide support with gentle persuasion to encourage the client to make a decision to change. Reflective listening involves the art of listening and not telling a client what they must do.
Developing discrepancy is when you work with your clients to focus their attention on how their behaviour is not ideal. You can help them to explore their personal goals and how those are not being reached because of their substance use.
Once the client starts to understand how their behaviour does not meld with personal values and goals, they are more inspired to work towards change.
Avoiding Confrontation
Avoiding arguments when a client is unwilling to change is also crucial. The client is initially going to display hostility and defiance and their unwillingness to accept labels like “drug addict” or “alcoholic”.
There is no reason why a client should be made to accept any label and no accusations should be made that a person is addicted or in denial. Arguing only causes a client to become defensive and resistant to change and does not serve to get the client any help.
Adjusting to client resistance helps the clinician to see the point of view of the client. It requires a clinician to listen more intently to the client and to adapt and invite your client to express their point of view rather than imposing yours on them.
Supporting self-efficacy is important because many clients do not believe that they have the strength to make and maintain changes. The goal of the clinician is to help clients to accept the belief that it is their responsibility to make a change and that a single step forward is going to help them get to the goal.
What Does an MI Therapist Do?
The most important role of an MI Therapist is to enable the client to move forward with change. They also must listen to their client’s issues and fears. This is called ‘rolling with resistance’ and is a practice where the therapist listens to the struggle of the client without giving any advice or pushing back.
The way to respond is with reflection which is simply repeating back to the client what they have said to you. This provides some momentum and energy to the patient to enable them to proceed.
An MI therapist must pause and unravel the ‘why’ aspect from the client in relation to what changes they want to adopt. It is only then that barriers can be overcome and comfort can be provided to a client so that they feel that the process of change is entirely their idea.
The clinician must listen to the client’s feelings and their struggles in order to open a dialogue to build change. When a client volunteers a solution, it is up to the clinician to reinforce the solution.
The clinician must collaborate with the client without trying to take control, add pressure or ‘fix’ the issues that the client has.
MI gives the power to the client so that they feel in control of their situation and this means that the clinician should not use directive language when they counsel a person. Controlling language causes a client to resist change and when people are made to feel pressured, shamed or guilty their prognosis for long-term change is not good.
An MI therapist does not use scare tactics. Instead, the therapist will look for any way to offer praise to the client and offer affirmation for their efforts. When a client is frustrated, fearful or disappointed, it is important to ensure that they feel their effort was not wasted.
What is OARS in MI?
The process of MI includes a set of communication skills referred to as OARS. This process includes the therapist asking open questions which encourages the client to participate in the dialogue.
The therapist will begin the process of Affirming a client’s strengths by making positive comments about the efforts and progress of the client. Reflecting is the next step in the process and it involves a therapist displaying understanding and empathy to a client.
It allows a client to see a piece of the puzzle that they might not have considered and it is in a non-offensive way.
Summarizing is where the therapist will gather together the concerns, information, and revelations that the client has shared for their consideration. A summary can help a client to start to talk change and move towards recovery.
Examples of Motivational Interviewing Questions?
There are many different questions that can be asked of a client, but here are a few examples:
- “Why are you here today?
- “What do you like about using drugs or drinking?”
- “What worries you about substance abuse?” [4]
What are the Limitations of Motivational Interviewing?
MI is not the ideal treatment for every client even though it has been shown to help many to find the road to recovery. For clients who suffer from complicated addiction issues and/or mental health issues, motivation is not always the answer.
MI is designed to work in as little as four sessions; however, if a client suffers from deeper issues, they will require much more counselling, combined with medication. If a client does not have cognitive clarity and cannot focus on a concept such as pros and cons, then MI may not be effective.
How Effective are Brief Interventions?
A brief intervention is a short, evidence-based, structured conversation about alcohol or drug consumption. It seeks to motivate and support the individual to consider a change in their drinking behaviour in order to reduce their risk of harm. There are a number of tools designed to help practitioners determine a patient’s level of risk to alcohol and drug harm. [5]
Brief interventions can be effective when a client is in primary care and can help to increase the willingness of a person to make a change about their drinking or drug habits.
People do not seem to take offence when a health professional asks them about their drug use or drinking habits and the use of a brief intervention helps to start a conversation that can help the client move toward recovery.
References
[1] https://www.who.int/substance_abuse/activities/en/Draft_Brief_Intervention_for_Substance_Use.pdf
[2] https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/motivational-interviewing-dos-donts
[3] https://www.ncbi.nlm.nih.gov/books/NBK64964
[4] https://www.rcn.org.uk/clinical-topics/supporting-behaviour-change/motivational-interviewing
[5] https://www.drinkaware.co.uk/health-practitioner-resource-centre/talking-to-your-patients-about-alcohol/alcohol-brief-i
About the author:
Jon writes for ADT Healthcare and a number of other websites. Jon graduated with a degree in psychology in 1992. Jon has been in recovery for 19 years.
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