OCCDHE 2005

Breaking the Cycle of Addiction Using

Motivational Interviewing

Mary Peracca, MFTCal Poly, San Luis Obispo

Counseling Services

The Cycle of Addiction Abstinence Use: low quantities, no adverse effects Overuse: one time overuse with negative

consequences Abuse: Continued overuse despite negative

consequences, party lifestyle Dependence (Addiction): Same as

abuse but unable to cut back or stop when desired, loss of control

Risk Factors for Chemical

Dependency Family history of

alcohol/drug problems

Age of 1st Abusive Use

Emotional & social coping skills

Environment: exposure to AOD

Motivational Interviewing

A client centered, directive approach for enhancing motivation for change

A method to manage resistance and help people commit to change

The therapist’s non-judgmental stance allows the client to freely choose to change or not

William R. Miller & Stephen Rollnick

Components of Motivational Interviewing

Express empathy Develop discrepancy between

present behavior and client’s stated goals (Cognitive dissonance)

Avoid argumentation or debate Roll with resistance Support self-efficacy

Stages of Change James Pochaska & Carlo DiClemente

Precontemplation: Minimizing or denying a problem

Contemplation: Awareness about the problem

Preparation: Planning to take action Action: Commitment to time and

energy to change Maintenance: Relapse prevention,

making adjustments to the plan of action

Ineffective Treatment Methods

•Confrontation: breaking down denial

•Labeling, diagnosing

•Advice-giving

•Cheerleading

Effective Interventions The First Session Build Rapport- humor can help ease the client’s

anxiety History taking can give information about a

client’s potential motivators Manage resistance: therapist style does make a

difference in outcomes & reducing dropout rate Clients may feel disempowered by complying

with a mandate from others, help to identify choices

Assessing Motivation What motivates you? The severity of the consequence doesn’t

necessarily create motivation Each student has unique motivators Be curious about what might motivate

the client: grades, sports, relationships, money, addiction risks?

Goals and values Using the e-CHUG to identify priorities

Effective Interventions Using Reflection: disarms

defensiveness by listening rather than the expectation getting advice Simple reflection: Rephrase

what you have heard Amplified reflection:

Exaggerate the feeling underlying the content

Double-sided reflection: Reflect the dilemma of possible choices

Rolling With Resistance

Use with the “Help-Rejecting Complainer” aka “Yes, but….”

Psychological martial arts: let the resistance pass by and give the responsibility back to the student

Do……Don’t approach Respectful of client’s autonomy

Solution Focused Interventions What are the student’s goals? What positive coping skills or activities did the

client use in the past? What have they tried recently? Addressing the need for social contact:

alternative activities and friends Define in positive & measurable terms, eg. Go

to the gym 3 times a week or go to the movies one night instead of partying rather than I won’t drink tonight

Refer to adjunct resources: Student Support Services, ASI, etc.

Empathize with the challenges of changing

Maintenance Follow up on goals & what was

successful or not Problem-solve possible triggers

to return to old behaviors & what steps to take if relapse occurs

Normalize the process of change & the need to continue to reassess the plan

Give appropriate feedback, predict successes & pitfalls