Motivational Interviewing for Substance Use Disorders

Behavioral therapy is a key feature of most addiction treatment programs. One particular therapeutic approach—motivational interviewing—is often used to assist patients in resolving or reducing their ambivalence about change.^1,2

This page will discuss motivational interviewing in the treatment of substance use disorders.

What Is Motivational Interviewing (MI)?

Motivational interviewing (MI)—also known as motivational enhancement therapy—is a person-centered form of behavioral therapy aimed at facilitating a patient’s ability to change their life. MI is used to reduce the ambivalence patients may feel toward making this change.³

MI is often used in:¹

• Social work.
• Chronic disease management.
• The treatment of sexual health conditions.
• Substance use disorder (SUD) treatment.

The aim of MI is to assist the patient in exercising free choice and self-determination.³

How Motivational Interviewing Works

Motivational interviewing is a collaborative approach between the therapist and the patient, which functions under the assumption that the patient is the expert in their own life and the therapist provides the right conditions for the necessary change to occur.^1,3

MI assumes that ambivalence about change is normal, and that it can be resolved by understanding and exploring a person’s values and motivations.³

In the sections below, we’ll discuss the fundamental theory of motivational interviewing, the elements that make up “the spirit of MI,” including the skills and techniques exercised by the therapist during therapy sessions, and the efficacy of using MI in treating substance use disorders.

Fundamental Processes of MI

Motivational interviewing calls upon the therapist and the patient to operate within and engage the fundamental processes of the theory.³ These 4 processes include engaging, focusing, evoking, and planning.³

• Engaging: Engaging the patient is the first step in evoking change. Engaging the patient is a technique that the therapist uses to build trust and rapport with a patient. Trust and rapport are the foundation of any working relationship, therefore, engaging the patient builds the foundation for which change is more likely.
• Focusing: Focusing involves ensuring the conversation is directed toward the agreed-upon topic that requires change. This may involve the patient and therapist collaborating to set an agenda for the treatment session.
• Evoking: Evoking is often considered the “heart of motivational interviewing.”¹ Evoking involves a therapist guiding the conversation so that the patient ends up arguing for the change they wish to make, developing hope and self-confidence in the process.
• Planning: Planning is a collaborative approach used to outline a path to change that the patient can adhere to. During this process, the therapist assists the patient in identifying and clarifying their goals and developing strategies to achieve them.

Working within these fundamental processes of motivational interviewing assists the patient in moving through the beginning and prompts awareness in the patient that stimulates motivation.³

The Spirit of MI

The “spirit of motivational interviewing” refers to the underlying perspective that although the patient is autonomous and the expert in their own life, the therapist is a partner who fosters a collaborative approach to change.³ This spirit is comprised of 4 interwoven processes that are essential to the collaborative therapeutic alliance. This spirit uses the acronym PACE:³

• P: Partnership. Partnership assumes that change happens within the context of a positive and collaborative working relationship between the patient and the therapist, each having their own equally important role in the process of change.
• A: Acceptance. Acceptance requires that the therapist approaches the patient with unconditional positive regard. This regard is reflected through showing empathy and affirming the patient’s experiences, values, and strengths.
• C: Compassion. The therapist exercises compassion when their actions reflect a genuine concern for the patient’s welfare and their specific needs.
• E: Evocation. Evocation is a skill used by the therapist to draw out the patient’s own values, strengths, and resources to promote and encourage motivation in the patient.

A therapist who works within these core elements can effectively assist the patient in enacting change within their life.³

Core Skills of MI: OARS

Motivational interviewing relies on 4 core skills that the therapist employs consistently.³ These motivational interviewing interventions are outlined in the acronym OARS.³

• O: Open questions. Asking open questions invites the patient to tell their story, allowing the therapist to understand the patient’s perspective and work within that perspective. Open questions help to build the therapeutic alliance and rapport.
• A: Affirming. Affirming, which may take the form of highlighting strengths, successes, and efforts, is a skill the therapist uses to express unconditional positive regard for the patient and an appreciation for their openness and transparency. Affirming boosts the patient’s confidence in their own worldview.
• R: Reflective listening. Reflective listening means formulating a hypothesis about the underlying meaning of something a patient says and presenting it back to the patient. Reflective listening shows a patient that the therapist accepts and respects their point of view. Reflective listening builds safety and allows a patient to explore their feelings, perceptions, and values without judgment.
• S: Summarizing. Summarizing is a form of reflective listening where a therapist —condenses the core of the patient’s statements and reflects it back to them. It is useful in developing a plan for change. Summarizing can be used to link various statements a patient makes that may be conflicting or congruent, and highlights talk that reflects a willingness to change.

Substance Use Disorders & Motivational Interviewing

Research into motivational interviewing has shown strong empirical support compared to no intervention or a non-therapy-based intervention. However, MI is just one of several evidence-based behavioral therapies used in addiction treatment.

In studies comparing MI alone with other other evidence-based therapies, patients who received motivational interviewing did no better (or worse) than those receiving other forms of therapy, such as cognitive behavioral therapy (CBT), perhaps the most widely used form of psychotherapy in treating substance use disorders.³

MI as a counseling style, however, is compatible with other evidence-based psychotherapy approaches and may be deployed in conjunction with these other approaches to support better outcomes. Integrating MI strategies into CBT, for example, can be useful to enhance patient motivation to engage in CBT treatments as well as improve long-term maintenance of behavior change.³

Substance use disorder (SUD) is a complex condition and treatment is most effective when it is tailored to the patient’s needs.⁴ Treatment often involves a combination of several interventions and services, including various behavioral therapies, medications, peer support, and medically managed detox.

Does Insurance Cover Motivational Interviewing?

Yes, the Affordable Care Act (ACA) requires providers to provide coverage for addiction treatment.⁵ The portion of treatment an insurance provider will pay for varies widely between insurance carriers.

Motivational interviewing is a common evidence-based treatment used in substance use facilities and is typically covered by insurance. If you or a loved one would like to seek treatment but would like more information about what your insurance will cover, our admissions navigators at can assist you in this process.

You can also verify your insurance coverage at Recovery First using the confidential .

MI and Addiction Treatment in Hollywood, FL

If you or someone you love is ready to seek addiction treatment, please call for more information on our Hollywood, Florida rehab center.

Our compassionate admissions navigators can help you begin the admissions process or answer questions on the various levels of addiction treatment or payment options. You can also verify your insurance coverage using the confidential .