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Using Motivational Interviewing to Discuss Substan ...
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This curriculum, presented by Dr. Brian Borsari and colleagues under the Addiction Psychiatry Advanced Psychotherapy Curriculum AAAP 2022, focuses on Motivational Interviewing (MI) as a method to engage patients in discussing substance use, particularly when they are ambivalent or reluctant to change. MI is defined as a collaborative, goal-oriented communication style that strengthens personal motivation and commitment to change through an atmosphere of acceptance and compassion.<br /><br />Rooted in client-centered therapy and behavior change research, MI evolved as an alternative to confrontational treatment for substance use disorders and continues to adapt with ongoing research. MI's “spirit” emphasizes partnership, acceptance, evocation, and compassion, fostering a nonjudgmental, autonomy-supportive therapeutic relationship.<br /><br />MI employs specific therapist behaviors summarized as OARS: Open-ended questions, Affirmations, Reflections, and Summaries. These communication skills enhance client engagement and elicit “change talk” — client statements indicating desire, ability, reasons, need, or commitment to change (DARN-C). In contrast, “sustain talk” reflects resistance or inclination against change and requires therapist skill to respond without escalating discord, which relates to relationship strain.<br /><br />The MI process involves four tasks: Engaging (building a trusting relationship), Focusing (maintaining a clear conversation direction), Evoking (eliciting client motivation and change talk), and Planning (developing change strategies). Engaging requires active listening and curiosity, while focusing uses techniques such as agenda mapping to clarify change targets.<br /><br />Training in MI involves learning its spirit, practicing OARS, recognizing and reinforcing change talk, managing sustain talk and discord, negotiating change plans, and flexibly integrating MI with other approaches.<br /><br />The curriculum highlights recent developments in MI (MI 4), including empowerment framing, addressing discord through reflective strategies, and accommodating telehealth delivery.<br /><br />Overall, this program equips clinicians with evidence-based skills to effectively support behavior change in substance use by honoring client autonomy, eliciting intrinsic motivation, and sustaining collaborative dialogue. Additional resources and research initiatives related to MI in various populations and health issues are also provided.
Keywords
Motivational Interviewing
Substance Use Disorders
Addiction Psychiatry
Behavior Change
Client-Centered Therapy
OARS Techniques
Change Talk
Sustain Talk
Therapeutic Relationship
Telehealth Delivery
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