Motivational Interviewing for Addiction Treatment
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- The Archangel Centers is a licensed outpatient addiction treatment provider.
- The Archangel Centers operates clinics in Tinton Falls, NJ and Charlotte, NC.
- Motivational interviewing is part of the outpatient continuum at The Archangel Centers.
- Medication-assisted treatment (MAT) includes Suboxone, Vivitrol, and Sublocade.
- The Archangel Centers works with most major commercial insurance plans with free benefits verification.
Motivational interviewing (MI) is not a technique applied to a passive client; it is a clinical conversational style that takes the client's ambivalence about change seriously, works with it rather than against it, and supports the client's own reasons for changing rather than supplying reasons from the outside. Developed by William R. Miller and Stephen Rollnick in the early 1980s, MI has become one of the most studied and most widely adopted approaches in addiction medicine, and is woven across the clinical conversations at The Archangel Centers regardless of the formal therapy modality in use.
The clinical problem MI addresses
Most people who arrive at treatment for substance use disorder are ambivalent. They want to change and they do not. They know the use is harming them and they are not sure they can imagine life without it. They feel pulled toward treatment and pulled toward leaving the call. This is not a moral failure or a sign of weak commitment. It is what change looks like when it is real.
Traditional confrontational approaches to addiction treatment ("you have to admit you have a problem, you have to surrender, you have to..." ) often produced reactance: the more the clinician pushed, the more the client argued against change. The clinician became, in the language Miller and Rollnick use, "the voice of change," and the client became "the voice for the status quo," which solidified the very position the clinician was trying to dissolve.
MI flips the dynamic. The clinician does not supply the arguments for change. The clinician supports the client's own emerging arguments for change, which are almost always present in the ambivalence.
The four processes of MI
MI is organized around four overlapping processes:
Engaging
Building the relationship. Without engagement, nothing else matters.
Focusing
Narrowing the conversation to specific behaviors or changes the client is considering.
Evoking
Drawing out the client's own motivations for change. This is the distinctive heart of MI.
Planning
Building a concrete plan once the client has resolved enough of the ambivalence to commit to action.
The processes are not linear stages. A skilled MI clinician moves among them as the conversation requires.
The OARS technique
The clinical techniques of MI are sometimes summarized as OARS:
These are not gimmicks. They are the operational form of a stance that takes the client's words seriously as data about their internal state.
- Open-ended questions: questions that cannot be answered with yes or no
- Affirmations: genuine recognition of the client's strengths and efforts
- Reflective listening: complex reflections that capture not just what the client said but what is underneath it
- Summarizing: gathering the threads of the conversation to make the client's own emerging change talk visible
Change talk and the heart of MI
The mechanism most associated with MI's effectiveness is the elicitation of "change talk": the client's own statements that move toward change. The categories (sometimes summarized as DARN-C):
The MI clinician notices change talk, reinforces it through reflective listening, and asks for more. Over time, the client's own change talk builds the case for change.
- Desire: "I want to..." "I wish..."
- Ability: "I could..." "I might be able to..."
- Reasons: "If I changed, then..." "I would feel better if..."
- Need: "I have to..." "I need to..."
- Commitment: "I will..." "I am going to..."
Where MI fits in addiction treatment
MI is most powerful in specific clinical situations:
MI is not the whole treatment for SUD. It is the conversational engine that supports the other modalities.
- Early in treatment, before the client has resolved ambivalence about being in treatment at all
- At decision points, when the client is weighing a specific change (going to inpatient, starting MAT, leaving a relationship that maintains the use)
- With clients who feel "stuck", where direct skill-building or psychoeducation is not landing
- In family work, where a loved one is ambivalent about change
- Throughout treatment, as the underlying clinical stance, regardless of the formal modality being used
MI alongside other modalities
MI integrates with:
- **CBT**: MI sets the stage; CBT supplies the structured behavior change work
- **DBT**: MI supports engagement with the skill modules
- **MAT**: MI helps resolve ambivalence about starting and staying on medication
- **Trauma-informed care**: MI supports pacing of trauma work to the client's actual readiness
- **Family therapy**: MI principles apply directly to family work, particularly through the CRAFT model
- **Relapse prevention**: MI is essential during relapse, when the client is reconsidering whether the work was worth it
How MI is delivered at The Archangel Centers
MI is the conversational stance the clinical team takes by default. Specifically:
- Admissions calls use MI principles to engage with the caller's ambivalence rather than pressuring for an immediate yes
- Individual therapy uses MI in the early sessions and at every decision point
- Group facilitation uses MI principles to engage group members who are ambivalent or resistant
- Family work integrates MI principles, including the CRAFT framework
What MI is not
A few clarifications:
- MI is not just being nice or "going easy on" the client. It is a structured clinical approach with specific techniques.
- MI is not avoiding the hard truths. It is letting the client name them.
- MI is not the only treatment for SUD. It is the engagement layer that makes other treatments work.
- MI is not magic. Some clients will not engage regardless. The point is to maximize the number who do.
Frequently Asked Questions
Will the therapist just agree with everything I say?
Does MI work if I don't want to change?
Is MI the same as motivational enhancement therapy (MET)?
Can MI be used in group?
Is MI evidence-based?
Will MI mean the therapist never tells me to do anything?
Does The Archangel Centers use motivational interviewing on the first admissions call?
Can MI help a family member who is ambivalent about supporting treatment?
Related Pages
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