Using Motivational Interviewing In the Treatment of Addiction and Other Change Processes
By: Robert J. Smith, LCSW – Providing Counseling Services in Chicago & Northwest Suburbs
Many clients come in to see me who have been in addiction treatment and 12 Step programs, but continue to relapse. They have difficulty following through with what they have learned in treatment. Looking for quick results which many addicts want, they lack the patience and openness that it sometimes takes to attend AA meetings to really learn about the Program and practice the 12 Steps daily. Many people in early recovery have a difficult time with AA due to focusing on the concept of turning your life over to God. It is possible to engage yourself with others at meetings who can be of support and they can become a â€œhigher powerâ€ or support. God doesnâ€™t have to be the only answer. For others, God is a very important support. It is all what you personally need to move forward in recovery. Not everyone believes the same way and that is okay.
There has been much research conducted by William Miller and Stephen Rollnick on what can be done to help addicts and others change their old limiting behaviors. Logic tells us that when people suffer from serious illnesses such as alcohol and substance abuse, have had a DUI, liver impairment or other related health problems, canâ€™t remember the previous night, that people would stop doing self-destructive behaviors. Unfortunately, that is not the case. Traditional treatment approaches sometimes donâ€™t work, or it may take several treatments before a person is open to accepting help and support.
Motivational Interviewing is an approach to therapy that takes into account the individual in his/her circumstances. We are affected by those with whom we interact. We donâ€™t live in a bubble. Sometimes, we need to look at how our relationships affect us in the process of change. A personâ€™s readiness to change and level of motivation to change are most important. Often, change occurs naturally. Brief or long term therapy may have similar affects. Threatening, shaming, having anger and resentment towards the drug and alcohol user does not often lead to making changes. Peoplesâ€™ perceptions about change often have much to do with making the change. If one believes that they can change, has hope and faith that they can change, they are more likely to initiate changes. The treatment context is of significant importance in helping people to change. I believe that when clients feel safe and supported, and are encouraged, there is a higher probability for them to explore and initiate their own change process. Oneâ€™s readiness, willingness, and ability to change are also important factors. If one is ready to change, the circumstances are right, is willing, and is really able to make the changes, there is a better probability for change to occur. Timing is very important. Like making a tasty soup, all of the proper ingredients need to be present. Having the right temperature, the right length of cook time, the right amount of spice, liquid, and other primary ingredients need to be mixed to make a delicious soup.
There are a few factors in therapy that are commonly present. The first is ambivalence. Ambivalence means that one is â€œon the fenceâ€ about making a change. There may be fear involved in taking the risk to do something different. Stopping drug and alcohol use is taking the risk that I can function and deal with my life without chemicals. It means that I have to face what has happened while I was using. I have to deal with the pain that I have caused myself and others. It isnâ€™t easy addressing these issues, but of great importance in developing sobriety. Another matter is that of relapsing also known as â€œslipping.â€ It is common for drug and alcohol users who have stopped for a period of time to go back out and use or drink once or twice. This is considered â€œtesting the waters.â€ It is a part of denying that I just canâ€™t use, because if I do, I will go back to using the way I did before I stopped. This idea of slipping doesnâ€™t have to mean that all of your recovery work is lost or a waste because of this brief use. It is possible to get back on track again and use the tools that you have previously learned to stay sober. It is also important for spouses and other family members to know the difference between a â€œslip and full blown relapse.â€ People who slip need support and to be accountable for their actions. Being accountable and having reasonable expectations placed on them can help them get back on track. Leaving anger and resentment out of the discussion can be most helpful. Family members showing disappointment is healthy. Anger and resentment often leads to being misunderstood and doesnâ€™t help with healing. Shaming the user for the slip can negatively affect their self-esteem and lead to a full blown relapse. Self-shaming when slipping is often a trigger for a relapse. Working to â€œget back on trackâ€ is what is most important. Self-shaming or â€beating oneself upâ€ stands in the way of sobriety.
According to Miller and Rollnick, constructive behavioral change seems to arise when the person connects it with something of internal value, something important, something cherished. When change is discussed in an empowering atmosphere, it helps one to feel safe to be able to address difficult, painful, and challenging matters in relation to what is wanted and most valued.
As a clinical social worker and psychotherapist, I like to have a positive encouraging respectful attitude, and want to validate my clientâ€™s feelings about their circumstances. I also believe that most people have the inner resources and ability to change. They need to find the direction and means by which to make changes. I believe that if I approach people in this manner, they may be more open to discussing important matters and exploring new ways to do things
Robert can be contacted at email: counseling@RobSmithLCSW.com or Ph.(847) 824-8366 to make an appointment. He is located in the Golf Mill Professional Building in Niles, Illinois and provides counseling services to clients in Chicago, Niles, Glenview, Park Ridge, Des Plaines, Northbrook, Skokie, Arlington Heights, Lincolnwood and the remaining Northwest suburbs of Chicago.
Email:Â Â counseling@RobSmithLCSW.comÂ or Ph. (847) 824-8366.