
Motivational Interviewing. Richard Rawson, Ph.D. Pacific Southwest ATTC UCLA Integrated Substance Abuse Programs 2008. Traditional approach (1). The Stick. Change is motivated by discomfort. If you can make people feel bad enough, they will change.
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Richard Rawson, Ph.D.
Pacific Southwest ATTC
UCLA Integrated Substance Abuse Programs
2008
The Stick
You better!
Or else!
If the stick is big enough,
there is no need for a carrot.
Someone who continues to use is
“in denial.”
The best way to “break through” the
denial is direct confrontation.
The carrot
The carrot
Ambivalence: Feeling two ways about something.
It is NOT that…
They are just early in the stages of change
Addiction is a brain disease that disables the brain from functioning normally in areas such as motivation, attention, perception, memory, planning, etc.
Take some time to think about the most difficult change that you had to make in your live.
How much time did it take you to move from considering that change to actually taking action.
Recognizing the need to change and understanding how to change doesn’t happen all at once. It usually takes time and patience.
People often go through a series of “stages” as they begin to recognise that they have a problem.
Helping people change involves increasing their awareness of their need to change and helping them to start moving through the stages of change.
Motivational interviewing is the process of helping people moving through the stages of change.
People at this stage:
People at this stage are considering whether or not to change:
?
People at this stage aredeciding how they aregoing to change
behaviour
It may take a long time to move to the next stage (action).
People at this stage:
People in this stage:
People at this stage have reinitiated the identified behaviour.
Motivational interviewing is founded on 4 basic principles:
I am so tired that I cannot even sleep… So I drink some wine.
You drink wine to help you sleep.
…When I wake up…I am too late for work already…
Yesterday my boss fired me.
So you are concerned about not having a job.
...but I do not have a drinking problem!
I only enjoy having some drinks with my friends…that’s all. Drinking helps me relax and have fun…I think that I deserve that for a change…
So drinking has some good things for you…Now tell me about the not-so-good things you have experienced because of drinking.
Well…as I said, I lost my job because of my drinking problem…and I often feel sick.
I do not want to stop drinking…as I said, I do not have a drinking problem…I want to drink when I feel like it.
But, Anna, I think it is clear that drinking has caused you problems.
You do not have the right to judge me. You don’t understand me.
I do not want to stop drinking…as I said, I do not have a drinking problem…I want to drink when I feel like it.
You do have a drinking problem
Others may think you have a problem, but you don’t.
That’s right, my mother thinks that I have a problem, but she’s wrong.
I am wondering if you can help me. I have failed many times.
Anna, I don’t think you have failed because you are still here, hoping things can be better. As long as you are willing to stay in the process, I will support you. You have been successful before and you will be again.
I hope things will be better this time. I’m willing to give it a try.
The OARS are the skills that can be used by interviewers to help move clients through the process of change.
Open-ended questions
Affirmation
Reflective listening
Summarising
Close Versus Open-ended questions:
Reflective listening is used to:
Summarizing is an important way of gathering together what has already been said, making sure you understood the client correctly, and preparing the client to move on. Summarising is putting together a group of reflections.
Eliciting Change Talk
Change talk: An indication that you are successfully using motivational interviewing.
If you are using MI successfully you will hear statements that indicate the client:
Ask the client to clarify their statements or elaborate:
Ask the client to imagine the worst consequences of not changing and the best consequences of changing.
Explore the client’s goals and values to identify discrepancies between the client’s values and their current substance use.
• Natural aversive consequences (“hitting bottom”)
• Feedback re problems/consequences - Confrontation - Motivational Enhancement Therapy
• Teach new behaviors and promote growth
• Promote self-esteem and self-confidence
Mammography Screening
Recommendation for Women Ages 50 and older:
ANNUAL MAMMOGRAM
With physician advice alone, few women receive an annual mammogram
(Stoner et al., 1998)
Rate of Compliance
Rates of mammogram screening were 2.5 times higher for the
incentive as compared to the control women.
(Stoner et al., 1998)
In 1989-91, immunization rates
were as low as 23% for two-year
olds in the Chicago area.
Childhood
Immunizations
Rate
Rates increased when WIC food vouchers were given to those who had their children immunized.
(Hoekstra et al., 1998)
PositiveNegative
- award ceremonies - extra therapy
- certificates; key chains - time restriction
- status/recognition - dismissal
- take-homes in methadone - probation, referral to judge
Could Work For You
Patient attends
treatment,
Gives negative samples
Give Incentive
More patients
Making abstinence a more
attractive option through
positive reinforcement of
behavior change
that matters……….
BEHAVIOR
REWARD
Giving things away for free
does NOT change behavior
Later Studies: Motivational Incentives with Monetary Rewards
Research has shown that monetary incentives can :
• Increase treatment retention
• Decrease drug use during treatment
Cocaine Alcohol Marijuana
Research studies have
tested incentives for
ability to improve
drug abuse
treatment outcomes
and shown they work