Breaking the Cycle of Addiction Using Motivational Interviewing OCCDHE 2005 Breaking the Cycle of Addiction Using Motivational Interviewing Mary Peracca, MFT Cal Poly, San Luis Obispo Counseling Services

The Cycle of Addiction Abstinence Use: low quantities, no adverse effects Overuse: one time overuse with negative consequences Abuse: Continued overuse despite negative consequences, party lifestyle Dependence (Addiction): Same as abuse but unable to cut back or stop when desired, loss of control

Risk Factors for Chemical Dependency Family history of alcohol/drug problems Age of 1st Abusive Use Emotional & social coping skills Environment: exposure to AOD

Motivational Interviewing William R. Miller & Stephen Rollnick A client centered, directive approach for enhancing motivation for change A method to manage resistance and help people commit to change The therapist’s non-judgmental stance allows the client to freely choose to change or not

Components of Motivational Interviewing Express empathy Develop discrepancy between present behavior and client’s stated goals (Cognitive dissonance) Avoid argumentation or debate Roll with resistance Support self-efficacy

James Pochaska & Carlo DiClemente Stages of Change James Pochaska & Carlo DiClemente Precontemplation: Minimizing or denying a problem Contemplation: Awareness about the problem Preparation: Planning to take action Action: Commitment to time and energy to change Maintenance: Relapse prevention, making adjustments to the plan of action

Ineffective Treatment Methods Confrontation: breaking down denial Labeling, diagnosing Advice-giving Cheerleading

Effective Interventions The First Session Build Rapport- humor can help ease the client’s anxiety History taking can give information about a client’s potential motivators Manage resistance: therapist style does make a difference in outcomes & reducing dropout rate Clients may feel disempowered by complying with a mandate from others, help to identify choices

Assessing Motivation What motivates you? The severity of the consequence doesn’t necessarily create motivation Each student has unique motivators Be curious about what might motivate the client: grades, sports, relationships, money, addiction risks? Goals and values Using the e-CHUG to identify priorities

Effective Interventions Using Reflection: disarms defensiveness by listening rather than the expectation getting advice Simple reflection: Rephrase what you have heard Amplified reflection: Exaggerate the feeling underlying the content Double-sided reflection: Reflect the dilemma of possible choices

Rolling With Resistance Use with the “Help-Rejecting Complainer” aka “Yes, but….” Psychological martial arts: let the resistance pass by and give the responsibility back to the student Do……Don’t approach Respectful of client’s autonomy

Solution Focused Interventions What are the student’s goals? What positive coping skills or activities did the client use in the past? What have they tried recently? Addressing the need for social contact: alternative activities and friends Define in positive & measurable terms, eg. Go to the gym 3 times a week or go to the movies one night instead of partying rather than I won’t drink tonight Refer to adjunct resources: Student Support Services, ASI, etc. Empathize with the challenges of changing

Maintenance Follow up on goals & what was successful or not Problem-solve possible triggers to return to old behaviors & what steps to take if relapse occurs Normalize the process of change & the need to continue to reassess the plan Give appropriate feedback, predict successes & pitfalls