1. 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

2. 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

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

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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