Motivational interviewing drug addiction & encouraging positive change 

Drug addiction continues to be a significant public health concern in the UK, with an increasing number of individuals seeking treatment for substance use disorders. The year ending March 2023 saw an estimated 9.5% of people aged 16 to 59 years (approximately 3.1 million people) reporting having used a drug at least once in the previous 12 months1 , with 137,749 entering into recovery services2 – a sharp increase on previous years.

Indeed, The Centre for Social Justice recently claimed3 that the level of substance dependency in the UK renders it effectively the ‘addiction capital of Europe.’

While detoxification and medical interventions remain crucial components of recovery, sustainable success often hinges on deeper psychological change. This is where motivational interviewing (MI) can prove invaluable: a therapeutic technique that has gained traction as an effective tool for promoting long-term recovery.4

Motivational interviewing is a client-centred, goal-oriented approach designed to strengthen a person’s motivation for change. Unlike traditional counselling methods, MI avoids confrontation and instead fosters a collaborative dialogue between the therapist and the patient. 

By evoking and reinforcing a person’s own reasons for wanting to stop using substances, MI helps individuals move from ambivalence or resistance to a genuine commitment to change5.

This method can be particularly effective because it empowers individuals to take control of their recovery journey. It nurtures self-efficacy, helping patients to set achievable goals while building the emotional resilience needed for sustained wellbeing. For many, motivational interviewing serves as a critical foundation for overcoming addiction and rebuilding a healthier, more balanced life.

If you know someone struggling with drug addiction, and you’re searching for a confidential, curated, whole-person approach to recovery, make a referral now – or read on, as we explore motivational interviewing for drug addiction in more depth. 

Exploring motivational interviewing: what it looks like 

Motivational interviewing (MI) is a therapeutic technique designed to help individuals resolve ambivalence toward change, particularly in the context of addiction recovery.6 

Originally developed in the 1980s by psychologists William R. Miller and Stephen Rollnick7, MI has since become a leading approach in the treatment of substance use disorders. The core principle of motivational interviewing is to foster a supportive, non-judgmental environment in which individuals can explore their feelings about addiction and their desire for change.

Rather than imposing directives or using confrontational tactics, MI seeks to engage individuals in a collaborative conversation. 

The therapist or clinician acts as a guide, using reflective listening and open-ended questions to help patients articulate their own motivations for overcoming addiction. This approach empowers individuals by allowing them to take ownership of the recovery process, recognising that the desire to change must come from within.

The methodology of motivational interviewing rests on four key principles9:

1. Express empathy: creating a safe, compassionate environment where patients feel understood.
2. Develop discrepancy: helping patients see the gap between their current behaviours and their broader life goals.
3. Roll with resistance: avoiding confrontation and working through a patient’s natural ambivalence about change.
4. Support self-efficacy: reinforcing a patient’s belief in their ability to make positive changes.

These principles make motivational interviewing particularly effective in treating drug addiction, as it aligns the therapeutic process with the patient’s internal motivations – creating a stronger foundation for lasting recovery.

How long does MI take?

The duration of Motivational Interviewing (MI) varies depending on several factors, including the severity of the addiction, the individual’s level of ambivalence, and the treatment setting. 

However, MI is typically a short-term, goal-oriented approach. Here’s an overview of what individuals might expect:

• Single sessions: in some cases, a single session of MI can be enough to evoke significant motivation for change10, especially when it is part of a broader treatment plan. One study was able to identify benefits after just 15 minutes11, but sessions generally last 30 to 60 minutes.
• Multiple sessions: MI can also be delivered over several sessions; arguably more effectively, especially when used for more complex or deeply rooted addiction issues12. These programmes usually range from 3 to 6 sessions, spaced over weeks or months, allowing the therapist and patient to revisit and reinforce the individual’s progress and motivation.
• Integration with other therapies: MI is frequently integrated into other addiction treatments such as Cognitive Behavioural Therapy (CBT) or longer-term counselling. In such cases, MI serves as a foundation to help patients become more receptive to other therapeutic interventions, and it may be revisited throughout the recovery process.

Motivational interviewing and drug addiction

Motivational interviewing has proven to be a highly effective tool in addressing drug addiction13, with clinicians noting its empathetic, patient-centred approach. Unlike confrontational or directive methods14, MI encourages individuals to explore their own reasons for wanting to change harmful behaviours such as drug and alcohol use or addiction. 

This makes it particularly valuable in drug addiction treatment, where patients often experience ambivalence or resistance to change.15,16

In MI, the therapist serves as a guide, helping the patient navigate their internal conflict about drug use. By fostering a non-judgmental and collaborative environment, motivational interviewing helps individuals build their own reasons to stop using substances.17 

It promotes autonomy, encouraging patients to recognise their own capacity to make positive choices. The focus is on eliciting “change talk” – statements from the patient that express a desire for recovery and a readiness to take actionable steps.18

This approach has proven particularly effective in drug addiction13 treatment because it addresses the psychological underpinnings of addiction. Many individuals with substance use disorders struggle not only with the physical aspects of addiction but also with deep-seated feelings of guilt, shame, and ambivalence.19 MI helps them confront these feelings in a supportive setting, ultimately leading to greater engagement in treatment programs and a stronger commitment to long-term recovery.

Clinical observations and potential criticisms of MI

It should be said that motivational Interviewing (MI) has garnered substantial clinical support10,11,13,17 as an effective therapeutic approach for addressing drug addiction. Numerous studies indicate that MI helps increase patient engagement and readiness for change, making it a crucial tool in addiction recovery. 

Clinicians have observed that MI empowers individuals by promoting autonomy, increasing self-awareness, and helping patients resolve ambivalence about their substance use. This patient-centred approach allows individuals to explore their own motivations for change rather than feeling coerced or pressured into making decisions, which fosters a deeper, more sustainable commitment to recovery.

However, despite its widespread success, MI is not without its possible limitations and potential criticisms. 

• One such criticism involves the variability in effectiveness depending on the “practitioner’s skill level”. Since MI relies heavily on the therapist’s ability to listen, reflect, and guide the patient without directing them, inconsistent or poorly executed MI sessions can hinder progress.20 
• Additionally, MI is often seen as less effective for individuals with severe substance use disorders21, or those with co-occurring mental health conditions; one report states that it may “not work well for clients with trauma or depression, as motivation may be limited.”22 In cases where addiction is deeply ingrained, or where individuals face additional psychiatric challenges, MI may need to be supplemented with more intensive therapeutic interventions.
• Some critics also argue that MI’s non-directive nature may lead to slower progress, as the patient’s internal motivation develops at their own pace – “it is common when attempting to change for clients to have shifts in momentum and progress, which can be confusing and frustrating.”23 

Nonetheless, MI remains a valuable and highly regarded tool in the therapeutic arsenal for addiction recovery, particularly when integrated into a comprehensive, multidisciplinary treatment plan.

MI, positive change, & looking at the big picture of addiction recovery

Motivational interviewing serves as a powerful catalyst for positive change in individuals battling drug addiction13, guiding them toward a more self-directed, empowered recovery journey. By fostering intrinsic motivation and resolving ambivalence15, MI encourages patients to take ownership of their recovery, setting the stage for lasting behavioural transformation.

But it’s essential to consider addiction recovery as a multifaceted process. Building long-term resilience against relapse means addressing underlying issues, including co-occurring mental health conditions, trauma, or social challenges that may perpetuate substance use.

In the broader scope of addiction recovery, MI is a key stepping stone, promoting the self-awareness and commitment necessary for sustained recovery. Yet, the true success of addiction treatment comes from a personalised, whole-person strategy that empowers individuals to not only break free from substances but also rebuild their lives with healthier coping mechanisms, a reliable support network, and renewed purpose. 

Make a referral today → 

References

1. https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2023 
2. https://www.drugwise.org.uk/how-many-people-are-addicted/ 
3. https://delamere.com/blog/uk-drug-addiction-report-2022 
4. https://www.mentalhealthacademy.com.au/blog/motivational-interviewing-update-your-understanding#:~:text=Motivational%20interviewing%2C%20a%20popular%20client,Miller%20and%20Rollnick%2C%202002). 
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330017/ 
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200683/ 
7. https://psycnet.apa.org/record/2002-02948-000 
8. https://motivationalinterviewing.org/understanding-motivational-interviewing 
9. https://positivepsychology.com/motivational-interviewing-principles/ 
10. https://www.psychologytoday.com/gb/therapy-types/motivational-interviewing 
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463134/ 
12. https://www.cambridge.org/core/journals/bjpsych-advances/article/motivational-interviewing-living-up-to-its-promise/301E29C38EC9D433802E164440E09A23 
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8939890/ 
14. https://www.ncbi.nlm.nih.gov/books/NBK571073/box/ch1.b5/?report=objectonly
15. https://www.psychologytoday.com/gb/blog/the-fallible-mind/201511/ambivalence-in-addiction
16. https://pubmed.ncbi.nlm.nih.gov/11239735/
17. https://americanaddictioncenters.org/therapy-treatment/motivational-interviewing
18. https://www.ncbi.nlm.nih.gov/books/NBK571068/
19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8932605/
20. https://www.iacp.ie/files/UserFiles/IJCP-Articles/IJCP-Articles-2018/A-critical-evalutation-of-Miller-and-Rollnicks-Motivational-Interviewing-as-an-approach-for-working-with-substance-misuse-by-Antoinette-Copley.pdf
21. https://www.rehab-recovery.co.uk/addiction-treatments/motivational-interviewing/ 
22. https://positivepsychology.com/motivational-interviewing-effectiveness/ 
23. https://academic.oup.com/book/1297/chapter-abstract/140253552?redirectedFrom=fulltext