Like in most states, addiction continues to hurt families and communities in the Prairie State.
In a recent report by America’s Health Rankings, 17.5% of adult Illinoisans admitted to having abused both prescription and illegal substances in the past 12 months, placing Illinois 35th in the country for drug misuse rates.
Youth usage is similarly concerning, with data from the Illinois Youth Survey revealing that the rate of alcohol drinking in teens is almost double the national average.
Abusing drugs comes with certain risks, including overdose and traffic accidents. In 2023, the Illinois Department of Public Health recorded over 3,500 overdose deaths and upwards of 2,000 fatal, alcohol-related crashes.
If someone you care about is engaging in risky substance misuse, encouraging them to seek treatment is the best way to lower the risk of serious harm.
Unfortunately, those who develop alcohol and drug use issues are often ambivalent about their condition.
Motivational interviewing (MI) can be an effective first step to resolve denial and ambivalence in those living with SUD. For concerned families and individuals in Illinois, MI can open the path toward lasting recovery.
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Denial and Ambivalence in Addiction
There are several reasons why someone struggling with substance use disorder (SUD) may hesitate to reach out for help. Denial and ambivalence are among them, and both are major obstacles in recovery.
Denial is when someone who’s clearly living with some kind of drug problem ignores or downplays the situation. Signs of denial include:
- Avoiding situations where their drinking or drug use is talked about
- Comparing your drinking habits to those of others
- Justifying drinking or drug use
- Acting dismissively or irritably, claiming that the issue is not as serious as their loved ones make it out to be
- Trying to blame their addiction on stress or another person
- Falsely believing that they’re still in control of their substance use behavior
It’s worth noting that feelings of denial and ambivalence are normal, especially during the early stages of recovery. However, these emotions can also prevent someone from taking their condition seriously.
Over time, denial can erode important relationships, leaving the person alone, allowing the SUD to persist and worsen. Isolation can be dangerous, especially during a health crisis.
Getting past denial and reluctance toward treatment is essential to overcoming SUD for good. Talking to a counselor or therapist is a good way to explore your or a loved one’s habits and recognize the problem.
For families and concerned individuals, staging an evidence-based intervention with motivational interviewing can be an effective way to encourage healing.
What Is Motivational Interviewing?
Motivational interviewing is a patient-centered counseling approach designed to help people find the motivation to change.
Developed by psychologists William R. Miller and Stephen Rollnick in the 80s, MI is particularly effective in individuals who feel conflicted feelings about receiving treatment.
Applied in the context of substance use disorders, MI can strengthen the patients’ commitment and resolve to achieve their recovery goals.
This counseling technique has several key principles, such as:
- Supporting self-efficacy: By building their confidence, a therapist can reinforce the individual’s conviction to make important behavioral changes.
- Rolling with resistance: Rather than directly challenging resistance, MI provides alternative perspectives and interpretations on subjects the patient feels strongly about.
- Expressing empathy: To establish a safe space, a counselor expresses empathy by understanding the issue from the patient’s point of view and without judgment.
- Developing discrepancy: By the end, motivational interviewing aims to help the individual see the gap between their goals and current behaviors.
Studies have shown MI to be highly effective in addressing denial and ambivalence among smokers, those with OUD and AUD, and teenagers struggling with cannabis use disorder (CUD).
Addiction treatment programs involving MI have also exhibited higher retention rates than those that don’t.
How Does Motivational Interviewing Work?
MI highlights collaboration over confrontation when dealing with denial and reluctance. This collaborative approach is essential to building rapport and fostering a trusting relationship.
Additionally, unlike other therapeutic models, motivational interviewing stresses that genuine change ultimately lies with the person. In this sense, the therapist acts more as a guide and a listener.
MI unfolds in four patient-centered stages as follows:
- Engaging
Engaging is all about getting to know the person. This step allows the healthcare provider to clear concerns they may have about the intervention and establish a working relationship with the patient.
At this early point, the priority is simply to build that connection. That, and learn about the client’s feelings and ideas about change.
Counselors and therapists create a safe space where the patient can feel heard without judgment. They also ensure the person feels in control of their own recovery, emphasizing MI’s collaborative nature.
In addition to building rapport, a successful engagement stage can reduce feelings of resistance and doubts about rehab.
- Focusing
It’s not uncommon for those trying to overcome addiction to feel unclear about the direction in which they would like to change.
Focusing is when the counselor moves the conversation toward determining the specific goals of the treatment. They help the patient clarify what they personally want to gain from the therapy.
Once priorities are decided and aligned, the healthcare provider can now support the client to achieve them.
In some cases, treatment goals may already be taking shape. For example, someone who wishes to overcome alcohol or drug use disorders may have particular goals ready even before entering treatment.
- Evoking
Evoking is the third step and heart of motivational interviewing. This is where the counselor or therapist draws out the person’s motivations for changing their behavior.
In MI, the professional doesn’t tell the individual why or how they should change, as in other types of psychotherapies. Instead, they guide them to explore their own good reasons for changing and taking action with them in mind.
During the evoking stage, the therapist listens closely for “change talks.” These are moments where the individual expresses their desire, need, or purpose to change.
It’s the therapist’s job to incite and reinforce the patient’s change talks to help the person hear their own reasoning more clearly.
Those with strong ambivalence may express “sustaining talks” (defensiveness) to justify drinking or using substances. Avoiding confrontations, the counselor explores both sides in a balanced and respectful way.
- Planning
The planning stage is where the professional counselor works with the patient to turn their motivations into actions. This is particularly crucial in ensuring the person stays and adheres to treatment.
Entering a rehab program, attending counseling sessions, and learning coping strategies are common steps taken after MI.
Planning takes place when the recovering patient begins to ask “how” to change rather than “if”—verbal indicators signaling confidence and readiness to engage in further addiction treatment.
Using their expertise, the therapist offers guidance, education, and professional insight, while ensuring the interaction remains collaborative, giving them control over their recovery.
Techniques in Motivational Interviewing
Treatment providers employ several interpersonal techniques for motivational interviewing. OARS (open-ended questions, affirmations, reflective listening, and summaries) is central to these strategies.
Asking Open-ended Questions
Open-ended questions are queries you can’t answer with a yes or no, and often begin with “How,” “What,” or “Tell me about…” to promote genuine dialogue.
An open-style questioning helps the person elaborate on their answers. In MI, they’re designed to evoke personal motivations and explore denial and feelings of ambivalence.
By asking “How would you like things to change?” instead of “Do you want to change?”, patients are encouraged to share their perspectives, values, and reasoning.
Affirming Strengths
One of the primary goals of MI is to boost the person’s confidence in their ability to change and overcome SUD. Recognizing their strengths through affirmation statements is an effective way to do that.
Examples of affirming words are:
- “It must have taken a lot of courage to see me today.”
- “You’re quite resilient despite these challenges.”
- “I appreciate your honesty in sharing that with me.”
- “You’ve clearly put a lot of work into changing your situation.”
In addition to fostering a positive relationship, affirmation statements have been shown to increase self-efficacy and reduce “sustain talks.”
Reflective Listening
Reflective listening is often done in two ways: simple and complex. Both approaches let the patient know the therapist is actually listening and trying to understand the problem from their perspective.
Simple reflections involve repeating the patient’s phrases word-for-word or with a slight variation.
For instance, when the person says, “I don’t have time to exercise,” the therapist can respond, “With your busy schedule, I can see how finding time can be difficult.”
On the other hand, complex reflection involves inferring meaning, unsaid emotions, or omitted information in the patient’s words.
Summarizing Information
Summaries are foundational in MI, as they allow the therapist to take pieces of information shared by the person and present them more coherently.
By summarizing, the patient can consider the situation more clearly, which may help them identify their reasons for changing easily. Summaries also act as a valuable tool in promoting change talk.
Who Can Benefit From Motivational Interviewing?
Motivational interviewing can be useful in many stages and levels of care in addiction treatment. It’s especially helpful for:
- Individuals reluctant to enter rehab: Motivational interviewing can convince those who, despite knowing they need help, are not sure whether or not they want to enter rehab.
- People who are resistant to treatment: Denial and ambivalence are the two common reasons why some people resist treatment, both of which are resolved in MI.
- Someone with a dual diagnosis: Motivational interviewing can be a good supplementary treatment for those dealing with SUD and other co-occurring psychotic disorders.
Those who have recently experienced relapse can also benefit from motivational interviewing.
Relapse can discourage a patient from continuing treatment. MI can help boost their confidence and re-engage in their recovery.
In many addiction treatment programs, motivational interviewing is used alongside other types of therapies, such as cognitive behavioral therapy.
Find Motivational Interviewing Services in Illinois
If you’re exploring your treatment options in Illinois, it’s important to find a treatment provider that offers holistic, personalized care in addition to motivational interviewing.
Accredited by The Joint Commission, Illinois Recovery Center is a premier provider of addiction treatment services incorporating MI and other evidence-based therapies.
The facility offers both inpatient and outpatient interventions for alcohol, opioid, prescription medication, cannabis, and benzodiazepine addictions. We’re ready to support you in every stage of your recovery.
Message Illinois Recovery Center and learn how we can help you. Take the first step toward change today!
