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Understanding Motivational Interviewing: A Guide for Families and Friends Supporting Loved Ones with Substance/Mental Health Disorders

Supporting someone we love with a substance use disorder can be incredibly challenging. You want to help, but sometimes it feels like nothing you say or do makes a difference. This is where Motivational Interviewing (MI) can come in handy. MI is a compassionate, person-centred approach that can help you support your loved one in finding their own motivation to change. Let's dive into what MI is and how you can use it to make a real difference.

Remember, you are in this for the long haul. It's important to remember that while family and friends can play a crucial role in supporting a loved one with a substance use disorder, they are not professionals in this field. Motivational Interviewing (MI) can be challenging to implement, especially at the beginning, as it requires practice and patience to develop the necessary skills. Frankly, for many of us, it’s a whole new way of thinking, and it will take time for you to shift to these new ideas.

You may not see immediate results, and that's perfectly normal. Meaningful change may take months or even years. At the very least, MI will help you and your loved one have a better relationship and stay connected.

The key is to stay committed to the process and not get discouraged if things don't go as planned right away. With ongoing practice and a genuine desire to help, you can build a supportive environment that encourages your loved one to explore their motivations for change. Don't give up; your support can make a significant difference in their journey toward recovery.

What is Motivational Interviewing?

Motivational Interviewing is a counselling technique designed to help people find their own motivation to make positive behavioural changes. It's not about telling someone what to do; it's about guiding them to discover their own reasons for change. MI is built on three key principles:

1. Collaboration: MI is a partnership between you and your loved one. It respects their autonomy and acknowledges that they are the expert in their own life.
2. Discovery: Instead of imposing reasons for change, MI seeks to draw out the individual's own motivations.
3. Autonomy: MI emphasizes that the person has the right to make their own choices, supporting their sense of control over their behaviour.

Core Skills of Motivational Interviewing (OARS)

To effectively use MI, you need to develop four core skills, often remembered by the acronym OARS:

1. Open-Ended Questions: These questions encourage your loved one to talk about their thoughts and feelings in depth. For example:
• "What have you tried in the past that has helped you reduce or stop using substances?"
• "How would things be different if you didn’t have to use substances?"
2. Affirmations: These are positive statements that recognize your loved one's strengths and efforts. For example:
• "I appreciate that you are willing to talk about this."
• "You've shown a lot of strength in dealing with this."
3. Reflective Listening: This involves carefully listening and then reflecting back on what your loved one has said. For example:
• "It sounds like you're feeling overwhelmed by your current situation."
• "I hear you saying that you're worried about the impact of this on your health."
4. Summarizing: This involves pulling together key points from the conversation to ensure shared understanding. For example:
• "Let’s summarize what we've discussed so far. You are concerned about your health and want to find a way to reduce your stress."

How to Use Motivational Interviewing with Your Loved One

Now that you understand the basics, let's talk about how you can use MI to support your loved one with a substance use disorder.

1. Listen More, Talk Less

One of the most important aspects of MI is listening. Focus on hearing and understanding your loved one's perspective rather than lecturing or giving advice. This shows that you respect their autonomy and are genuinely interested in their feelings and thoughts.

2. Ask Open-Ended Questions

Encourage your loved one to explore their own thoughts and feelings about their situation. Open-ended questions can help them think more deeply about their behaviour and its impact. For example:

• "What are your thoughts about your current situation?"
• "How would you like things to be different?"

3. Use Reflective Listening

Show that you understand what your loved one is saying by reflecting back the content and emotions you hear. This can help them feel heard and understood, which is crucial for building trust. For example:

• "It sounds like you're feeling overwhelmed by your current situation."

4. Offer Affirmations

Recognize your loved one's strengths and efforts to build their confidence in making changes. Affirmations can be incredibly powerful in boosting their self-esteem. For example:

• "I appreciate that you're willing to talk about this."
• "You've shown a lot of strength in dealing with this."

5. Summarize Key Points

Pull together key points from the conversation to ensure shared understanding and reinforce your loved one's motivations and plans for change. For example:

• "Let me summarize what we've discussed so far. You are concerned about your health and want to find a way to reduce your stress."

6. Avoid Being Confrontational or Judgmental

Respect your loved one's autonomy and create space for them to explore their own motivations for change. Avoid confrontational or judgmental language, as this can push them away.

7. Help Examine Pros and Cons

Help your loved one examine the pros and cons of their current behaviour and potential changes. This can help them see the benefits of making a change and the drawbacks of staying the same.

8. Stay Balanced and Problem-Focused

Stay balanced between different perspectives and remain focused on the problem at hand. This helps keep the conversation productive and centred on finding solutions.

9. Use the "Elicit-Provide-Elicit" Technique

When sharing information, use the "Elicit-Provide-Elicit" technique:

• Elicit: Ask what they already know about the topic.
• Provide: Share new information in a neutral way.
• Elicit: Ask for their thoughts on the information.

10. Explore Understanding of Others' Concerns

Explore your loved one's understanding of others' concerns about their behaviour in a curious, non-threatening way. This can help them see how their actions affect those around them.

Examples of Motivational Interviewing in Practice

Let's look at a couple of scenarios to see how MI can be applied in real-life situations.

Scenario 1: Reducing Opioid Use

Imagine your loved one is struggling with opioid use. You might start by asking, "What are your thoughts about your current opioid use?" This open-ended question encourages them to explore their own feelings and concerns about their drug use. During the conversation, you might offer affirmations like, "I appreciate your honesty in talking about this. It takes courage to discuss such a sensitive topic." If they express worry about the risks associated with their drug use, you can use reflective listening: "It sounds like you're concerned about the dangers of using unregulated opioids. Can you tell me more about what worries you the most?"

Scenario 2: Addressing Stimulant Use

Suppose your loved one is struggling with stimulant use, such as methamphetamine or cocaine. You could ask, "How would you like your life to be different if you weren't using stimulants?" This helps them think about their goals and desires beyond drug use. Affirm their efforts by saying, "I've noticed you've been trying to cut back on your use lately. That shows real strength and determination."If they mention feeling trapped by their drug use, reflect back to them: "It sounds like you're feeling stuck in a cycle with your stimulant use and you're not sure how to break free."Summarize the conversation to reinforce their motivations: "Sounds like you are worried about the impact of stimulants on your health and relationships, and you'd like to find ways to regain control over your life."

Applying MI to Unregulated Drug Use Situations

When dealing with unregulated drug use, there are some specific considerations to keep in mind:

1. Safety First: Always prioritize your loved one's safety. If they're using unregulated drugs, you might ask: "What steps are you taking to stay safe when you use?" This shows concern without judgment and can open up conversations about harm reduction.
2. Acknowledge the Complexities: Illicit drug use often comes with complex challenges. You might say: "It seems like there are many factors influencing your substance use. Can you tell me more about what you see as the biggest challenges?"
3. Explore Ambivalence: Many people who use drugs have mixed feelings about their use. You could ask: "What are some things you like about using substances, and what are some things you don't like?"
4. Discuss Alternatives: Without pushing, you can explore alternatives to drug use. For example: "Have you ever thought about what you might do instead of using substances if you decided to cut back or stop?"
5. Address Stigma: People who use illicit drugs often face significant stigma. Acknowledge this: "It must be hard dealing with people's judgments. How do you cope with that?"
6. Focus on Harm Reduction: If your loved one isn't ready to stop using entirely, you can still support them in reducing harm. You might ask: "Are there ways you've thought about making your substance use safer?"

Remember, the goal of MI is not to force change, but to help your loved one explore their own motivations and options. By using these techniques, you can create a supportive environment that encourages them to think critically about their substance use and consider positive changes, all while maintaining their autonomy and self-respect.

Conclusion

Motivational Interviewing is a powerful tool that can help you support your loved one in finding their own path to change. By listening more, asking open-ended questions, using reflective listening, offering affirmations, and summarizing key points, you can create a supportive environment that encourages positive change. Remember, MI is not about telling someone what to do. It's about guiding them to discover their own reasons for change and supporting their sense of control over their behaviour. With patience, empathy, and these MI techniques, you can make a real difference in your loved one's journey to recovery. Supporting someone with a substance use disorder is never easy, however, by using MI, you may be able to help them find the motivation to make lasting, positive changes.

The Author: Ron Merk – Ron advocates for people and families experiencing concurrent disorders.

Resources:

• The Motivational Interviewing Network of Trainers (MINT) is an international organization of trainers in motivational interviewing
  
  
• National Library of Medicine - Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice.
  
  
• National Library of Medicine - Motivational interviewing—an evidence-based, collaborative, goal-oriented communication approach in lifestyle medicine: A comprehensive review of the literature
  
  
• Phycology Strategies - Motivational Interviewing Strategies
  
  
• The Motivational Interviewing Network of Trainers - (MINT) - Resource Page - All kinds of additional info on MI