Use of MI in Treating Substance Abuse in Adolescents
The paper explores motivational interviewing (MI), its basic components, and principles of usage when treating adolescents with substance addiction. It consist of the introduction, a chapter about MI and its usage in addiction treatment, a chapter about usage of MI in treating adolescents from substance abuse, and a conclusion. The paper explores how therapists influence their patients in order to help them stop drug intake by using MI themes, such as autonomy, evocation, and collaboration. It also evaluates the stages of change in which MI is of paramount importance. Another focus of the paper is on challenges that the therapists can face working with adolescents addicted to drugs. These are lack of autonomy, resistance, underdeveloped values and norms, absence of goals, and lack of self-efficacy. Overcoming these difficulties is also possible through usage of principles of MI. The sources used in the paper are books on psychology or peer-reviewed articles about motivational interviewing.
Keywords: motivational interviewing, MI, evocation, autonomy, adolescents, addiction.
Use of MI in Treating Substance Abuse in Adolescents
MI is a relatively new person-centered guiding style. However, it has already gained popularity due to positive results in working with addictions. MI is often used with the transtheoretical model as it facilitates movement through stages of change. Main principles of MI are based on non-confrontation with a client and avoidance of imposing therapist’s or societal values and norms on a client. The main task of MI is to elicit intrinsic motivation for a person that is based on real values and goals. Using MI with adolescents presents a number of challenges. These are resistance to therapy, dependence on parents’ or peers’ opinions and norms, absence of autonomy, underdeveloped goals and imposed values. Adolescents might also lack self-efficacy, which is important to make a change. Thus, the therapist’s task is to create a collaborative, empathetic, supportive, and caring atmosphere during MI sessions. The thesis of this paper is that MI is an efficient guiding style for motivating adolescents to stop substance abuse.
MI as a Guiding Style
Motivational interviewing (MI) is often used together with transtheoretical therapy; however, it is not a part of or synonymous to TTM. Instead MI is defined as “…a collaborative, person-centered form of guiding to elicit and strengthen motivation for change” (Miller & Rollnick, 2002). The purpose of MI is to motivate a client to change their detrimental behavior and to replace it with a positive one via exploring their personal arguments for change. MI also works towards reducing a client’s resistance to change.
MI as a form of communication developed as an alternative to existing theories that promoted confrontation with clients in order to show them negative consequences of their behavior. In contrast to these theories, motivational interviewing aims at helping clients to verbalize the arguments for change rather than confronting them with those arguments. MI is based on a concept that human beings are progressing organisms that are growth-oriented and have inner resources for personal development. Hence, MI’s purpose is to facilitate the process of change towards personal growth by activating existing resources (Jones-Smith, 2012).
There are three main components of MI: 1) collaboration or partnership between a therapist and a client rather than confrontation 2) verbalization of clients’ arguments rather than imposing arguments on them (evocation) 3) respect of clients’ autonomy. Motivational interviewing also requires the therapist to follow some guidelines in their relationships with clients: the therapist has to be empathetic; they have to develop discrepancies between a client’s behavior and goals, avoid direct confrontations, overcome client’s resistance, and support self-efficacy. All these principles are directed towards releasing client’s motivation to change maladaptive behavior. The basic techniques used by therapist during MI are called OARS: these are open-ended questions, affirmations, reflective listening, and summaries (Jones-Smith, 2012).
MI is efficient in making an adolescent believe that they have enough strength to stop the addiction. As soon as an adolescent makes a decision to stop substance intake, other cognitive-behavioral therapy can be added to a treatment plan. While MI elicits why a young person should change, it does not cover the issue of what steps should be taken in order to do so. Thus, MI cannot be a primary treatment. On the other hand, it can become an important basis at the beginning of treatment that will determine the future success (Naar-King & Suarez, 2011).
Although MI is generally applicable, it works particularly efficiently with young people. Project MATCH has discovered that polydrug-abusing adolescents who had received motivational interviewing report lower substance abuse and three times longer periods between treatments (“Enhancing Motivation for Change”). Motivational Interviewing helps adolescents to move quickly through the stages of change. It is beneficial not only during the first stages of precontemplation and contemplation, but also during other stages up to maintenance.
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Specifics of Working with Adolescents
Working with adolescents who suffer from substance abuse has its challenges. In order for MI to be effective, the therapist has to help a young person to vocalize their values and goals. For adolescents, these goals can be rather vague and underdeveloped, as they are just starting to make their lives independent from parents’ and, thus, tend to re-evaluate principles imposed on them by their families. It is common for young people to feel a lack of communication with parents as they feel that their family does not fully accept or understand them. Young people may also lack necessary life experience to make an accurate judgement. For example, due to young age and good health they can underestimate the negative influence of drugs, alcohol, and smoking on their bodies. The therapist has to be careful in differentiating a client’s life goals and values from those of their family in order for MI to be beneficial (“Enhancing Motivation for Change”).
Another important external influence on adolescents that should be taken into account is their peers. Adolescents tend to see their peers as an example rather than parents, and, thus, their friends can have more influence than family members. Many adolescents start taking drugs because of their friends. MI requires young people to take responsibility for their lives and make decisions independently from their families and friends. Young adolescents and those with less developed cognitive functions usually require identification of short-term goals, while older adolescents need to focus on long-term aims and values.
Among the three MI themes or MI spirit (collaboration, evocation, autonomy), autonomy is probably the most problematic concept when working with adolescents suffering from substance abuse. Obtaining autonomy is the main task of adolescence; however, it can be complicated by an existing addiction created by incorrect reasoning. MI does not suggest imposing “correct” argumentation on young addicts, though. Moreover, when pushing young people to stop using drugs, therapists and parents are often confronted with resistance. Miller, when developing MI, underlined that it is impossible to make a person change. Change is an internal process, and a therapist can only motivate a client to do so, but will not get any results by imposing change. Hence, the therapist’s task is to guide a person towards stopping drug abuse and elicit their perspectives based on personal choice and responsibility (Naar-King & Suarez, 2011).
Collaboration is the second MI theme. Naturally, a therapist has to be in collaboration with parents of an adolescent in order to coordinate a young person’s goals. Studies indicate that in order to treat drug addiction, a client does not have come into treatment voluntarily. However, it is important to be in partnership with a client. A general atmosphere of support should be established. The last but not least for successful MI is evocation. An addict needs to verbalize their goals, motivation, and decision to stop using drugs in order to start the changing process. Here, the therapist might feel the urge to correct poor decision making and wrongful reasoning. Miller and Rollnick called it a righting reflex, which is a human’s desire to correct things that they consider to be wrong. However, such a technique can be detrimental to the client as it stifles autonomy. MI aims at revealing intrinsic motivation through personal goals and values. A young person should verbalize and argue for change rather than have a therapist doing it for them (Naar-King & Suarez, 2011).
During MI sessions with addicts, the therapist invariably uses MI principles. Empathy is one of the key principles of MI. The therapist’s task is to create a supporting and caring atmosphere and also a sense of acceptance in a young person. It will evoke trust towards the therapist and also will eliminate distress during MI sessions. Decision to stop substance abuse should be based on intrinsic motivation, which in turn relies on one’s goals and values. If it is based on external motivation, it results in shame, guilt, and resistance. External behavior change is much less stable and less prolonged than internal change. Thus, the therapist’s goal when working with adolescents is to show discrepancies between one’s addictive behavior and their personal values. By doing so, the therapist stimulates an adolescent to make a change in order to eliminate this discrepancy and elicit intrinsic motivation. For example, the therapist working with a young person who highly values personal independence can demonstrate how drug abuse can enhance dependence (on drugs, dealers, finances etc.). This can encourage a young person to fight addiction. Very often a young person’s intrinsic values can differ from those of the therapist’s. Imposing external values can result in a young person’s arguing against change (Naar-King & Suarez, 2011).
Adolescents can be characterized by higher resistance to therapy than other age groups. For adolescents, resistance can sometimes transform into an outright rebellion, especially when the adolescent has been forced to come to treatment by authoritative figures. The MI practice suggests rolling with resistance: it is better to express understanding of a young adult’s point of view rather than arguing for change.
Boosting self-efficacy is another principle of MI. People in treatment often feel inferior to their peers. They can feel that they are not capable of change, even if they understand the benefits of it. Thus, the therapist’s task is to establish a “can do” attitude and show a young person assurance in their abilities and strong will. A sense of hope should come from the therapist to a client. When self-efficacy strengthens, it helps the client to diminish discrepancy about one’s goals and perception of what one is capable of (Rosengren, 2009).
Naturally, all of the abovementioned principles of MI do not mean that the therapist should simply agree with an adolescent. The therapist offers their views in form of advice or open-ended questions, which would make a client consider and make one’s own decision on whether to take this advice or not. The solution, however, should be found within the person rather than from outside sources. The therapist can only guide a client to look for this solution (Rosengren, 2009).
Motivational interviewing is a relatively new method of communication between a therapist (practitioner) and a client. However, it has already gained popularity due to its effectiveness. It is often used when working with addiction and substance abuse. MI is effective in working with all age groups, including adolescents. However, MI with adolescents presents a number of challenges to the therapist. These difficulties are connected with personality development during the adolescent years. Young people struggle for autonomy from their parents; however, they may experience misunderstanding, judgement, lack of support and communication from family members. As adolescents become more distant with their parents, they also become more dependent on their peer’s norms and values. Thus, the therapist’s task is to differentiate a young person’s real values and goals from that of family and the rest of society. MI enhances autonomy from all external forces and helps find intrinsic motivation to change maladaptive behavior. Although it may seem like an easy task to conduct a motivational interviewing, it requires a therapist to create a genuine atmosphere of trust, support, acceptance, and hope.