Motivational interviewing - how can I use it to help motivate my loved one to change harmful substance use habits?

communication
#1

In the past I’ve loved the idea that motivational interviewing is a technique we can use to help our loved ones tap into their intrinsic motivation to change harmful substance using habits.

I realized lately that I’ve completely forgotten how to use it and how to think about when to use it.

@erica help!

#2

The best time to use Motivational Interviewing (MI) is when our loved one has some idea that there are negative consequences to their use. Each person is in a different stage of readiness, and as supportive loved ones we can help facilitate the movement from one stage to the next.

Many people struggling with substance use lack motivation to change for three main reasons.

  1. They don’t think that their substance abuse problem is as serious as it really is.
  2. They don’t want to give up the positive sensations associated with their drug use (this is a good place to tap into positive sensations they can experience in recovery to combat this).
  3. They fear the consequences of ceasing substance use, including withdrawal symptoms and cravings.

Here is the Stages of Change model:

  • Pre-contemplation: no intention of taking action anytime soon (next 6 months). Oblivious that behavior is a problem or that it brings negative consequences *conversations about change at this stage may cause more harm than good
  • Contemplation: Intend to start healthy behavior sometime soon (next 6 months). Can see that the behavior might be a problem, or there’s good reason to make a change, and mindful of the pros and cons of changing behavior with almost equal emphasis on both.
  • Preparation: Ready to take action within the next 30 days. Small steps in direction of behavior change, and believe that changing our behavior can lead to a healthier life
  • Action: conversations should be about action. in the last 6 months behavior has changed in some way and plan to keep moving forward in change direction towards healthier behaviors
  • Maintenance: behavior has been maintained for more than 6 months and there is an intention to fully sustain this change. Work is done to prevent relapse to earlier stages.

The activity: ask where your loved one feels they are in the stages of change, and what collaboratively could be done to move to the next stage of change. When you have the conversation remember to emphasize that you are allies in this, and you both want the same thing: for you and them to be happy and healthy.

Another activity/thought experiment: Think about something you’ve considered changing, thinking should change, want or need to change, but haven’t done so yet. (think of a change you are ambivalent about). Now imagine someone telling you how much you need to make this change, gives reasons, emphasizes the importance of changing, tells you how to do it, assures you that you can do it, and prods you to get on with it. How would you respond?

Evidence shows general responses are angry and not understood, defensive and judged, uncomfortable and ashamed, powerless and discouraged.

If you communicate in this way to your loved one, it can make them feel bad which stalls instead of helps change begin.

Now imagine you’re in a conversation with someone about something you want to change, but are ambivalent about. This time your friend doesn’t give advice, instead they ask you a series of questions and listen receptively to what you have to say, and afterwards provides a summary of what you said: why you want to change, why it’s important, what the best reasons are, and how you could do it in order to get results.

  • Why would you want to make this change happen?
  • How could you go about it in a way that gets you the results you want?
  • What are you top three reasons to do it?
  • How important is it for you, and why?

After this interaction is complete, they ask one more question

  • What do you think you’ll do?

Communicating with your loved one this way tends to make them feel engaged and ready to keep talking, empowered and hopeful, open and respected, understood and connected.

Please comment below so we can continue this dialogue. I’m here and happy to help!

A note from Village :love_letter: : Our Coaches are trained in the leading evidence-based methods. If you’re interested to learn more about Coach Erica, click here.

#3

Love the call to empathy @erica!

Another activity/thought experiment: Think about something you’ve considered changing, thinking should change, want or need to change, but haven’t done so yet. (think of a change you are ambivalent about).

This is something I think about pretty regularly as we talk about our loved one’s behaviors on this site. What changes do I need to make myself? Am I walking the walk?

(Like, I have a pile of clothes that moves from my bed to the floor and back every day :grimacing: Getting on my case about isn’t gonna make me change my behavior, but some coaching or motivational support might.)

#4

Ah yes - I forgot about the stages of change model too!

Now that I’m thinking this through too I want to try to apply it to something relevant to my situation. Will post separately.