Substance Misuse

Substance use, misuse, and addiction is prevalent in society. According to a new study by EU drug agency, Ireland has the third highest rate of drug deaths in Europe (Bohan, C. 2011). Providing treatment for substance misuse is similar to those in the treatment of other mental health issues (Falkowski, 2000). One of the techniques that can be applied to clients who present with substance misuse is Motivational Interviewing (MI).

MI refers to a guiding and person-centered style approach in part developed by clinical psychologist Professor William R. Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. Miller introduced MI in a 1983 article in the journal of Behavioural Psychotherapy discussing addiction. The first edition of MI was co-written

The “relationship” for both MI and Rogerian approaches play a momentous part in the therapeutic alliance (Miller and Rollnick, 2013). Roger's (1992) believed that a minimal relationship, and psychological contact, must exist. Ultimately for Roger's, positive personality change can only happen in a relationship, in order to bring about therapeutic change (Cheston, 2000). The spirit of MI refers to the “heart-set and mind-set of the therapist” (Miller & Rollnick, 2013 p. 14). They propose that there are four key elements of the spirit of MI: Partnership, acceptance, compassion, and evocation (Miller & Rollnick, 2013).

In supporting the spirit of MI the therapist must be aware of the following pitfalls. The question answer trap whereby the overuse of question’s controls the session; taking sides, since this gives the client the position to argue against; labelling which runs the risk of leading; the expert trap which can result in a client adopting a passive role; the premature focus trap, where the problem of addiction precludes a focus on the current issues; and finally the blaming trap, which does not support the client in making the changes they want to make (Miller & Rollnick,

Another strategy a therapist can integrate along with MI when the client relapses the (RPM) “relapse prevention model" developed by Marlatt & Gorgon in (1995). It is based on a cognitive and behavioural framework and provides numerous strategies that helps the client cope with relapse indicators (Marlatt, G.A., & Donovan, D.M., 2005).

In applying MI while working with the client who presents with substance misuse, the foremost principle is for a therapist to express empathy. “Empathy is to understand another’s frame of reference and the conviction that it is worthwhile to do so” (Rogers, 1965 as cited by Miller & Rollnick, 2013, p. 18). In addition to empathy the following core skills are also critical, reflective listening; open ended questions; affirming; summarising; developing discrepancy; exploring ambivalence; rolling with resistance; paraphrasing; and finally promoting