Addiction and Motivation; what works? Presentation at the 2012 Europad conference in Barcelona. Three main points: - Evidence base for Motivational Interviewing - Practitioner competency - Implementation issues

1. Addiction and Motivation:
What Works?
Rik Bes
Centre for Motivation and Change
Hilversum, the Netherlands
www.motivationalinterview.nl
www.motivationalinterviewing.org

2. Addiction and Motivation:
What Works?
• Motivational Interviewing; evidence base
• Practitioner’s competency
• Implementation in organizations

3. Addiction and Motivation:
What Works?
• Motivational Interviewing; evidence base
• Practitioner’s competency
• Implementation in organizations

4. MI Outcome Studies by Era

5. MI and evidence-based research
Meta-analysis
Hettema JM, et al.
Annual Review of Clinical Psychology 2005;1:91–111
Hettema JM, et al.
J of Cons Clin Psychol 2010;78(6):668–84

6. Mean combined effect size by problem area
(N = 72 RCT’s)
HIV risk 0.71
Drug abuse 0.51
Public health 0.51
Gambling 0.44
3 Months
Treatment adherence 0.42
Alcohol 0.41
Diet / exercise 0.14
Smoking 0.04
HIV risk 0.53
Drug abuse 0.29
Public health 0.3
Gambling 0.29
Follow-up
Treatment adherence 0.72
Alcohol 0.26
Diet / exercise 0.78
Smoking 0.14
0 0.2 0.4 0.6 0.8 1

7. Adoption Curve for Innovations
N umber of Adoptions
Source: Everett M. Rogers Diffusion of Innovations

8. Number of MI Publications
550
500
Number of Publications
450
400
350
300
250
200
150
100
50
0
83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5
Years
Source: www.motivationalinterviewing.org
Publications double about every three years

9. Adoption Curve for MI
Number of Adoptions
If Rogers’ curve holds, approximately 30% of those who will
ultimately adopt MI have done so

10. So, after 30 years of research we
have a treatment method that is:
• Evidence-based >90 RCT’s
• Relatively brief
• Specifiable (but be careful with manuals)
• Grounded in testable theory
• With specifiable mechanisms of action
• Generalizable across problem areas
• Complementary to other treatment
methods
• Learnable by a broad range of providers
• Verifiable – Is it being delivered properly?

11. Addiction and Motivation:
What Works?
• Motivational Interviewing; evidence base
• Practitioner’s competency
• Implementation in organizations

12. A continuum of styles
Directing Guiding Following
70
60
50
40
30
20
10
0
Informing Asking Reflective Listening

13. A working definition:
• Motivational interviewing is a collaborative,
• person-centered
• structured form of guiding
• to elicit and strengthen
• intrinsic motivation for change

14. Eight Stages in Learning MI
1. Getting the spirit of MI
2. Using client-centered skills (OARS)
3. Recognizing change talk
4. Eliciting and reinforcing change talk
5. Rolling with resistance
6. Developing a change plan
7. Consolidating client commitment
8. Integrating MI with other intervention methods
Miller, W. R., & Moyers, T. B. (2006). Eight stages in learning motivational
interviewing. Journal of Teaching in the Addictions

15. 10 things that MI is . . .
1. A refined form of guiding
2. in a conversation focused on change
3. that evokes and strengthens personal motivation
4. in a person-centered, autonomy-honoring way
5. using specific methods in certain ways
6. toward a particular change goal
7. that is attuned to and guided by client speech
8. and is relatively brief
9. adaptable across people, cultures and problems
10. and is specifiable and learnable

16. Where MI Clinicians Can Get
Stuck
1. Letting go of the expert role (righting
reflex)
2. Using complex reflections
3. Missing opportunities for MI
4. Giving insufficient direction
5. Opposing resistance
6. (Not) moving on to focusing and
planning
7. (Not) attending to commitment language

17. MITI (Motivational Interviewing Treatment
Integrity)
• Therapist behavior counts
• Global markers
– Empathy
– Collaboration
– Evocation
– Autonomy
– Direction/focus

18. Learning MI
Some findings
• Reading about MI doesn’t affect
competency
• 2-3 day workshops will raise awareness and
interest; they won’t increase competency
enough to score ‘competency’ on MITI
• Advanced workshops help to get ‘un-stuck’
• Continued coaching and observed practice
lead – over time – to full competency

19. Addiction and Motivation:
What Works?
• Motivational Interviewing; evidence base
• Practitioner’s competency
• Implementation in organizations

20. Examples from MI
implementation
• Addiction services in the Netherlands
(mid 90’s)
• Various hospitals (2007 ->)
• Criminal Justice systems
(Netherlands, Sweden, UK) (2000 ->)
• Health Care standards (f.i. diabetes
care, smoking cessation)

21. Implementation challenges
• MI is not ‘easy’ to do for a practitioner,
neither for the organisation to implement
• Need for longer term planning
• Sustainability of competency:
• Professional peer support
• Intervision/supervision/coaching
• Life-long-learning
• More than what happens between patient
and therapist

22. Some helpful resources
• Monitoring and research
• Tailor-made:
• Teaching tools
• Peer-support solutions
• E-Learing and blended learning
• Webinars
• Online coaching

23. Addiction and Motivation:
What Works?
Rik Bes
Centre for Motivation and Change
Hilversum, the Netherlands
www.motivationalinterview.nl
www.motivationalinterviewing.org