How can you motivate patients in medication-assisted treatment?

1 What is MI?

MI is a collaborative, person-centered, and goal-oriented approach that helps people discover their own reasons and strategies for change. MI is based on four principles: expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. MI aims to elicit and strengthen the patient's intrinsic motivation, rather than imposing external pressure or judgment.

2 How can you use MI in MAT?

Motivational Interviewing (MI) can be utilized in different stages of MAT, from the initial assessment to the maintenance and follow-up. For instance, during the assessment stage, MI can help to build rapport, understand the patient's situation, and identify their readiness for change through open-ended questions, affirmations, reflections, and summaries (OARS). During the planning stage, MI can be utilized to help the patient set realistic and achievable goals, explore different options for MAT, and elicit their preferences and expectations. In the implementation stage, MI can support adherence to MAT, monitor progress, and address challenges or barriers. Finally, in the maintenance stage, MI can reinforce achievements, prevent relapse, and encourage long-term recovery.

3 What are some dos and don'ts of MI in MAT?

MI is not a one-size-fits-all technique, but rather a flexible and adaptable method that depends on the patient's needs, preferences, and stage of change. To enhance effectiveness and avoid common pitfalls, it is important to express empathy and respect for the patient's autonomy and choices while avoiding judgement, criticism, or blame. Developing discrepancy between the patient's current situation and their desired goals is also key, without arguing, confronting, or persuading them to change. Furthermore, rolling with resistance and exploring the patient's ambivalence and concerns should be done rather than opposing, challenging, or correcting them. Lastly, supporting self-efficacy and confidence in the patient's ability to change is essential while avoiding assuming, directing, or advising them on what to do or how to do it.

4 How can you learn and improve your MI skills in MAT?

Learning and improving MI skills in MAT requires practice and feedback. To help you get started, you can read books and articles by William Miller and Stephen Rollnick, the founders of MI, and other experts in the field. You can find a list of recommended readings on the Motivational Interviewing Network of Trainers (MINT) website. Watching videos and podcasts of MI demonstrations and interviews with MI practitioners and researchers is another way to learn about the skill. Additionally, attending workshops or trainings on MI in MAT, either online or in person, can be beneficial. You can also seek supervision and feedback from a qualified MI trainer or mentor. Finally, to practice what you have learned, record and review your own MI sessions with patients in MAT using tools such as the Motivational Interviewing Treatment Integrity (MITI) code or the Behavior Change Counseling Index (BECCI). All of these resources can be found on the MINT website.

5 How can you measure the impact of MI in MAT?

MI is an evidence-based technique that has been proven to improve outcomes in various settings and populations, including MAT. However, the impact of MI in MAT may vary depending on factors such as the patient's characteristics, the type and dose of medication, the frequency and duration of MI sessions, and the quality and fidelity of MI delivery. Therefore, it is important to measure the impact of MI in MAT using valid and reliable indicators and methods. To do this, surveys, interviews, or focus groups can be used to assess patient satisfaction and engagement with MI and MAT. Pharmacy records, urine tests, or self-reports can be used to measure medication adherence and retention. Biological tests, self-reports, or collateral reports can be utilized to measure substance use and related outcomes. Finally, standardized instruments, self-reports, or collateral reports can be used to measure psychosocial and functional outcomes.

6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?