How can you use MI to address co-occurring mental health and substance use disorders?

The Motivational Interviewing (MI) approach is person-centered; it works on co-occurring mental health and substance use disorders by enhancing motivation for change and building self-efficacy. Through aligning values and aspirations of the individual to their drivers for change therapists can help them discover their strenghts and ambitious goals. They look at coping skills, strategies, and the potential barriers to change, bringing in and dealing with the possible resistance or ambivalence that comes up. With collaborative goal-setting and the continuous provision of support, MI helps people bring about positive changes in the management of both their mental health symptoms and substance use, & promotes long-term recovery and well-being.

How can you use MI to address co-occurring mental health and substance use disorders? First, when I am using MI I am uisng a communication style to build a relationship with a person. That person may have symptoms of substance ues disorder and/or somemental health disorder, but to assist the person, I have to build a relationship with that person. To do this, the most effective method is to practice the most basic skills of MI, the OARS of active listening. Only when I have developed the relationship with the PERSON, can I begin to help guide them to solutions for the issues they want to change.

Motivational Interviewing is a therapeutic intervention that emphasizes the power of open-ended questions to promote a client's self-awareness of their relationship to a desired change. Change is necessary to create the possability for a new way of being, and it involves the appropriately terrifying reality of leaving an old way of being in the past. It results in grief, requires resilience, and is met, at the start, with complicated feelings of desire and resistance as well as motivation for change-oriented behavior and sabotage. A MI approach allows for these paradoxical drives, the actions they result in, and the emotions they lead to, to be a part of the of the counseling process to promote resilience to engage in the change process.

Motivational interviewing is a way to have conversations with people that promote change and growth (Miller & Rollnick, 2023). Essential to MI is the practice of creating psychological safety through a humble, open, and flexible therapeutic stance. MI uses basic reflective listening and related communication skills: strength affirmation, content summarization, open-ended questions, and collaboration when offering education and advice. Through the combination creating psychological safety and empathic listening skills, individuals are engaged in conversations. The skilled MI practitioner can then notice, elicits, and reinforce “change talk”, which are client verbalizations that move away from focusing on the problem to considering change.

The premise of MI is to get the individual to make behavioral changes to achieve a personal goal, helping them move from ambivalence about change to actually working on the change. MI requires that the therapist roll with the patient's resistance without judging, let the patient do the change talk, and then reinforce the change talk. Through this approach, a therapist can help the individual state the change they want to work towards and then help them overcome their doubt or reluctance. Using it in substance use and mental health can help the person navigate their feelings in regard to their use and their need for mental health care, whether it be taking medications, seeing a therapist regularly, or moving towards a sober lifestyle.

Without friendship, there is no Recovery. It's not an item that is often mentioned in education programs. But, it's the most effective 'tool' to enhance motivation for change. To apologize is the second best 'tool'. "I apologize for what I am about to say, but is it OK with you if I postpone my opinion about what is going on, and what might help you? We hardly know each other, and it will take some time to develop friendship. Otherwise, I am not the expert. That's you. I might just be wrong in addressing what is happening to you. I promise that I will tell you in time what my thoughts are. By the way, I totally agree with you that you refuse to use medication. I would do the same. What happened?"

Motivational Interviewing is a key intervention for COD because COD indicates levels of complexity; an individual with COD has co-occurring mental health and substance use disorders and often other health and social issues. In order to effectively engage, we need to find out where someone is willing to start. It is not uncommon for an individual to have some motivation with some issues, but not others. So, we can use a number of evidence based practices to address the concerns where someone is ready to act - for instance DBT for emotional regulation or psychopharmacology for psychiatric issues. For issues in which someone is ambivalent, we use motivational interviewing. It is common to have many targets to explore when using MI for COD.

Motivational interviewing (MI) can be effective when addressing mental health comorbidity with substance abuse disorders by fostering a collaborative and empathetic therapeutic relationship. Through open-ended questions and reflective listening, therapists employing MI can explore clients' ambivalence about change, helping them recognize discrepancies between their values and current behaviors. MI also encourages individuals to express their own reasons for change, enhancing their intrinsic motivation. This approach respects autonomy, allowing clients to explore and articulate their goals, ultimately increasing their commitment to positive behavioral changes related to both mental health and substance use.

MI naturally opens up dialogue for a Client to move forward with their own solutions thus creating investment in their goals towards improving mental health and Substance abuse (although MI is not limited to these populations).

The non-confrontational style inherent in MI is especially crucial in the context of co-occurring disorders. Individuals facing these challenges may already encounter stigma and judgment, and MI's non-judgmental approach creates a safe space for them to navigate their complexities.

Motivational interviewing can be highly effective for individuals with co-occurring disorders by helping them explore their ambivalence towards change and guiding them towards positive behavioral changes. In the context of depression and substance use disorder (SUD) as co-occurring disorders, motivational interviewing (MI) can help by exploring the individual's feelings about change and their reasons for using substances to cope with depression symptoms. For example, a therapist might use MI to gently guide the individual to reflect on their experiences with both depression and substance use, helping them recognize any discrepancies between their goals and current behaviors.

There are many ways to apply MI in treatment, but one that resonates most to me is that the approach fosters autonomy. MI emphasizes the client's autonomy and personal responsibility in the change process, which can be particularly important for individuals with co-occurring disorders, as they often feel defeated by their illness, and disempowered or stigmatized by their families and communities. By respecting their autonomy, MI helps them regain a sense of control and self-determination.

I personally enjoy using MI in my sessions with COD because it puts the client in the driver seat of their own life. Rather than being told what to do, clients are encouraged to collaborate on their goals through open ended questions and curiosity. It can assist in helping the client put their guard down and see that the counselor is on their side.

I agree, all of these are significant challenges when trying to utilize MI with COD. I’ve found it’s helpful to focus on the little changes surrounding happiness. Finding something that sparks an interest with our clients that will not feel like “work” whether it’s coloring, meditating, exercise, reading, singing, etc. beginning here it makes it much easier to expand their openness to change. Reflecting their statements of small wins because they were doing a healthy alternative builds on their momentum to change even while living with COD.

Formal Training: This can be through workshops, seminars, or courses led by experienced MI practitioners. Training typically involves learning the principles and techniques of MI, along with understanding its application in COD. Regularly practicing MI techniques, such as open-ended questions, affirmations, reflective listening, and summarizing, is important. Supervision and Coaching: Seek supervision or coaching from experienced MI practitioners, particularly those with expertise in COD. Learn how MI can be integrated with other therapies and approaches commonly used in treating COD. Understanding how MI complements other treatments can enhance your effectiveness as a therapist.

In treating co-occurring disorders, it's essential to conduct a thorough dual diagnosis assessment, considering both mental health and substance use. An integrated treatment approach, involving collaboration between mental health and addiction specialists, is crucial. A comprehensive evaluation of physical and mental health, crisis intervention, and safety planning are key components. Engaging the support system, respecting cultural backgrounds, and incorporating relapse prevention strategies are vital. Providing a continuum of care and embracing trauma-informed care principles are essential. Finally, tailoring treatment plans to individual needs ensures a more effective and holistic approach.

MI is about changing behavior, patients with co-occurring mental health and substance use disorder involve ambivalence and their self confidence is weak,MI responsible for change and this change just happen by patient’s decision.Therefore MI aim is strengthen internal motivation in patients &create atmosphere to change,motivation reinforce patients to awareness and build ability to make decision.Empathy ( active listening &acceptance and understanding of patient’s feelings view )is the basic feature of MI,help transition from ambivalence stage to the positive change in behavior,MI respect autonomy and give right to choose and it’s kind of cooperation and patient participation toward self-discipline.