How can you use MI to address substance use denial?

I believe confronting the denial is something that can be done and will indeed work, but only once a realtionship of trust and understanding has been established. As someone that has been addicted to various things as well as an alcoholic, my denial was very much a crutch I wasn't aware I needed. What I do with service users is something that possibly would have worked with me when I was in denial - MI - through the sharing of lived experience, open questioning, gentle challenging but at all times zero judgement. It allows us as an organisation to get through to people of all ages far better than other organisations have before us.

As a someone in recovery, I understand the denial and defensiveness that hinders addiction treatment. Confrontation often backfires. Motivational interviewing (MI) is one of the most effective approaches I’ve learned. The principles resonate with my experience: establish trust and rapport, reflect clients’ sustain talk without judgement, ask open questions to draw out change motivations, and support self-efficacy. Recovery cannot be imposed. By understanding and eliciting clients’ own reasons for change, MI overrides denial and evokes readiness to acknowledge harms. With empathy and listening, not confrontation, we allow clients to resolve ambivalence on their own terms.

As a person in recovery, it is with humility that I start by disagreeing with the quoted function of denial. In short, it is not a coping mechanism nor a way to preserve "identity, autonomy, and self-esteem". It is important to understand that denial is the primary symptom of the disease which makes confronting it, even though MI that much more difficult as it is immune from any rational argument. Motivational Interviewing may result in garnering some trust in the relationship, but without care, it can actually turn into codependency causing more harm than good in a person with an active addiction. That is to say, denial has no function. Denial is the desease.

The magnitude of having your thoughts repeated back to you and summarized in contrast with the reality of social, emotional, health and legal aspects of overuse, are all the more striking with the use of MI. OARS, when used consistently helps to bring denial to the surface and develop discrepancy in a way that is empowering to the addict. It is worth the time to let the process work its magic. MI is the tool for all the peaks and valleys of addiction journeys.

Someone I look up to suggested a counterintuitive but effective MI strategy - reflect and reinforce client sustain talk rather than argue against it. This validates their rationale for continuing substance use. Though it seems backwards, it creates space for motivations and goals for change to arise. Clients often contradict their own sustain talk, thus initiating change talk. By reinforcing rather than imposing external reasons to quit, clients access their own inner motivations and readiness for change. This indirect approach elicits change talk to override denial.