How do you use Motivational Interviewing to support clients with dual diagnosis?

1 What is dual diagnosis?

Dual diagnosis is a term that describes the co-occurrence of a substance use disorder and a mental health disorder, such as depression, anxiety, bipolar disorder, or schizophrenia. Dual diagnosis is very common, affecting about half of the people who seek treatment for substance abuse. However, it can also make recovery more difficult, as the two conditions can interact and exacerbate each other. For example, a person with depression may use alcohol to cope with their negative emotions, but alcohol can worsen their depression and increase their risk of suicide. Likewise, a person with schizophrenia may use cannabis to reduce their psychotic symptoms, but cannabis can trigger or worsen psychosis and impair their cognitive functioning.

2 Why use MI for dual diagnosis?

Motivational Interviewing (MI) is an evidence-based practice that has been shown to be effective for both substance use disorders and various mental health disorders. It can help clients with dual diagnosis by building a trusting and empathic relationship, enhancing their motivation and readiness to change, reducing their resistance and defensiveness, strengthening their confidence and self-efficacy, and supporting their action and maintenance. This is done through reflective listening, avoiding confrontation or persuasion, eliciting and reinforcing change talk and coping skills, as well as helping them develop and implement a personalized change plan and addressing any barriers or relapses.

3 How to use MI for dual diagnosis?

Using MI for dual diagnosis involves four main processes: engaging, focusing, evoking, and planning. To successfully engage a client with dual diagnosis, it is important to be sensitive to their mental health symptoms and needs, and tailor your communication style accordingly. This may include using simpler language, shorter sentences, and more frequent summaries for a client with cognitive impairment, or more validation, empathy, and reassurance for a client with anxiety or low self-esteem. The focusing process requires helping the client identify and prioritize their main concerns and goals, and agreeing on a common agenda for change. Evoking the client's own motivation for change can be done through open-ended questions, affirmations, reflections, and summaries to explore their ambivalence, values, hopes, and fears. Lastly, planning involves developing and implementing a concrete and realistic change plan that includes SMART goals, addressing potential obstacles, providing feedback and support.

4 What are some challenges of using MI for dual diagnosis?

Using MI for dual diagnosis can present some challenges, such as dealing with complex and multiple issues that require more time and attention, balancing the client's autonomy and safety when they have impaired judgment or insight, adapting to the client's fluctuating motivation and mental state, coordinating with other professionals and services involved in the client's care, and managing your own emotions and reactions when facing difficult or distressing situations. All of these require a great deal of effort and skill to be successful.

5 How to overcome these challenges?

To overcome these challenges, you need to be flexible and creative in your approach, adjusting your pace and style to the client's needs and preferences. It is essential to be respectful and supportive of the client's choices, but also assertive and protective of their welfare when necessary. Additionally, you should practice patience and persistence in your efforts, celebrating any small or incremental changes. Collaborating and communicating with other providers and agencies is important, as is seeking consultation or supervision when needed. Finally, self-care is necessary to avoid burnout or compassion fatigue, so it is important to seek support for yourself.

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?