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Indiana Prevention Resource Center (IPRC)

Motivational Interviewing

-- “Ms. Anderson, I’m Mr. Jones, the clinic’s Behavioral Health Specialist. I’d like to talk with you briefly about the alcohol use questionnaire you completed. According to the answers you gave, you average about 3 or 4 alcoholic drinks per day and drink more than 4 times a week.”
-- “Yeah, that’s about right. But I’m not an alcoholic, if that’s what you’re thinking!”

-- “Can you tell me a little bit about your drinking patterns?”
-- “I have a beer when I get home from work … my job is really stressful and I need it to relax and unwind. I like to cook nice meals, so we usually have a couple of glasses of wine with dinner. Then we might go out and meet with friends, or I’ll stay in and watch TV with my boyfriend. Sometimes I’ll have a couple through the evening, but only one when we go out, because I have to drive. And some nights I don’t drink at all after dinner.”

-- “How do you feel about your drinking?”
-- “It’s not a problem for me. I drink because I enjoy it; I’m not an alcoholic. Sometimes I won’t drink anything for a few days and I feel just fine.”

-- “That’s great that you can sometimes go without drinking for a while, and are careful never to drink very much when you plan to drive. Can you tell me more about what you like about drinking?
-- “Like I said, it relaxes me. My job is stressful. And I like the way wine tastes.”

-- “What about negatives? Is there anything you don’t like about your drinking?
-- “Well, my parents think I drink too much. When I visit them or they visit me, those are the times I don’t drink. I just don’t want to deal with the hassle. I’ve missed work a few times when I drank a little too much … I couldn’t get up in the morning … which made things harder when I went in the next day and found all the work piled up on my desk.”

-- “So it seems that while you do enjoy drinking, you also see some negatives – you drink to relax but sometimes drinking adds stress. Your parents hassle you about it, and it sometimes causes you problems at work. Does that sound accurate?”
-- Yeah, I guess that about sums it up.

-- "Ms. Anderson, your score on the alcohol use assessment was 11, which puts you at moderate risk for some alcohol-related health problems. Would it be ok if I shared some information with you about how your drinking can affect your health?“
-- “Sure … I guess so.”

Wouldn’t it have been so much easier, and so much faster if Mr. Jones had just stormed into the room and said “Honestly, Ms. Anderson … 4 drinks a day? Do you have any idea how many brain cells you have fried? I can’t imagine what your liver is going to look like in 20 years if you keep this up. You are obviously in denial about being an alcoholic. You absolutely have to stop drinking right now and start attending AA meetings.”

Or, perhaps, “Ms. Anderson your alcohol consumption is well above the recommended limit, and this can result in alcohol dependence, liver cirrhosis, sexual victimization, and, should you become pregnant, a baby with Fetal Alcohol Syndrome. If you value your health it is crucial that you stop drinking immediately. “

Faster? Yes. Easier? Probably. But also much less likely to do any good.

Nobody likes to be told what to do. Nobody likes to be lectured. Studies have shown that when people are told what to do, their natural instinct is to resist and respond with defensiveness and denial. “It’s not that bad.” “I’m not drinking that much.” Ms. Anderson, in fact, does just that when she says “I’m not an alcoholic!” She is already defending herself against what she expects to hear. And she is surprised to not hear it. Instead of a lecture about her “drinking problem”, the health specialist continues with her gentle questioning and active listening, getting Ms. Anderson herself to think about, and talk about, her reasons for drinking, and some reasons why she may want to change.

This concept, encouraging the patient to think about her reasons for drinking (or using drugs) and come up with her own motivations for stopping or cutting back, is known as Motivational Interviewing (MI). MI is client-centered, stressing that the client/patient is responsible for her own choices, and her own decisions.

Nobody is going to tell Ms. Anderson that she has to stop drinking. The health specialist will, with Ms. Anderson’s permission, offer some information about how she might benefit from drinking less. And then he will encourage her to consider making one small change in her drinking patterns. Maybe he’ll help her look for another way to relax after work. Or avoid drinking at all when she plans to drive. Or have wine with dinner only three times a week. Whatever she decides to do, however small, will be a step in the right direction. For patients at moderate risk, small and achievable changes are the goal, and may be enough to get her down to low risk levels of alcohol use. (If Ms. Anderson was a heavier, higher-risk drinker, the goals would be different.)

Will our Ms. Anderson choose to cut back? Maybe, or maybe not. But we do know that telling people like Ms. Anderson what they should do usually backfires, resulting in anger, resentment and resistance. Motivational Interviewing allows the patient to feel understood, respected and empowered. When provided with the information she needs, she will be able to make her own decisions, and be responsible for her own healthcare choices.

For more information, please visit IndianaSbirt.org

By Naomi Pardue, 9/4/2012