Chapter 25. Motivational Enhancement

Carlo C. DiClemente, Ph.D., A.B.P.P.; Miranda Garay, B.A.; Leigh Gemmell, Ph.D.
DOI: 10.1176/appi.books.9781585623440.353214



Patient motivation is a necessary ingredient in substance abuse treatment and recovery. Because of the reinforcing nature of addictive substances and the physiological and psychological reliance they engender, individuals with problematic and dependent patterns of substance use often refuse to acknowledge problems or seek treatment. Even when substance abusers arrive at a treatment program, many are ambivalent about the need to modify their substance use and resist any notion that they need to reduce their use or abstain completely. Going to treatment is not a panacea that turns ambivalence and lack of readiness into commitment to change—a significant number of individuals who enter a treatment facility fail to complete the treatment and many drop out after intake or a single session (Simpson and Joe 1993; Wickizer et al. 1994). Engagement in substance and alcohol abuse treatment is sporadic. Even those who comply and complete treatment do not always achieve stated goals. Reluctance to seek help, attrition, and relapse are significant problems facing treatment providers as they try to help individuals who abuse drugs and alcohol along the path to recovery. All of these barriers are connected in some way to patient motivation.

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Table Reference Number

Motivation is a multidimensional concept that is critical to understanding recovery and providing substance abuse treatment.

Motivation consists of the patient's readiness to change and engagement in the multiple tasks needed to successfully achieve and maintain sobriety, often identified by the stages of change.

Motivational enhancement strategies can include brief interventions in opportunistic settings (e.g., emergency department, primary care, substance abuse testing or screening) and more extensive multisession treatment protocols.

Motivational interviewing developed by Miller and Rollnick is both a style of interacting and a set of techniques that addresses patient ambivalence and lack of motivation.

Although more research is needed (especially with more severe cases and in individuals with multiple diagnoses), studies generally support use of motivational interviewing and motivational enhancement for individuals with a broad range of substance abuse problems.

More extensive research on motivational enhancement approaches has been done with alcohol problems followed by studies of nicotine and marijuana and fewer studies involving cocaine and opiates.


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