LT Chad Wheeler MSW, LCSW-C

Assessing Substance Abuse Through Motivational

Interviewing

Objectives

• Identify substance abuse/dependence in clients and provide a motivational

• Interview.

• Apply motivational Interviewing in their daily practice.

• Integrate motivational interviewing into any existing substance abuse

• assessments.

Topics

• Addiction/Substance abuse…. What is it?

• Motivational Interviewing

• Withdrawals

• Treatment

What is Addiction/Substance Abuse?

• Disease model • A behavior that persists even though there

is apparent risk or harm to oneself or others (consequences)

• To an outside observer the individual demonstrates diminished, but retrievable, capacity for self-regulation of the behavior

• Life for the individual has become unmanageable

Motivational InterviewingProfessor William R Miller, Ph.D. and Professor

Stephen Rollnick, Ph.D.

• Meeting patient “Where they Are”• Ask, listen, inform• Express empathy• Develop discrepancy• Roll with resistance • Support self efficacy • Ask open ended questions• Listen reflectively • Affirm & summarize • Elicit change talk

Three stage process

• Pre-contemplation stage

Not thinking about change

• Contemplation stage

Thinking about it

• Action and maintenance stages

Ready for action/made change

Adolescents

• Decision made by an authority figure

• Readiness to change

• No Diagnosis

• Parents concern vs. clients

Substance Abuse

• A maladaptive pattern of substance use leading to clinically significant impairment or distress

• Missing obligations

• Hazardous situations

• Legal problems

• Continued use despite consequences

Substance Dependence

• Tolerance

• Withdrawal

• Cannot cut down

• Larger and larger amounts

• Continued use despite consequences

Brief Interventions

• Increasing insight and awareness

• Motivation toward behavioral change

• Drawing out rather than imposing ideas

• Empowering to the individual

• No judgment

• No right or wrong

• Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Meeting patient “Where they Are”

• Does the client want to stop?

• Skip the diagnosis

• Brief interventions

• Denial, anger and refusal of treatment by the client

• No challenging, opposing or criticizing

• “Would you be open/willing to…?”

Express Empathy

• “This must be very hard”

• Careful with “I” statements

• Does not mean agree

• What makes sense to the client may not make sense to you

• Come back to this stage when met with Resistance

Develop Discrepancy

• I’m confused

• Motivation for change happens when a person recognizes a difference between their present behavior and important personal goals

• Help client to recognize ambivalence

• Reflective statements

Develop Discrepancy What NOT to do

Develop Discrepancy

Support Self Efficacy

Affirm & Summarize

• Encourage and praise seemingly small accomplishments

• “What I’m hearing you say is…”

• Longest amount of “clean” time

• Perfect world scenario

• No judgment or tone

Elicit Change Talk

• Increase rapport and commitment to change from clients

• Not necessary to admit to or acknowledge having substance abuse problems

• Readiness to change

• What addiction means to them

• Open-ended questions

• Active listening

Resistance

Assessment

Withdrawals

• Alcohol withdrawal syndrome– barbiturates and clonidine– Can be fatal

• Barbiturates and Benzodiazepines – reducing in steps of 10% every 2–4

weeks depending on the severity of the dependency and the patient's response to reductions

– Can be fatal

Withdrawals

• Opiates -Fentanyl -Morphine -Vicodin (hydrocodone) -Oxycontin -Oxycodone -Codeine -Methadone

• Nicotine• Benzodiazepines(can be fatal)

Symptoms

• Dysphoria• Depression • Anxiety• Craving• Seizures• Hallucinations• Tremors• Paranoia• Fatigue• Flu-like symptoms

Symptoms

• Nausea• Sweating• Sleep disturbance• Vomiting• Reduced sensory threshold • Headache• Palpitations• Diarrhea • Weakness• Agitation

Treatment

• Patient can only receive treatment if they are ready

• Pharmacological Interventions

• Prevention/Education

• Community reinforcement approach

• Contingency management strategies

• Inpatient/Outpatient

Anonymous Programs

“God grant me the serenity to accept the things I cannot change; courage to change the things I can;

and wisdom to know the difference.”

Questions/Comments