Motivational Interviewing is a strategy for decreasing adolescent substance misuse and increasing adherence to treatment regimens.
Illinois DocAssist’s Webinar on Adolescent Substance Use and Motivational Interviewing presented by Medical Director, Diane Misch, M.D.
- Taking an empathic, non-judgmental stance and listening reflectively
- Developing discrepancy between the adolescent’s goals and their current behavior
- Rolling with the patient’s resistance and avoiding argumentation
- Supporting self-efficacy for change
- Substance misusing youth often do not come to treatment voluntarily. When using Motivational Interviewing, it is not necessary for adolescents to admit to having a problem to start treatment in contrast to more traditional approaches.
- Experimentation with alcohol is normative during adolescence. Motivational Interviewing can be applied to varying degrees of “readiness for change.”
- Motivational Interviewing places an emphasis on avoiding hostile confrontation, lecturing or telling the patient what to do.
- Motivational Interviewing strategies can be employed to encourage participation in treatment, to enhance motivation for change (when engaging in risky and harmful behaviors), and to facilitate adoption of learned skills.
- Encourage your patient to make a specific change plan to abstain or reduce alcohol and/or substance misuse. For patient’s that are resistant, discuss contingencies that can be utilized to encourage the patient to follow-up or participate in treatment. A “Change Plan Worksheet” is available in the Illinois DocAssist tool kit.
Behaviors that are not appropriate for Motivational Interviewing and require immediate intervention include: high risk behaviors such as driving while using alcohol, high levels of substance misuse per occasion, polypharmacy, intravenous drug use, alcohol or substance related emergency room visits and extreme binge drinking.
Explain the practice’s confidentiality policy and set aside private time with patients
• The primary care provider should talk to parents and adolescents about confidentiality before problems arise.
• Decide when it is appropriate to break confidentiality. What a patient discloses is confidential except when the patient is a danger to themselves or others.
• The limit to confidentiality relies on the primary care provider’s judgement regarding prevention of harm and protecting the patient’s health and safety.
When Breaking Confidentiality
- Inform your patient and strategize together about how to disclose information to the parents or caregivers
- Maintain the bond with the patient throughout this process
- By involving parents, the patient is more likely to follow through with interventions