Our primary contribution as MI practitioners is to listen. Through Motivational Interviewing (MI) skills and practices, we empower those in our care to find their own reasons and motivation to make positive changes. Over 40 years of science clearly show this is the impact of utilizing an MI approach to fidelity.
In addition, MI has been specifically proven to improve Opioid treatment program participation, retention, and success because it supports individuals find their “why” for change—their reasons. It’s through MI’s empathetic and evoking approach we can reduce the harm associated with opioid use.
Understanding the Opioid Epidemic
In 2002, more than 80,000 deaths were attributed to opioid-related overdoses, and that number continues to climb. It’s estimated that over 27 million people in the United States use drugs or misuse prescription drugs. There is a clear and critical need for comprehensive and compassionate approaches to provide care and treatment.
Harm Reduction models offer practical strategies to reduce the risks and harms of opioid use. Whether it’s offering free training to community members on the use of nasal spray to prevent drug overdoses or making sure free naloxone is available for family members if they need to provide first aid, harm reduction helps combat the risk of drug overdose.
We’re in an opioid overdose emergency, where intervention can prevent overdose death with life-saving medication. It’s crucial to saving lives, but once a person has survived the effects of an opioid overdose, or if they’re struggling with substance abuse, there are options to help them make changes rather than just offering an anecdote to the prescription medication itself. It’s crucial that mental health and medical professionals continue to provide broader picture interventions to not just save a person’s life but to help them continue to live in a positive, healthy way. This approach, when combined with MI, offers the practical skills that community organizations and practitioners—nurses, teachers, therapists, and counselors—need to address not only the risks of opioids but also the underlying issues that may contribute to their misuse.
At Share, we work with many folks in these human service roles to support them as they understand and develop skills to foster change in those they serve. It’s important to realize that even with positive changes, such as reducing substance use and abuse, there are still emotions of loss in those affected by opioid addiction tied to changing their identity and way of life.
When we use Harm Reduction as an approach to treatment, we meet people where they are on their journey but don’t leave them there. They may not be ready to stop using opioids at the time, but they still need support to stay safe and reduce the risk of overdose and escalating use. Ultimately, Harm Reduction is about meeting individuals where they’re at, without judgment, focusing on improving their health and safety.
Key Components of Effective MI Training
At Share, all of our training programs focus on the importance of context. We need to start with real-world scenarios. All people are more than their behaviors, circumstances, and choices. Change is challenging, and those challenges are often the source of ambivalence people experience when considering a new approach.
As practitioners, we listen and ask questions to support folks as they identify why positive changes might outweigh negative drawbacks–the upsides of change and the downsides of not changing. Through this connection, we build rapport and avoid a one-size-fits-all approach to treatment, recovery, and Harm Reduction.
Our approach through MI is ongoing, but it begins with the following steps:
1. Engage: Building Rapport
Engagement is the cornerstone of MI and any interaction or intervention. It is the number one indicator of a positive outcome in any service relationship, no matter the role type or service population. Through engagement, we develop rapport and a collaborative relationship with our clients.
Engaging involves establishing trust by actively and empathetically listening. And then, in the next step, demonstrating that empathy in our responses. When we provide a safe space and supportive environment, folks in our care feel seen, understood, valued, and respected. Further, empathy cuts through the self-shame and blame many experience in their journey to healing and reducing or letting go of opioid use.
2. Focus: Identifying Behavioral Topics
Focusing our approach means working with the individual in our care to identify the behavioral issues that may be causing them negative consequences.
In the context of opioid addiction and use, it could mean recognizing use triggers, patterns, and factors that may contribute to addiction, relapse, overdose, and on. Identifying these areas of focus is crucial for helping people make the connection to start their path toward positive change. We can’t do the next step in MI’s process, evoking, unless we have clearly identified the Focus of change.
3. Evoke: Encouraging Change Talk
The heart of MI is “evoking change talk.” Change talk is the voicing of the served person’s why. Why do clients want to change their behavior? When we empower folks to identify their own reasons for change, it’s much more powerful than simply telling someone what to do or that they must make a change. The key difference is we are drawing out rather than installing the reasons for change.
Throughout our MI work, we use evoking change talk strategies to facilitate the voicing of change talk. These strategies are questions and explorations to help our clients explore their ambivalence about change and reinforce their commitment and resolve. Evoking helps folks surface what’s already there.
4. Plan: Developing Action Plans
Once we’ve worked with clients to help them engage, focus, and find their motivation (evoke), the next step is action planning. In this process, we collaborate with our clients to brainstorm practical and achievable steps to take.
In the case of opioid use, this might mean planning how to use safely, how to start on medication-assisted detox and treatment, or how they will respond to triggers. The plan will depend on the individual’s circumstances, capabilities, and goals. Pro tip: always start by inviting the person to come up with a plan rather than supplying one.
The Importance of Contextual Training
In opioid treatment and Harm Reduction, context is crucial. Theoretical reasons and scenarios aren’t as powerful as practical situations. When we start with listening to the client’s statement, we’re setting up a contextual framework.
In Motivational Interviewing, we emphasize a person-centered approach. In part, that means respecting the autonomy of our clients—they are the experts of their own lives. As practitioners, we’re supporting them in their decision process, not imposing solutions. We’re not there to “fix” them but to support them as they find the ways and desires to change themselves.
Our Intention: To Hold Space
We get asked a lot about “holding space.” What does it mean to hold space for someone? Is it just listening? In MI, we learn that holding space is more than just being “in” a space with someone. It’s about support.
One metaphor we use in training is a broken bone and a cast. The cast isn’t healing the bone. The body is sewing the bones back together. The cast is holding the body part in place so it can do the work it needs to do.
As practitioners, we’re the cast. We’re there, holding space by creating a safe conversational environment where someone can express what they’re thinking and feeling about their reasons for change.
To successfully hold space, we have to express empathy. This is where it can get tricky sometimes. Empathy is not just an expression; it’s a demonstration. So saying, “I get it. I see where you’re coming from,” isn’t empathy. It might be helpful, but it’s not demonstrative that we actually “get it.”
Empathy requires deep listening and working to understand the other person’s perspective in a non-judgmental, not assessing but rather accepting way. In the case of opioid use, it’s not just saying, “I get it,” but rather, “I understand—you use it to manage your anger,” or, “So you use to manage your emotional pain.”
Once people feel empathized with (get that they’re “got”), they will feel more comfortable and safer to further open up. Carl Rogers once said, “The curious paradox is that when I accept myself just as I am, then I can change.” The question then becomes: How can a person accept themselves as they are if we don’t accept them as they are?
Small Steps Toward Lasting Change
Making positive changes, whether it’s with opioid use, other addictions, or another damaging behavior, starts when a person feels heard, felt, and seen. Even though changes can be significant (for example, going through a detox program and quitting), they begin with the small steps of identifying the reason for the change (evoking).
Our role as Motivational Interviewers and care providers is to offer up a compassionate, safe space with empathy. When we build that engagement and rapport, we can empower the person to choose to make the changes on their own—something much more effective for lasting change than saying, “You must quit.”
The Surgeon General’s report on Alcohol, Drugs, and Health cites Motivational Interviewing as an important approach to enhance motivation and evoke change among those coping with substance use and misuse.
The opioid crisis requires a compassionate and comprehensive response. When professionals are equipped with the tools they need, like MI skills, they can genuinely make a difference and help those who are struggling.
When we share MI with practitioners, we always do so in a contextual manner. We recently did a conference session on MI + Harm Reduction. In that session, we walked folks through MI’s 4 Processes using a served person statement they generated at the outset of our time together. At the end of the training, anonymous evaluations clearly indicated that those participants walked away with an approach they felt connected with themselves and would be beneficial to those they serve.
For more information on our programs and resources for teams, please explore our website or contact us. Together, we can find effective ways to empower positive change in those we serve.