MI for AOD use disorders involves a non-judgemental collaborative discussion, which explores specific medical, social, interpersonal, or psychiatric effects that AOD use has had on the client’s life. Just as clients may be resistant to the idea of changing their AOD use, they may also be resistant to the notion of addressing their co-occurring mental disorder (see Chapter B3 for a discussion of readiness to change). MI may be used to increase the client’s motivation in this regard [757]. MI is a directive client-centred counselling process that assumes equity in the client-AOD worker relationship and emphasises a client’s right to define their problems and choose their own solutions. It is, in this sense, a counselling style (as opposed to a set of techniques) based on collaboration rather than confrontation, evocation rather than education, and autonomy instead of authority [757–759], that aims to increase a person’s motivation and commitment to change [758, 759].
The strategy involves a non-confrontational conversation seeking out the ambivalence in the client’s attitudes that can be used as encouragement for them to think about further change. For example, a client may say they are not really interested in dealing with their social anxiety but agree that it is a problem. Probing around this ‘problem’ and exploring ambivalence may lead to the client contemplating further ways to address the problem. The strategy is to use available openings to help the client advance towards a decision to make changes that will benefit their mental health. There is considerable evidence supporting the use of MI for treating mental and AOD use disorders [760–763]. Examples of MI strategies and techniques are provided in Appendix E, along with a number of useful resources for MI.