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 comorbid mental health disorder (see Chapter B2 for a discussion of readiness to change). MI may be used to increase the client’s motivation in this regard [388].
MI is a directive, client-centred counselling process aimed at increasing a person’s motivation and commitment to change [389]. The strategy involves a non-confrontational conversation seeking out the ambivalence in the client’s attitudes that can be used as encouragement for him/her to think about further change. For example, a client may say he/she is not really interested in dealing with his/her 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 have his/her mental health condition treated. Examples of MI strategies and techniques are provided in Appendix E, along with a number of useful resources for MI.
An MI strategy assumes equity in the client-AOD worker relationship and emphasises a client’s right to define his/her problems and choose his/her 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 [388, 389].