Guideline 74: The management of harmful drinking and alcohol dependence in primary care

The management of harmful drinking and alcohol dependence in primary care
Annex 5

Important elements of motivational interviewing

Adapted from Miller and Rollnick, 2002.¹⁵⁸

Portraying empathy

use of open ended questions and avoiding premature closure
respect for individual differences
reflective listening so that patients sense you are trying to “get on their wavelength”
expressing interest/concern
acceptance that ambivalence is normal.

Developing discrepancy

patients are helped to see the gap between the drinking and its consequences and their own goals/values - the gap between “where I see myself, and where I want to be”
enhancing their awareness of consequences, perhaps adding feedback about medical symptoms and test results: “How does this fit in?” “Would you like the medical research information on this?”
weighing up the pros and cons of change and of not changing
progressing the interview so that patients present their own reasons for change.

Avoiding argument (“rolling with resistance”)

resistance, if it occurs (such as arguing, denial, interrupting, ignoring) is not dealt with head-on, but accepted as understandable, or sidestepped by shifting focus
labelling, such as “I think you have an alcohol problem” is unnecessary, and can lead to counterproductive arguing.

Supporting self efficacy

encouraging the belief that change is possible
encouraging a collaborative approach (patients are the experts on how they think and feel, and can choose from a menu of possibilities)
the patient is responsible for choosing and carrying out actions towards change.

Facilitating and reinforcing “self motivating statements”

A tenet of motivational interviewing is “People believe what they hear themselves say”.