So, how is addiction treated? How can therapists and health care practitioners, including doctors, help people who struggle with addiction? Addictions are highly treatable. Antoine Douaihy, MD, professor of psychiatry and of medicine, University of Pittsburgh School of Medicine, says that successful treatment often involves a practice called motivational interviewing. The American Psychological Association describes motivational interviewing as a therapeutic approach that uses “structured conversations that help patients increase their motivation to change and overcome addictive behaviors.” Motivational interviewing helps patients “recognize the difference between how they are living right now and how they wish to live in the future.”
“When you look at the research, the better predictor of a patient’s likelihood of a successful treatment outcome is the particular style of the therapist, physician or health care practitioner,” says Dr. Douaihy. “Therapeutic empathy is one of the strongest predictors of a health care practitioner’s effectiveness in treating substance use disorders. Empathy is based on interpersonal warmth and genuineness. Also, believing in the patients’ potential to do well and recover makes a big difference. Meaning, if I work with persons with addictions and expect that they’ll get better in terms of substance use, most likely they will get better. But if I have an expectation that they won’t get better, most likely they won’t.”
The practice of motivational interviewing is client-centered. It means that the health care practitioner engages the patient in a conversation about change without being judgmental and believes that the patient is capable of change. The practitioner helps the patient to identify what is keeping him/her from changing a behavior and helps him/her work to make the change.
Motivational interviewing sounds like common sense, right? But Dr. Douaihy points out that persons with addictions are not always treated by someone who is trained in motivational interviewing.
“Our systems of care still use confrontational approaches,” he says. “People are told, ‘I’m going to tell you what works for you,’ or ‘I know what’s best for you because I’m the physician.’ People are attacked, preached to or scolded to change their behaviors. Research showed no evidence that this approach works at all. In fact, motivational interviewing is consistent with the self-determination theory, which is the thinking that “I will do whatever is right for me—not what you tell me do.” Practitioners can be experts on addictions and other illnesses, but they’re never going to be an expert on you struggling with addiction. People are the experts on themselves. It makes sense. But not everyone accepts it as the approach for how we work with patients.”
Dr. Douaihy recommends that people become advocates for themselves and for loved ones. The more people can know about what has been proven to be effective, the more they can seek it out in their health care providers.
“Motivational interviewing is based on compassion—respecting and supporting people’s right to make decisions about their own lives and behaviors,” he says. “The core of it is recognizing what makes us human and caring for others. And we have the scientific evidence to prove that it works.”
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