Motivational interviewing (MI) is a counseling approach in which motivation is used to help clients change their behaviors. This treatment was first described by Professor William R. Miller, Ph.D., in a 1983 issue of Behavioral Psychotherapy. Motivational interviewing for substance abuse is effective for many clients because a lack of motivation to quit drugs or alcohol can be one of the greatest challenges for people with addictions, even despite health, financial, social, and legal problems. The idea behind using motivational interviewing in addiction treatment is to help the individual understand the negative consequences of their drug use and help them reach a stage of readiness when it comes to changing their behavior and getting sober. 

Objectives of Motivational Interviewing for Substance Use Disorders 

There are seven key points to motivational interviewing for substance abuse treatment: 

  1. Motivation comes from the client, not from outside sources. 
  2. Clients are responsible for resolving ambivalence (uncertainty,) not the counselor. 
  3. Uncertainty cannot be resolved through direct persuasion by the counselor. 
  4. The counselor quietly elicits information from the client. 
  5. The counselor guides the client in recognizing and resolving uncertainty. 
  6. Readiness to change is a fluctuating result of interpersonal interaction, not a character trait. 
  7. The client-counselor relationship should resemble a partnership. 

With these guidelines in mind, MI therapists at our Massachusetts inpatient drug rehab utilize the following steps to help clients: 

  • Engaging: Engaging the client about issues, concerns, and hopes while establishing a trusting relationship with them. The alliance between the therapist and the client is important for helping the client realize their goals. Counselors must be empathetic and ensure that the client knows that setting and working towards goals is a collaborative effort. 
  • Focusing: Centering the conversation on the patterns and habits the individual wants to change. There are two different scenarios that usually bring addicts into rehab. Either they have realized they need help, or it was mandated by their family or a judge – otherwise called court-ordered rehab. The focusing stage is meant to help individuals who did not come in with a plan to create goals that they would want to set in recovery. 
  • Evoking: Gently eliciting client motivation for change by explaining the importance of change, confidence that change can occur, and readiness for change. After finding their focus, MI specialists must address and bring their patients’ attention to their reasons behind recovering. Therapists must recognize even subtle instances where the client brings up their desire to change and highlight this internal motivation. 
  • Planning: Work on developing a set of practical steps the client can use to implement the desired changes discussed during treatment. This is the most important stage of motivational interviewing, as it sets clients up for the future by helping them apply their skills and knowledge as they transition to life outside of rehab.  

Motivational interviewing addiction treatment is a client-centered form of counseling that focuses on figuring out what clients need and want rather than what the counselor thinks is best. This requires elevated levels of empathy, reflective listening, and the ability to form strong bonds with clients, as well as openness, vulnerability, and willingness to change from clients. 

Common Motivational Interviewing Questions for Substance Abuse 

Encouraging clients to discuss their addiction and their need for treatment is often a matter of asking the right questions. It is important to note that there are not any wrong answers. 

Motivational interviewing in addiction treatment is all about empowering the individual to take responsibility for their actions and helping them decide that getting sober is the right thing to do. Therapists at our rehab in Massachusetts want clients to talk about their concerns, feelings, ideas, and plans rather than have someone else decide what is best for them. 

Common motivational interview questions for substance abuse used in sessions include: 

  • Tell me about your concerns or challenges related to your drug or alcohol use. 
  • What do you like most about the drugs or alcohol you use? 
  • What are the positives about these substances for you? And what are the negatives? 
  • What are your worries about your drug or alcohol use? 
  • Tell me what you have noticed about your drug or alcohol use. How has it changed over time? 
  • What things have you noticed that concern you that might become problems? 
  • What have other people told you about your drug use? 
  • What do you think other people are worried about regarding your drug or alcohol use? 
  • Tell me what concerns you about your drug or alcohol use. Tell me what it cost you. 
  • What makes you think that you need to change your drug or alcohol use? 
  • What do you think would be the consequences if you continue to use drugs or alcohol? 
  • What might be the positives of giving up drugs or alcohol? 
  • What might be the negatives of giving up drugs or alcohol? 

The last question will help the individual realize what they fear about getting sober. Rather than invalidating clients’ fears about sobriety, we want to identify these concerns and help them realize that the pros of sobriety far outweigh any cons. 

Motivational Interviewing & Substance Abuse Treatment 

The purpose of using motivational interviewing for substance abuse is to help clients overcome their internal battles about wanting to quit. Even though there are many apparent reasons to quit drug or alcohol abuse, for a person with a substance use disorder, there are also several reasons not to quit. As a result, many addicts will go back and forth on the “pros and cons” of quitting, delaying their progress, or preventing it entirely. 

In one study, students addicted to tobacco who received motivational interviewing treatment were four times more likely to attempt to quit or cut down on their use of tobacco than others who did not receive MI.1 Motivational interviewing aims to lay out the pros and cons of quitting based on what the client believes is important. Once the individual overcomes denial and develops their conclusions about the pros and cons of quitting, their desire to change, what change means, and how they want to apply that change, it becomes a lot easier for them to change. 

By taking these steps with clients to develop their personal desire to change and understand why it is necessary for their lives, clients will not feel forced to give something up. Instead, they are pursuing the better and healthier lifestyle that they have chosen. 

Addiction and Mental Health Support in MA 

Motivational interviewing for addiction and mental illness is just one of the various addiction and mental health therapy programs offered at Clearbrook Treatment Centers Massachusetts. By offering various modalities of treatment, our team can help more people in varying stages of recovery. 

For more information about our motivational interviewing services or our other Massachusetts drug rehab programs, contact Clearbrook today. 



  1. National Library of Medicine – The Effectiveness of Motivational Interviewing Delivered by Youth Workers in Reducing Drinking, Cigarette, and Cannabis Smoking Among Young People: Quasi-Experimental Pilot Study 


Related Reading:  

Benefits of Residential Substance Abuse Treatment 

Substance Abuse in Veterans