Motivational enhancement therapy

Brief psycho therapeutic intervention

1. MOTIVATIONAL ENHANCEMENT BY Dr Ajay Kumar -MD 1 Dr Ajay Kumar - PGIMER-CHD

2. Motivation plays an important role in alcoholism treatment by influencing patients to seek, complete, and comply with treatment as well as make successful long-term changes in their drinking. Researchers and clinicians have shown increased interest in the concept of motivation and the role that motivation plays in recovery from alcohol problems . Alcohol-abusing and alcohol-dependent people can be classified into different "stages of change" in terms of their readiness to alter their drinking behavior . 2 Dr Ajay Kumar - PGIMER-CHD

3. STAGES OF MOTIVATION DiClemente and Prochaska 1998; Prochaska et al. 1992 Pre-contemplation (i.e., not yet considering change ) Contemplation (i.e., considering change but not taking action ) Preparation (i.e., planning to change ) Action (i.e., making changes in one's behavior Maintenance ( i.e,changing one's lifestyle to maintain new behavior ) 3 Dr Ajay Kumar - PGIMER-CHD

4. External influences and pressures, as well as internal thoughts and feelings, contribute to a persons motivation both to consider and implement a change in behavior (Cunningham et al. 1994) Programs to recruit and motivate unmotivated patients are designed to address specific tasks and obstacles that arise at the different stages of change. 4 Dr Ajay Kumar - PGIMER-CHD

5. SOURCES OF MOTIVATION Intrinsic sources of motivation (e.g., feeling a sense of accomplishment) Extrinsic sources of motivation (e.g., financial incentives) ( Deci and Ryan 1987). 5 Dr Ajay Kumar - PGIMER-CHD

6. Internal motivation is associated with greater long- term change than external motivation ( Deci and Ryan 1985) Internal motivation appears to be more effective for long-term success External motivation seems to promote short-term abstinence from alcohol and other drugs. 6 Dr Ajay Kumar - PGIMER-CHD

7. Ryan and colleagues (1995) found that people who received outpatient alcohol treatment, internal motivation (as assessed by a treatment motivation questionnaire) was related positively to both treatment involvement and retention. Irrespective of their level of external motivation, outpatients with low internal motivation had the worst treatment outcomes. The severity of the patient's alcohol problems enhances internal motivation, presumably because the problem severity increases distress and thus influences decisionmaking . 7 Dr Ajay Kumar - PGIMER-CHD

8. A study of 263 inpatients in alcohol treatment Patients whose motivations to enter treatment were related to current external threats ( e.g.,threatened loss of lob, driver's license, or spouse) experienced better treatment outcomes 8 Dr Ajay Kumar - PGIMER-CHD

9. TRADITIONAL APPROACHES Aggressive and confrontational strategies used in response to the patients' denial A team of family members, friends, and colleagues unite to confront the drinker and convince him or her that alcoholism treatment is necessary Clinicians who work with unmotivated patients must implement less confrontational and more motivation- generating treatment approaches - Miller (1985) . 9 Dr Ajay Kumar - PGIMER-CHD

10. MOTIVATIONAL TREATMENT APPROACHES (MTA) Designed to enhance patients' intrinsic motivation Brief Motivational Intervention (BMI) Motivational Interviewing (MI) and Motivational Enhancement Therapy (MET) 10 Dr Ajay Kumar - PGIMER-CHD

11. Brief Motivational Intervention (BMI) vary in duration from one to four sessions (10 to 60 minutes) straightforward advice and information on the negative consequences of alcohol abuse minimal motivational interventions for alcohol- dependent patients relevant for problem drinkers who are not yet alcohol dependent Goal Reduce drinking rather than abstinence 11 Dr Ajay Kumar - PGIMER-CHD

12. Treatment provider’s advice patients on the need to reduce their alcohol consumption and offer feedback on the effects of the patients' drinking. Feedback is designed to increase patient motivation to reduce or stop drinking Technique does not involve overtly confrontational tactics - to reduce patients' defensiveness A respected professional giving the patient advice and providing personally motivating information BMI patients tend not to be self-referred Increasing self-awareness of problematic drinking patterns by itself may be a motivating factor in changing drinking patterns. 12 Dr Ajay Kumar - PGIMER-CHD

13. Specific training, does increase the frequency and effectiveness of brief motivational interventions. Variable affecting the outcome evaluation of brief-intervention Patient's level of motivation also may contribute to the effectiveness of brief interventions Pre-treatment level of motivation Rate of attrition Participants tend to be younger (i.e., in their twenties and thirties), less educated, and heavier drinkers may have less motivation, fewer resources, and additional complicating problems. 13 Dr Ajay Kumar - PGIMER-CHD

14. Motivational Interviewing (MI) MI focuses on enhancing and facilitating the patient's internal motivation to change (Miller and Rollnick 1991) Patient is responsible for changing his or her addictive behavior Recognizes ambivalence as a natural part of the process MI is designed to assist patients in working through their ambivalence and in moving toward positive behavioral change. 14 Dr Ajay Kumar - PGIMER-CHD

15. Various techniques to help increase the patient's motivation Reflective listening - a form of paraphrasing that enables patients to more fully tell their stories and to feel that they are being heard by the empathetic MI therapist Exploring the pros and cons of change - which may help patients realistically evaluate their behavior and current situation and, ideally, determine whether the pros of change outweigh the cons. Support patient's self-efficacy or confidence - that he or she can change, can help bridge the gap between a patient's desire to change and concrete behavioral change Interview and assessment data - to provide patients with personalized feedback regarding the problem behavior (e.g., comparing the patient's level of alcohol use with national drinking norms) as a means of increasing self-awareness and of highlighting the discrepancy between th e patient's current behavior and the target behavior . 15 Dr Ajay Kumar - PGIMER-CHD

16. Eliciting self-motivational statements from the patients - such as recognition of the problem and concern for one's own welfare Propel patients to change - as they reflect the topics of greatest concern to themselves The MI therapist emphasizes - The patient's personal choice regarding change, De-emphasizes diagnostic labels and Avoids arguing with and confronting the patient. 16 Dr Ajay Kumar - PGIMER-CHD

17. Motivational Enhancement Therapy (MET) Developed for Project MATCH - initiated in 1989 MET combines MI techniques with the brevity of a less intensive intervention Four treatment sessions over 12 weeks preceded by an extensive assessment Therapist provides the patient with clear, structured, personalized feedback concerning his or her: drinking frequency (number of drinking days per month), drinking intensity (number of drinks per drinking occasion) typical level of intoxication risk for negative consequences of alcohol use results of liver function and neurological tests risk factors for alcohol problems (e.g., familial risk and tolerance symptoms). 17 Dr Ajay Kumar - PGIMER-CHD

18. 2. The therapist concentrates on strengthening the patient's commitment to change by using MI techniques that are appropriate for the patient's stage in the change process and on helping the patient develop a specific plan for change (e.g., what he or she will do, how he or she will do it, and who can help). 3. In the third and fourth session the therapist focuses on reviewing patient progress and renewing motivation and commitment by exploring remaining ambivalent feelings that the patient might have about changing the targeted behavior 4. Termination of the treatment and future plans are also discussed at the end of session 4, which involves a summary of the treatment progress 18 Dr Ajay Kumar - PGIMER-CHD

19. In general, motivated patients enter and attend treatment at higher rates than do less motivated patients. However, some extr in the insically motivated patients may attend treatment regularly but be reluctant to participate treatment program . Other minimally motivated patients may attend and participate to some degree but tail to make substantial changes or sustain changes made in treatment. Both the type and intensity of the patient's motivation for change are important potential moderators of treatment participation and recovery success. 19 Dr Ajay Kumar - PGIMER-CHD

20. REFERENCE http://findarticles.com/p/articles/mi_m0cxh/is_2_23/ai_59246571/ Motivational Enhancement Therapy with Drug Abusers William R. Miller, Ph.D. Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA) The University of New Mexico 20 Dr Ajay Kumar - PGIMER-CHD