The Power of Words: How Motivational Interviewing Sparks Real Change in Addiction Treatment
Clinically Reviewed by Lauren Barry, LMFT, MCAP, QS
Medically Reviewed by Ali Nikbakht, PsyD
Reviewed / Updated: October 1, 2025 — Editorial Policy | Research Policy | Privacy Policy
By We Level Up | Author Alex Evans, PharmD, MBA | Editorial Policy | Research Policy
What is Motivational Interviewing?
Motivational interviewing is a counseling approach that helps people make positive changes in their lives. It’s a collaborative process where you work with a therapist to explore your goals and values. Through open-ended questions and reflective listening, the therapist helps you build motivation and commitment to change. With motivational interviewing, the therapist is a helpful guide. They help you discover your own reasons for change. Together, you can create a plan that matches your values and priorities.
This method has proven effective in addressing various problems. These include substance abuse, addiction, chronic disease management, and mental health issues. Here, we’ll learn more about motivational interviewing.
Motivational Interviewing Key Takeaways
- Motivation-Driven Counseling is a friendly and supportive way to help people make positive changes. It encourages them to explore their own motivations and values, which helps define motivational interviewing.
- Key principles of Motivation-Driven Counseling are expressing empathy, developing discrepancy, rolling with resistance, supporting self-efficacy, and engaging in collaborative conversation.
- Motivation-Driven Counseling employs techniques such as open-ended questions and reflective listening to facilitate change. It also uses the OARS and DARN-C models. These methods help encourage change talk and build commitment to positive change.
The Core Principles & Spirit of Motivational Interviewing
Motivational Interviewing is more than just techniques. It is based on a “spirit” or way of being with clients. This spirit shapes the therapeutic alliance and is the foundation of every MI session. It combines empathy, respect, and collaboration to help individuals discover their own motivation for change.
The Four Core Principles of Motivational Interviewing
From the spirit of MI flow four guiding principles that shape therapist behavior and client interaction. Reinforcing hope and belief in their ability boosts confidence and readiness for action.
Express Empathy
- Use reflective listening to understand the client’s experiences without judgment.
- Empathy builds trust and reduces defensiveness.
Develop Discrepancy
- Help clients recognize the gap between their current behaviors and their broader goals or values.
- This gentle contrast motivates change without confrontation.
Roll With Resistance
- Resistance is seen as natural, not something to oppose.
- Instead of arguing, the therapist reframes or explores resistance to reduce tension and keep dialogue open.
Support Self-Efficacy
Emphasize the client’s strengths and capacity to change.
The Spirit of Motivational Interviewing
The MI spirit is built around four key elements:
Partnership
- MI is a collaboration between therapist and client, not an expert–patient hierarchy.
- The clinician works with the client, respecting autonomy and shared decision-making.
Acceptance
- Acceptance means honoring each person’s worth, potential, and perspective.
- It involves empathy, affirming strengths, and supporting the client’s right to choose.
Compassion
- The counselor’s focus is always on promoting the client’s welfare.
- Compassion ensures the client feels safe, heard, and valued throughout treatment.
Evocation
- MI draws out (evokes) the client’s own reasons for change rather than imposing external goals.
- The therapist listens for “change talk” and helps strengthen it, guiding clients to connect with their personal values and goals.
Top 5 Motivational Interviewing Studies with Insights
Motivational Interviewing (MI) is a client-focused counseling method. It is based on evidence and aims to boost motivation for change. This approach is constructive for people dealing with substance use or mental health issues. Rooted in empathy and collaboration, MI helps clients resolve ambivalence and commit to recovery-oriented goals. To understand MI’s real-world impact, we have gathered five important studies. These studies look at how effective MI is in treating addiction and behavioral health care.
How We Level Up Turns Research Into Real Recovery
At We Level Up, we stay current with the latest research on Motivational Interviewing. We use this knowledge in our inpatient treatment programs. The studies show that getting involved early and keeping clients engaged are important for lasting recovery. That is why we use MI as soon as clients arrive. Our skilled clinicians are trained and coached to deliver MI effectively. This ensures that every conversation builds real motivation and readiness to change.
| Study | Treatment Implications | Insights for Patients |
|---|---|---|
| Motivational Interviewing to Improve Treatment Engagement and Outcome in Subjects Seeking Treatment for Substance Abuse Review Study | In a multisite RCT with 423 substance users entering outpatient treatment, MI techniques were integrated into the intake/evaluation. MI increased retention over the first 28 days, but did not produce significant reductions in substance use at 28 or 84 days. | Incorporating MI early (at intake/evaluation) can help reduce early dropouts. Programs should train and supervise clinicians so that MI is delivered with fidelity. Early retention is important even if short‑term substance use change is not yet evident. |
| Motivational Interviewing and Treatment Retention among Drug User Patients: A Pilot Study View Source | Heroin users assigned to MI vs control showed significantly higher retention at 6 months: ~50% vs ~20%. | MI may be particularly useful in drug‑free (non‑medication) outpatient contexts to reduce dropout. For programs working with heroin addiction, retention is critical for enabling other interventions (counselling, support) to take effect. |
| Cochrane Review: Motivational Interviewing for Substance Abuse Read Article | Meta‑analysis of ~59 RCTs, ~13,342 participants. MI had a moderate effect compared to no intervention right after it happened. The effect size was weaker in the short and medium term. It was not significant in the long-term follow-up. MI vs treatment‑as‑usual or other active interventions generally showed no strong advantage. | MI is better than doing nothing. However, when other active treatments are available, MI can be one of many helpful options. To maintain gains, booster sessions or combining MI with other therapies might be needed. Monitoring long‑term outcomes is important. |
| Clinician Acquisition and Retention of MI Skills: A Two-and-a‑Half‑Year Exploratory Study View Study | This study looked at how clinicians learn MI and how well they maintain skill over ~2.5 years. It found that skills decline without ongoing coaching, supervision, and feedback. | Training is not enough; programs need to provide ongoing support, fidelity checks, and refresher training to retain MI quality. Clinician skill directly affects outcomes. |
| Examining Motivational Interviewing in Drug Abuse Therapy Read Review | MI may be particularly useful in drug‑free (non‑medication) outpatient contexts to reduce dropout. For programs working with heroin addiction, retention is critical for enabling other interventions (counseling, support) to take effect. | Single sessions may not be enough. This is especially true if they move too quickly to change planning or feedback before building enough motivation. Therapists should attend to patient readiness and avoid moving too fast. Additional sessions/follow-ups may be necessary for lasting change. |
What This Means for Your Care at We Level Up
Together, these studies underscore a significant takeaway: Motivational Interviewing is most effective when it’s delivered with skill, consistency, and as part of a comprehensive treatment plan. By integrating MI with other proven therapies, we create a personalized roadmap that supports your progress at every stage. The studies remind us that recovery is a journey. It often needs ongoing support and engagement. We focus on this through continuous care and follow-up.
Ready to turn evidence into action? Contact We Level Up Treatment Centers for a private, free assessment. We will create a personalized plan tailored to your needs, informed by research.
What is Motivational Interviewing Used For?
Motivational interviewing is a flexible method. It can be used for many mental health issues and behavioral problems. It is very effective in helping people make positive changes. It also helps them overcome obstacles in their lives. This shows how Motivation-Driven Counseling works.
Motivational Interviewing for Addiction Treatment
Motivational interviewing is widely used for substance use disorders. It helps people explore their ambivalence about change and develop intrinsic motivation to overcome substance abuse.
By using open-ended questions and reflective listening, therapists guide clients to identify their own reasons for change. This approach is especially beneficial for those who may be resistant to traditional confrontational methods. Motivation-Driven Counseling has been shown to help people engage in treatment. It can reduce substance use and improve long-term results in addiction recovery.
Motivational Interviewing for Anxiety and Depression
Motivational interviewing may also be effective in treating anxiety and depression.
Therapists listen with empathy and provide gentle guidance. They help clients think about their feelings about change. Together, they create plans to improve mental health. By focusing on the client’s strengths and resources, motivational interviewing can enhance motivation and confidence in overcoming anxiety and depression. Research shows that this approach can lead to significant improvements in mood, coping skills, and overall quality of life.
Motivational Interviewing Stages of Change
MI recognizes that change is a process involving several distinct stages. These stages, known as the Transtheoretical Model, include precontemplation, contemplation, preparation, action, maintenance, and termination.
In the precontemplation stage, people may not be aware of the need for change or feel ambivalent about it. The role of the therapist is to raise awareness and plant seeds of change.
During contemplation, clients acknowledge the need for change but may feel uncertain or hesitant. Your therapist can help you explore the pros and cons of change to foster intrinsic motivation and drive.
The preparation stage is characterized by creating a plan of action. Collaborate with clients to set realistic goals and identify potential obstacles. Provide support as they take concrete steps toward change in the action stage. Celebrate successes and help them troubleshoot challenges.
Maintenance focuses on sustaining change over time. Assist clients in developing coping strategies and preventing relapse. Termination refers to the act of people deciding not to revert to their old habits. This often happens with motivational interviewing skills. They are confident they will not relapse.
Progress isn’t always linear. Setbacks are normal. Use them as learning opportunities to strengthen commitment and resilience.
Supporting Self-Efficacy
This principle focuses on strengthening your belief in your ability to make and sustain positive changes. They will highlight past successes and help you recognize your strengths and resources. They will also work with you to set realistic goals and develop actionable plans.
Rolling with Resistance
Your therapist will avoid arguing or confronting resistance head-on. Instead, they will acknowledge and explore your perspective, reframing resistance as an opportunity for deeper understanding. This approach helps you feel in control of your positive change.
Motivational Interviewing Principles
Motivational interviewing (MI) is a collaborative, person-centered counseling approach guided by five key principles that enhance interview motivation. These principles help foster a supportive environment that encourages positive change and personal growth.
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Expressing Empathy
Your therapist will start by expressing empathy and understanding. They will acknowledge your feelings without judgment so you feel heard and understood. In doing so, they can gradually explore sensitive topics, allowing you to consider change.
Developing Discrepancy
At this stage, your therapist will help you see the differences between your current actions and your goals or values.
They will guide you in exploring the pros and cons of your choices. This process helps you feel motivated to change. You will see the results of your actions and the benefits of positive change.
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7/365 Line (844) 597-1011Motivational Interviewing Statistics
A study from the National Center for Biotechnology Information (NCBI) reviewed and analyzed randomized controlled trials. This research focused on using motivational interviewing as the main method.
1
More than 1 encounter with the patient confirms the effectiveness of MI.
Source: NCBI
64%
When using MI in brief 15-minute sessions, 64% of the studies showed an effect.
Source: NCBI
75%
In approximately three out of four studies, MI exhibited significant and clinically relevant development, resulting in equal physiological (72%) and psychological (75%) outcomes.
Source: NCBI
Models of Motivation Interviewing
Several models guide the implementation of MI, providing structured frameworks for navigating the change process. These models help therapists understand the stages of change and tailor their approach accordingly. They also offer specific strategies for evoking motivation and supporting clients in each phase of transformation.
EPE Motivational Interviewing
The Elicit-Provide-Elicit (EPE) model is a fundamental MI approach. Your therapist starts by eliciting your understanding and perspectives on their situation. Then, they provide relevant information or feedback, followed by asking for your thoughts and reactions to the new insights. This collaborative exchange promotes ownership and engagement in the change process.
DARN-C Motivational Interviewing
The DARN-C model focuses on five key elements of change talk: Desire, Ability, Reasons, Need, and Commitment. You explore these elements with your therapist through open-ended questions, reflections, and affirmations.
OARS Motivational Interviewing
OARS stands for Open-ended questions, Affirmations, Reflective listening, and Summarising. These core MI skills foster a supportive and non-judgmental environment. Open-ended questions encourage exploration, while affirmations recognize strengths and efforts. Reflective listening demonstrates empathy and understanding. Summaries clarify key points and reinforce change talk.
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(844) 597-1011Benefits of Motivational Interviewing
The following are the benefits of motivational interviewing in the treatment of substance abuse disorders:
- Increased treatment program retention rates.
- Increased treatment program participation rates.
- Increased probability of successful treatment outcomes.
- Higher treatment post-program abstinence rates.
- Well-suited for a managed care setting.
- Designed as a brief intervention.
- Generally delivered in 2-4 sessions.
- Triggers change in high-risk lifestyle behaviors.
- Significant effects from brief motivational counseling have been consistently observed across various real-life clinical settings.
- Mobilizes the client’s resources for change.
- Invokes behavior change.
- Delivered within the context of a more extensive healthcare delivery system.
- Compatible with health care delivery.
- Do not assume a long-term client-therapist relationship.
- Single sessions have invoked behavior change.
- Emphasizes building client motivation — a strong predictor of change.
- Clients typically learn something that will likely benefit them within the first few sessions.
- Enhances adherence, which improves treatment outcomes.
Motivational Interviewing can be highly beneficial for individuals who have not achieved satisfactory results with Cognitive Behavioral Therapy (CBT). A lack of motivation can make it hard to change thoughts and behaviors. Addicted individuals who feel unsure about quitting may need to try MI first. MI is more effective than CBT for individuals who require additional support and validation of their feelings. Some individuals feel that CBT does not offer this close relationship with their counselors.
Motivational Interviewing Drug Addiction
The primary goal of MI is to overcome the internal battle over whether one wants to quit. There are many reasons to stop using drugs or seek addiction treatment. However, there are also reasons not to. Clients may change their minds many times. They might feel motivated to quit after facing health or legal issues from drug abuse. A talk with a loved one can also spark this motivation. However, they often lose that motivation the next day.
In a study, students who were addicted to tobacco received treatment. Those who got the treatment were four times more likely to try to quit or cut down on smoking. This was compared to students in the control group.
MI aims to lay out the pros and cons of quitting based on what the client feels is necessary. Once clients accept the reality of drug abuse, they can weigh its pros and cons. This helps them see their desire to change. They can then consider what that change entails and how to implement it. This makes it much easier for change to occur. Clients don’t feel forced to give up something they love. Instead, they’re pursuing a life change that they have chosen.
Motivational Interviewing in the Treatment of Anxiety and Depression
When it comes to anxiety and depression, motivation is everything. If you’re not motivated to seek treatment and change your lifestyle, it’s unlikely that any progress will be made. Motivational interviewing is a technique that therapists use to help their patients overcome this hurdle. It is based on the idea that people are more likely to change their behavior when they feel motivated from within. External motivation is less effective.
In other words, people are more likely to adhere to treatment if they do it for themselves rather than for someone else. This doesn’t mean that therapists don’t provide support and guidance. But ultimately, it’s up to the individual to find the motivation to make the necessary changes.
Reclaim Your Life From Addiction With Motivational Interviewing
Individuals addicted to drugs or alcohol don’t think their substance abuse problem is as severe as it is. They don’t want to give up the positive sensations associated with their drug use. They fear the consequences of ceasing substance use, including withdrawal symptoms and cravings. Many addicted persons go through stages of grief after giving up their drug of choice.
Substance abuse disorder is a condition that can lead to serious health, social, and economic issues. It should not be ignored. We Level Up treatment, rehab, and detox center offers motivational interviewing services. We provide professional and safe care for you or someone you love. Feel free to call us to speak with one of our counselors. We can help you explore treatment resources and options.
One study found that people who got MI at the start of treatment had double the abstinence rate. This was true 3 to 6 months after inpatient or outpatient treatment. In addition, different meta-analyses have shown that MI is better than or equal to cognitive-behavioral treatments or pharmacotherapy (medication) for helping people decrease alcohol use.
Motivational Interviewing For Alcohol Abuse
MI treats alcohol use disorder by helping individuals overcome their ambivalence about changing their drinking behaviors. At the start of treatment, MI can help people find their reasons for wanting to change. It can also boost their motivation to take part in treatment.
MI is often very helpful in the early stages of the change process. This is especially true for people who do not want to be criticized or lectured about stopping drinking. However, MI can also be used during alcohol treatment. It helps you strengthen your commitment to your goals. It also encourages you to actively engage in your treatment plan.
The National Institute on Drug Abuse (NIDA) states that research shows MI works differently for each substance. MI is very effective for people with alcohol use disorder. It helps them get into treatment and cut down on problem drinking.
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Frequently Ask Questions
Motivational interviewing (MI) is a collaborative approach that helps clients explore and resolve ambivalence about change. It empowers them to make informed, positive life decisions that align with their values and goals.
What Is the Primary Goal of Motivational Interviewing?
The primary goal of MI is to build a foundation of intrinsic motivation for change. It helps people find their own reasons for making positive life changes. This is better than having others decide for them. MI helps people explore their mixed feelings. It clarifies their values and creates a change plan. This plan matches their personal goals and desires.
What Is Motivational Interviewing Therapy?
Motivational interviewing therapy is a collaborative, goal-oriented counseling approach that helps clients resolve ambivalence and make positive changes in their lives. It’s based on the principles of expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. In MI therapy, the therapist acts as a helpful guide. They use open-ended questions, reflective listening, and affirmations to facilitate effective communication. This helps people explore their motivations, values, and goals.
What Differentiates Motivational Interviewing From Person-Centered Therapy?
While both MI and person-centered therapy emphasize a non-judgmental, empathetic approach, there are some key differences. Person-centered therapy primarily focuses on creating a supportive and accepting environment for clients to explore their feelings and experiences. In contrast, MI adds a goal-oriented component, actively guiding clients toward positive change. MI also focuses more on exploring and resolving mixed feelings. It helps people see the gap between their current actions and their goals.
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Resources
Motivational Interviewing in Addiction Treatment – This page discusses how Motivational Interviewing (MI) is utilized in addiction treatment to help individuals resolve ambivalence and embrace their treatment efforts.
Partial Hospitalization Program (PHP) – Explains the structure and benefits of PHP, including how MI is integrated to support clients in maintaining motivation for change.
Addiction Counseling Near Me – Provides information on finding addiction counseling services, including the application of MI to enhance motivation for recovery.
Drug Counseling Services – Details the various drug counseling services offered, highlighting the role of MI in addressing substance use disorders.
Bipolar Disorder and Addiction – Discusses the intersection of bipolar disorder and addiction, and how MI can be effective in treating individuals with co-occurring conditions.
Sources
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[2] Trends & Statistics – National Institute on Drug Abuse (NIDA)
[3] Bischof G, Bischof A, Rumpf HJ. Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice. Dtsch Arztebl Int. 2021 Feb 19;118(7):109-115. doi 10.3238/arztebl.m2021.0014. PMID: 33835006; PMCID: PMC8200683.
[4] Empowering Change: Motivational Interviewing – Substance Abuse and Mental Health Services Administration (SAMHSA)
[5] USING MOTIVATIONAL INTERVIEWING IN – Advisory 35 – Substance Abuse and Mental Health Services Administration (SAMHSA)
[6] Motivational Interviewing Strategies to Engage Patients – Agency for Healthcare Research and Quality (.gov)
[7] Motivational Interviewing for the Prevention of Alcohol Misuse in Young Adults – https://health.gov/healthypeople/tools-action/browse-evidence-based-resources/motivational-interviewing-prevention-alcohol-misuse-young-adults
[8] Motivational Interviewing and Managing Homelessness – Veterans Affairs (.gov) https://www.va.gov/HOMELESS/nchav/docs/3m_MI.pdf
[9] Motivational Interviewing, the Transtheoretical Model of Change – Department of Education (.gov)