Motivational interviewing with dually diagnosed patients

Motivational interviewing is a highly recommended component of a comprehensive treatment approach for patients who suffer from co-occurring severe mental illness such as schizophrenia or schizoaffective disorder and alcohol or drug use disorders. Yet, how would a practitioner proceed to use MI with psychotically ill substance-abusing patients? Is a direct application of MI appropriate without alteration, or must one modify the practice of MI to accommodate the clinical challenges presented by these dually diagnosed patients? Like others, we take the position that some modification of MI practice is necessary to address the complex needs of dually diagnosed patients. This chapter describes recommended modifications to MI when working with patients impaired by psychotic functioning. We first detail the unique clinical issues presented by patients impaired by psychosis. Next, we present recommended modifications to MI through case vignettes and discuss situations where skill-building, supportive, and crisis interventions are more appropriate than MI. We conclude the chapter with a summary of how MI has been applied in dual diagnosis treatment and the related research, and future directions needed to advance these and other dual diagnosis MI applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)