Motivational interviewing

(from the chapter) In some past programs for co-existing mental and substance use disorders, a requirement for entry has sometimes been a demonstration of control over substance use and a stabilization of symptoms. Unless supported by other services, such programs abrogate responsibility for eliciting motivation and assisting the person in the earliest and often hardest stages of their attempt. This policy leads to some of those who most need the treatment being excluded. The focus of this chapter is on the generation of commitment to address jointly-occurring problems of substance misuse and mental disorder, and the development of a collaborative therapeutic relationship to achieve that end. Within forensic settings and with some individuals who put themselves or others at unacceptably high and immediate risks of harm, change in substance use or management of their mental disorder may be mandated, and incentives or disincentives may be applied to obtain behaviour control. However, within this chapter we emphasize the clarification and fostering of the client's own goals for their lives and, within that context, their goals in relation to mental health, substance use and other physical health maintenance. There is no assumption by therapists that any substance use is necessarily dysfunctional, despite their knowledge that even low consumption levels tend to be problematic or unstable for many people with severe mental health problems, cognitive deficits or limited financial resources. Individual variations in effects of given doses have been observed, even within the same diagnostic group. These considerations suggest that individual tailoring and a client-centred focus should form the framework in which engagement and motivation are developed. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (chapter)