Motivational Interviewing (MI)

1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium

About This Program

Target Population: Caregivers of children referred to the child welfare system, has been used with adolescents

Program Overview

MI is a client-centered, directive method designed to enhance client motivation for behavior change. It focuses on exploring and resolving ambivalence by increasing intrinsic motivation to change. MI can be used by itself, as well as in combination with other treatments. It has been utilized in pretreatment work to engage and motivate clients for other treatment modalities.

Program Goals

The goals of Motivational Interviewing (MI) are:

  • Enhance internal motivation to change
  • Reinforce this motivation
  • Develop a plan to achieve change

Logic Model

The program representative did not provide information about a Logic Model for Motivational Interviewing (MI).

Essential Components

The essential components of Motivational Interviewing (MI) include:

  • Emphasis of two essential dimensions related to an individual's ambivalence to change:
    • the importance of the change
    • the confidence that the change can be accomplished
  • Inclusion of open-ended questions encouraging the client to talk about circumstances surrounding his or her referral for evaluation, as opposed to the standard substance abuse evaluation that includes administering a number of structured interviews asking closed-ended questions. Examples of the types of open-ended questions that might be used are as follows:
    • What worries you about your substance use?
    • How has your use of substances presented problems for you in the past?
    • What kinds of things would need to happen to make you consider changing your substance use?
    • What are the things that would prevent you from changing your substance use?
    • What are your concerns about entering substance abuse treatment at this time?
  • Utilization of reflecting listening statements that focus on the client's language around change. The goal is to evoke from clients their own reasons, needs, desire, and abilities to change.

Program Delivery

Adult Services

Motivational Interviewing (MI) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Substance abuse or dependence and other health/lifestyle behavior change issues

Recommended Intensity:

Usually 1-3 individual sessions, 2-3 sessions are preferred

Recommended Duration:

30-50 minutes each session; brief interventions have also been supported by research

Delivery Settings

This program is typically conducted in a(n):

  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care

Homework

This program does not include a homework component.

Languages

Motivational Interviewing (MI) has materials available in languages other than English:

Bulgarian, Chinese, Czech, Danish, Dutch, Estonian, French, German, Greek, Hebrew, Italian, Japanese, Korean, Portuguese, Romanian, Spanish, Swedish, Turkish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

A room to conduct the session

Manuals and Training

Prerequisite/Minimum Provider Qualifications

There are no minimal educational requirements to be trained in MI.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training can be provided on-site. Follow-up feedback and coaching can be delivered effectively by telephone. The website http://www.motivationalinterviewing.org/ contains a list of trainers by state along with current training offerings.

Number of days/hours:

Please see http://www.motivationalinterviewing.org/motivational-interviewing-training for more information.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Motivational Interviewing (MI).

Formal Support for Implementation

There is formal support available for implementation of Motivational Interviewing (MI) as listed below:

Melinda Hohman, see contact information at end of entry, has a list of trainers who provide formal support and coaching.

Fidelity Measures

There are fidelity measures for Motivational Interviewing (MI) as listed below:

The Motivational Interviewing Treatment Integrity (MITI) is an instrument that yields feedback that can be used to increase clinical skill in the practice of motivational interviewing. The MITI measures how well or how poorly a practitioner is using MI and can be found on https://casaa.unm.edu/download/miti4_2.pdf. Coding resources to measure fidelity can be found at http://casaa.unm.edu/codinginst.html.

Implementation Guides or Manuals

There are implementation guides or manuals for Motivational Interviewing (MI) as listed below:

The Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA-STEP) package is a collection of tools for mentoring counselors and other clinicians in the use of MI skills during clinical assessments. MIA-STEP was produced by The Addiction Technology Transfer Center (ATTC) Network under a cooperative agreement from the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) and the National Institute on Drug Abuse (NIDA). This document can be found at http://www.motivationalinterviewing.org/sites/default/files/mia-step.pdf.

Research on How to Implement the Program

Research has not been conducted on how to implement Motivational Interviewing (MI).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Safety

Several meta-analyses have been conducted on the effects of MI:

  • Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of Motivational Interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71(5), 843-861. https://doi.org/10.1037/0022-006X.71.5.843
  • Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational Interviewing. Annual Review of Clinical Psychology, 1(1), 91-111. https://doi.org/10.1146/annurev.clinpsy.1.102803.143833 
  • Vasilaki, E. I., Hosier, S. G., & Cox, W. M. (2006). The efficacy of motivational Interviewing as a brief intervention for excessive drinking: A meta-analytic review. Alcohol and Alcoholism, 41(3), 328-335. https://doi.org/10.1093/alcalc/agl016
  • Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D. & Burke, B. L. (2010). A meta-analysis of Motivational Interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137-160. https://doi.org/10.1177/1049731509347850

Baer, J. S., Marlatt, G. A., Kivlahan, D. R., Fromme, K., Larimer, M. E., & Williams, E. (1992). An experimental test of three methods of alcohol risk reduction with young adults. Journal of Consulting and Clinical Psychology, 60(6), 974-979. https://doi.org/10.1037/0022-006X.60.6.974

Type of Study: Randomized controlled trial
Number of Participants: 134

Population:

  • Age — 17-40 years (Mean=21.2 years)
  • Race/Ethnicity — 91% White, 5% Asian, less than 1% Black, Latin American, or Native American
  • Gender — 52% Female
  • Status — Participants were student volunteers recruited through the media.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of 3 forms of alcohol risk reduction programming for young adults: a 6-wk class and discussion group, a 6-unit self-help manual, or a single 1-hr feedback and advice session with professional staff [now called Motivational Interviewing (MI)]. Participants were randomly assigned to one of the three risk reduction groups. Measures utilized include the Brief Drinker Profile (BDP), the Michigan Alcoholism Screening Test (MAST), the Drinking Habits Questionnaire (DHQ), the Symptom Distress Checklist (SCL-90), and the Daily Drinking Questionnaire. Results indicate that there were significant reductions in self-reported drinking at the end of the intervention phase, and a maintenance of drinking changes throughout a 2-year follow-up period. Comparable drinking reductions were rated across treatments; however, noncompliance with the self-help reading program suggested limited utility. Treatment response was related to subject age, as subjects showed increased drinking during the year they reached legal drinking status. Limitations include lack of an assessment-only control group and lack of generalizability due to ethnicity.

Length of controlled postintervention follow-up: 3, 6, 12 and 24 months.

Baer, J. S., Kivlahan, D. R., Blume, A. W., McKnight, P., & Marlatt, A. G. (2001). Brief intervention for heavy drinking college students: 4-year follow-up and natural history. American Journal of Public Health, 91(8), 1310-1316. https://doi.org/10.2105/AJPH.91.8.1310

Type of Study: Randomized controlled trial
Number of Participants: 461

Population:

  • Age — Younger than 19 years
  • Race/Ethnicity — High risk sample: 84% White; Normative sample: 78% White
  • Gender — High risk sample: 55% Female; Normative sample: 54% Female
  • Status — Participants were college freshmen who reported drinking heavily while in high school.

Location/Institution: University of Washington

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine long-term response to an individual preventive intervention [now called Motivational Interviewing(MI)] for high-risk college drinkers relative to the natural history of college drinking. Participants were randomly assigned to MI or a normative comparison sample. Measures utilized include the Daily Drinking Questionnaire, the Rutgers Alcohol Problem Inventory, the Alcohol Dependency Scale, the Diagnostic Interview Schedule, and the Brief Drinker Profile. Results indicate that high-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency. Those receiving the MI reported significant additional reductions, particularly with respect to negative consequences. Categorical individual change analyses show that remission is normative, and they suggest that participants receiving MI are more likely to improve and less likely to worsen regarding negative drinking consequences. Limitations include reliability on self-report measures, lack of generalizability due to ethnicity, and study included participants from only one large university.

Length of controlled postintervention follow-up: 1, 2, 3, and 4 years.

Carroll, K. M., Libby, B., Sheehan, J., & Hyland, N. (2001). Motivational Interviewing to enhance treatment initiation in substance abusers: An effectiveness study. The American Journal on Addictions, 10(4), 335–339. https://doi.org/10.1080/aja.10.4.335.339

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

  • Age — Standard: Mean=34.0 years; MI Enhanced: Mean=34.7 years
  • Race/Ethnicity — Standard: 86% Caucasian, 10% Hispanic, and 3% African American; MI Enhanced: 81% Caucasian, 10% Hispanic, 7% African American, and 3% Other
  • Gender — Standard: 62% Female; MI Enhanced: 81% Female
  • Status — Participants were individuals referred by child welfare caseworkers for a substance abuse evaluation.

Location/Institution: Connecticut

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of Motivational Interviewing (MI) as an enhanced treatment initiation with substance abusers. Participants were randomly assigned to receive either standard treatment or standard treatment with MI. Measures utilized include participant attendance rates in subsequent drug abuse treatment sessions after the conclusion of the evaluation, as well as basic demographic data and substance abuse history. Results indicate that significantly more participants in the MI group went on to attend treatment sessions than in the standard group (59.3% versus 29.2%). Limitations include the somewhat specialized study population, lack of substance abuse outcome data, small sample size, lack of standardized measures, lack of follow up, and lack of generalizability of findings due to ethnicity.

Length of controlled postintervention follow-up: None.

Mullins, S. M., Suarez, M., Ondersma, S. J., & Page, M. C. (2004). The impact of Motivational Interviewing on substance abuse treatment retention: A randomized control trial of women involved with child welfare. Journal of Substance Abuse Treatment, 27(1), 51-58. https://doi.org/10.1016/j.jsat.2004.03.010

Type of Study: Randomized controlled trial
Number of Participants: 71

Population:

  • Age — MI: Mean=24.3 years; EC: Mean=27.9 years
  • Race/Ethnicity — MI: 46% Caucasian, 34% African American, 11% Native American, and 9.0% Hispanic; EC: 50% Caucasian, 31% African American, 14% Native American, and 6% Hispanic
  • Gender — 100% Female
  • Status — Participants were women enrolled in a 12-month treatment program for pregnant women using drugs following Child Protective Services referral.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of Motivational Interviewing (MI) on substance abuse treatment retention for women. Participants were randomly assigned to either receive three MI sessions or to watch two educational videos and participate in a home visit (education control [EC] condition). Results indicate that no differences were found between the MI and EC conditions. Limitations include lack of use of standardize measurements, small sample size, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Freyer-Adam, J., Coder, B., Baumeister, S. E., Bischof, G., Riedel, J, Paatsch, K., Wedler, B., Rumpf, H.-J., John, U., & Hapke, U. (2008). Brief alcohol intervention for general hospital inpatients: A randomized controlled trial. Drug and Alcohol Dependence, 93(3), 233-243. https://doi.org/10.1016/j.drugalcdep.2007.09.016

Type of Study: Randomized controlled trial
Number of Participants: 595

Population:

  • Age — Control: Mean=40.40 years; MI Liaison: Mean=42.52 years; and MI Physician: Mean=38.80 years
  • Race/Ethnicity — Not specified
  • Gender — Control: 94% Male; MI Liaison: 94% Male; and MI Physician: 95% Male
  • Status — Participants were hospital patients with alcohol problems based on a positive screening result.

Location/Institution: Twenty-nine wards from four general hospitals of one region in Germany

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the effectiveness of a brief alcohol intervention [now called Motivational Interviewing (MI)] among non-dependent general hospital inpatients with alcohol problems. Participants were randomly assigned to either MI based counseling administered by a specialized liaison service; hospital physicians trained under routine conditions; or to receive hospital treatment as usual without additional counseling. Measures utilized include the Alcohol Use Disorder Identification Test (AUDIT), the Luebeck Alcohol Dependence and Abuse Screening Test (LAST), the Readiness to Change Questionnaire (RCQ), the Treatment Readiness Tool (TReaT), the Health Behaviour Questionnaire, and the Mental Health Inventory (MHI-5). Results indicate that at baseline, the three groups differed regarding motivation, with higher motivation among the controls. At follow-up, the groups did not differ regarding alcohol consumption, alcohol-related problems and well-being. All groups decreased their alcohol consumption significantly. Regarding motivation, longitudinal analyses revealed significant interaction effects of time and intervention, indicating a stronger increase of readiness to change drinking and a less profound drop of readiness to seek help among those who received intervention compared to the controls. Limitations include lack of generalizability due to gender, inability to fully answer the question of what is the most effective way of delivery—by physicians or by a liaison service, small sample size in the physician group, and missing data.

Length of controlled postintervention follow-up: Approximately 11 months.

Osterman, R. L., & Dyehouse, J. (2012). Effects of a Motivational Interviewing intervention to decrease prenatal alcohol use. Western Journal of Nursing Research, 34(4), 434-454. https://doi.org/10.1177/0193945911402523

Type of Study: Randomized controlled trial
Number of Participants: 67

Population:

  • Age — 18-44 years
  • Race/Ethnicity — 67% Non-Hispanic African American
  • Gender — 100% Female
  • Status — Participants were pregnant women with previous year alcohol use.

Location/Institution: Three Midwestern U.S. prenatal clinics

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of Motivational Interviewing (MI) in decreasing prenatal alcohol use in a sample of pregnant women. Participants were randomly assigned to MI or a comparison group. Measures utilized include the Alcohol Use Disorders Identification Test (AUDIT), the Basic Psychological Needs Scale (BPNS), and the Treatment Self-Regulation Questionnaire (TSRQ). Results indicate that MI was not effective in decreasing prenatal drinking behaviors in this study; however, nonspecific factors were identified, such as treatment structures, participant motivation for improvement, and provider qualities, which may have influenced these results. Limitations include the small sample size, possible fear of punitive and legal consequences of prenatal alcohol use, and a higher attrition rate in the intervention group than the comparison group.

Length of controlled postintervention follow-up: 4-6 weeks.

Magill, M., Colby, S. M., Orchowski, L., Murphy, J. G., Hoadley, A., Brazil, L. A., & Barnett, N. P. (2017). How does brief motivational intervention change heavy drinking and harm among underage young adult drinkers?, Journal of Consulting and Clinical Psychology, 85(5), 447-458. https://doi.org/10.1037/ccp0000200

Type of Study: Randomized controlled trial
Number of Participants: 167

Population:

  • Age — 17-20 years (Mean=18.2 years)
  • Race/Ethnicity — 59% Non-Hispanic White, 14% Multiethnic, 11% Hispanic, and 10% Non-Hispanic Black/African American
  • Gender — 58% Female
  • Status — Participants were underage, past-month heavy drinkers recruited from community (i.e., non-4-year college or university) settings.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the sample from Colby et al. (2018). The purpose of the study was to test mediating processes hypothesized to explain the therapeutic benefit of Motivational Interviewing (MI). Participants were randomly assigned to brief MI or to a time- and attention-matched control of meditation and relaxation training for alcohol use. Measures utilized include the Contemplation Ladder, the Strategies to Limit Drinking Scale, the Timeline Follow Back (TLFB), and the Brief Young Adult Alcohol Consequences Questionnaire (BYAACQ). Results indicate that MI efficacy for reducing 6-week heavy drinking days (HDD) was mediated by baseline to postsession changes in the following 3 processes: increasing motivation, increasing self-efficacy, and decreasing the amount participants intended to drink in the future. For 6-week alcohol consumption (AC), MI efficacy was mediated through 1 process: decreased perceived drinking norms. At 3-month follow up, increased cognitive dissonance mediated HDD, but not AC. Further, increased use of certain protective behavioral strategies (i.e., avoidance of and seeking alternatives to drinking contexts) from baseline to 6-weeks mediated both 3-month HDD and AC. Limitations include lack of generalizability due to recruiting sample of young adults from high schools and various community service and educational settings, and length of follow-up.

Length of controlled postintervention follow-up: 6 weeks and 3 months.

Colby, S. M., Orchowski, L., Magill, M., Murphy, J. G., Brazil, L. A., Apodaca, T. R., Kahler, C. W., & Barnett, N. P. (2018). Brief motivational intervention for underage young adult drinkers: Results from a randomized clinical trial. Alcoholism: Clinical and Experimental Research, 42(7), 1342-1351. https://doi.org/10.1111/acer.13770

Type of Study: Randomized controlled trial
Number of Participants: 167

Population:

  • Age — 17-20 years (Mean=18.2 years)
  • Race/Ethnicity — MI: 58% Non-Hispanic White, 13% more than one race, 12% Hispanic/Latino, 11% Non-Hispanic Black/Afr. Am., 1% AI/Native American, & 1% AAPI; REL: 61% Non-Hispanic White, 14% more than one race, 10% Hispanic/Latino, 8% Non-Hispanic Black/Afr. Am., & 7% AAPI
  • Gender — MI: 59% Male and 41% Female; REL: 57% Male and 43% Female
  • Status — Participants were underage, past-month heavy drinkers recruited from community (i.e., non-4-year college or university) settings.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the efficacy of a brief Motivational Interviewing (MI) intervention to a time-matched attention control intervention (relaxation training [REL]) for reducing alcohol consumption and related negative consequences in an underage young adult sample. Participants were randomly assigned to receive a single session of MI or REL. Measures utilized include the Timeline Follow Back (TLFB) and the Brief Young Adult Alcohol Consequences Questionnaire (BYAACQ). Results indicate that there is strong support for the efficacy of MI for reducing harmful drinking in these young adults. Compared to REL, and after controlling for baseline covariates including gender, those who received MI subsequently reported significantly fewer average drinks per week, percent drinking days, percent heavy drinking days, lower peak and typical estimated blood alcohol concentration on drinking days, and fewer adverse consequences of drinking. These between-group effects did not weaken over the course of the 3-month follow-up period. Limitations include a nonrepresentative sampling approach, reliance on self-reported measures, small sample size, and length of follow-up.

Length of controlled postintervention follow-up: 6 weeks and 3 months.

Magill, M., Janssen, T., Mastroleo, N., Hoadley, A., Walthers, J., Barnett, N., & Colby, S. (2019). Motivational Interviewing technical process and moderated relational process with underage young adult heavy drinkers. Psychology of Addictive Behaviors, 33(2), 128-138. https://doi.org/10.1037/adb0000440

Type of Study: Randomized controlled trial
Number of Participants: 167

Population:

  • Age — 17-20 years (Mean=18.2 years)
  • Race/Ethnicity — 59% Non-Hispanic White, 14% more than one race, 11% Hispanic, and 10% Non-Hispanic Black/African American
  • Gender — 62% Female
  • Status — Participants were underage, past-month heavy drinkers recruited from community settings.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the sample from Colby et al. (2018). The purpose of the study was to test technical and relational processes hypothesized to explain the therapeutic benefit of brief Motivational Interviewing (MI). Participants were randomly assigned to brief MI or an attention-matched control (i.e., relaxation training [REL]). Measures utilized include the CASAA Application for Client Therapist Interactions (CACTI), the Client Language Assessment – Proximal/Distal (CLA-PD) the Timeline Follow Back (TLFB) and the Brief Young Adult Alcohol Consequences Questionnaire (BYAACQ). Results indicate that membership in the moderate-increasing class rather than the low-increasing class mediated MI effects on alcohol-related consequences at 6 weeks. Mediation tests for consequences at 3 months and heavy drinking were non-significant. Limitations include the study could have been underpowered to detect small effect sizes, participants were recruited from various community service and educational settings and this might affect study generalizability, and length of follow-up.

Length of controlled postintervention follow-up: 6 weeks and 3 months.

Oveisi, S., Stein, L. A. R., Babaeepour, E., & Araban, M. (2020). The impact of Motivational Interviewing on relapse to substance use among women in Iran: a randomized clinical trial. BMC Psychiatry, 20(1), Article 157. https://doi.org/10.1186/s12888-020-02561-9

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

  • Age — Intervention: Mean=30.93 years; Control: Mean=30.90 years
  • Race/Ethnicity — 100% Iranian
  • Gender — 100% Female
  • Status — Participants were adult, female drug users.

Location/Institution: A drug treatment center in Qazvin, Iran

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine long-term response to an individual preventive intervention [now called Motivational Interviewing(MI)] for high-risk college drinkers relative to the natural history of college drinking. Participants were randomly assigned to MI or a normative comparison sample. Measures utilized include the Daily Drinking Questionnaire, the Rutgers Alcohol Problem Inventory, the Alcohol Dependency Scale, the Diagnostic Interview Schedule, and the Brief Drinker Profile. Results indicate that high-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency. Those receiving the MI reported significant additional reductions, particularly with respect to negative consequences. Categorical individual change analyses show that remission is normative, and they suggest that participants receiving MI are more likely to improve and less likely to worsen regarding negative drinking consequences. Limitations include reliability on self-report measures, lack of generalizability due to ethnicity, and study included participants from only one large university.

Length of controlled postintervention follow-up: 1, 2, 3, and 4 years.

Additional References

Hohman, M. (2012). Motivational Interviewing in social work practice. Guilford Press.

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). Guilford Press.

N'zi, A. M., Lucash, R. E., Clionsky, L. N., & Eyber, S. M. (2017). Enhancing Parent-Child Interaction Therapy with Motivational Interviewing techniques. Cognitive and Behavioral Practice, 24(2), 131-141. https://doi.org/10.1016/j.cbpra.2016.03.002

Contact Information

Melinda Hohman, PhD
Agency/Affiliation: San Diego State University
Department: School of Social Work
Website: www.motivationalinterviewing.org
Email:
Phone: (619) 594-6247
Fax: (619) 594-5991

Date Research Evidence Last Reviewed by CEBC: August 2021

Date Program Content Last Reviewed by Program Staff: December 2018

Date Program Originally Loaded onto CEBC: August 2006