Motivational Interviewing (MI) for Substance Use Disorder

Behavioral therapies are an important part of most effective substance use disorder treatment programs.1 One common therapeutic approach is motivational interviewing.2

Read on to learn about motivational interviewing and how it is used in addiction treatment.

What is Motivational Interviewing?

Motivational interviewing (MI) is a short-term therapeutic strategy to help people with substance use disorders or other behavioral health issues.2,3 This treatment technique helps patients understand the consequences of their substance use and how not making a change impedes them from reaching their goals.2

Helping a patient resolve ambivalence, develop momentum to change, and believe that change is possible are the ultimate goals of motivational interviewing.3

How Does Motivational Interviewing Work?

Motivational interviewing is based on the following 4 processes:3

  1. Engaging the patient. This is the process by which the patient and therapist establish mutual respect and trust.
  2. Evoking change. The counselor shapes conversations so that the patient—not the counselor—is the one arguing for change.
  3. Patient and therapist collaborate to outline steps the patient must take to achieve their goals.
  4. Strengthening commitment. The patient must show their commitment to their own plan through their actions.

Usually, motivational interviewing is conducted 1 to 4 times total for about an hour each session.2


Respect and trust are paramount to all counseling approaches. The first step in MI—engaging with the patient—is to “establish a mutually trusting and respectful relationship.” Research finds this kind of relationship in MI is associated with more positive treatment outcomes, such as reduced drinking.3

The therapist will foster this type of relationship by employing the use of certain opening strategies designed to see how ready the patient is to set goals and act. While engaging with the patient, the counselor is careful to avoid identifying the patient’s goals until they can address their ambivalence toward treatment.3


The counselor and patient will then focus the conversation and process in the direction of making a positive change. The counselor and patient work together to set an agenda for the session and treatment overall. This often involves agenda mapping, in which the patient identifies several issues they feel they should address (e.g., finances, legal problems, depression, substance use). The counselor can then encourage the patient to talk about these issues and how they think they could be resolved.3

Through conversation, the counselor will help the patient see the discrepancy between how the patient feels they could make a positive change and the actions they have taken. Helping the patient see how their current behavior inhibits their goals is a powerful motivator for change.3


The patient and counselor work together to develop a change plan that is acceptable, accessible, and appropriate to both parties.3

Once a plan is developed and the patient expresses the intention to work towards change, they work with the counselor to meet their goals.3

Strengthening Commitment

Simply creating a plan is not enough, the patient must follow through. To strengthen the patient’s commitment to change, the counselor may ask questions like, “What actions are you willing to take this week to achieve your goals?”3

The patient may have an overarching goal like quitting drinking. But to accomplish this, they’ll need to commit to completing the small tasks along the way, such as attending 12-step meetings or filling their prescription medication.3

Throughout treatment, the counselor maintains an empathic and supportive style to provide the perfect conditions for change to occur.3


The conversational approach that counselors use in motivational interviewing can be summed up with the acronym OARS.3,4

  • O: Open-ended questions; The counselor will use open-ended questions to allow the patient more freedom to respond to questions and tell their story. For example, the therapist may ask, “What has the doctor told you about your drug use?”
  • A: Affirmations; The counselor will use affirmations to express empathy during rough spots and excitement in celebrating the patient’s accomplishments. For example, the therapist may say, “That’s a great idea for how to avoid situations in which you might use drugs.
  • R: Reflective listening; The counselor will encourage the patient to reflect on statements expressed to elicit conversation and help the patient arrive at ideas for change. Reflective listening helps the patient understand that they may already have the solutions to their issues.
  • S: Summarize; The counselor will provide recaps of what was said to correct any misunderstandings, allow the patient to add anything that the counselor missed, and work with the counselor to identify instances of ambivalence. Summarizing enables the patient and counselor to reinforce key statements a third time: first when the patient makes a statement, again when the therapist reflects it back to them, and finally when summarizing.

How Effective is Motivational Interviewing?

Studies have found that motivational interviewing is associated with higher rates of positive outcomes when compared to those who simply received traditional advice.3

A review of 72 studies found that motivational interviewing effectively helped patients change behavior in about 80% of cases.5

However, addiction treatment is not one-size-fits-all; the combinations of various treatment approaches utilized by a treatment provider (e.g., behavioral therapies, peer support, medication) will vary depending on the patient’s individual needs. Motivational interviewing is simply one tool often used to effectively treat someone’s substance use disorder.1

What Are Some Additional Benefits of Motivational Interviewing?

The benefits of utilizing motivational interviewing in a treatment program include the following:3

  • MI can be applied to various behavioral health issues beyond substance use disorders.
  • MI can be used to complement other evidence-based behavioral therapies, such as cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), or contingency management.
  • A variety of providers such as primary care professionals, behavioral health professionals, peer providers, and criminal justice personnel can incorporate motivational interviewing into treatment in a range of different settings.
  • MI helps patients learn to help themselves. In other words, patients will understand their available resources and how to use them to their advantage.
  • Because MI can be delivered in brief interventions, it can cut back on the total cost of treatment.

Is Motivational Interviewing Covered by Insurance?

The  Affordable Care Act (ACA) and other federal mandates ensure that nearly all health insurance plans cover addiction treatment. This includes residential treatment, outpatient counseling, and other services (many of which will utilize motivational interviewing among other approaches).6,7

The extent of one’s coverage and the out-of-pocket cost of treatment will depend on their individual insurance policy.

Addiction Treatment at River Oaks in Florida

American Addiction Centers’ rehab center in Riverview, FL—River Oaks—offers a variety of levels of care for substance use disorder treatment, including:

To learn more about your treatment options and the admissions process, contact one of our admission navigators today at . Our admission navigators can also help you check your insurance coverage and payment options. You can also verify your insurance using the confidential .

Was this page helpful?
Thank you for your feedback.

American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information. We strive to create content that is clear, concise, and easy to understand.

Read our full editorial policy

While we are unable to respond to your feedback directly, we'll use this information to improve our online help.

You aren't alone. You deserve to get help.
River Oaks is located in Riverview, Florida, which is easily accessible from Tampa.
Take your next step toward recovery:
✔ learn more about our addiction treatment programs.
✔ see how popular insurance providers such as Aetna or Carelon offer coverage for rehab.
view photos of our facility.