Motivational Interviewing for Primary Care
Goal:

To train health care providers and students in primary care and other clinical settings in the basic motivational interviewing techniques to motivate people having problems with substance use and other health problems to change their behaviors in order to improve their health.

: 1 hr

After completing this activity participants will be able to:

  • Use a patient-centered, non-authoritarian, collaborative approach to establish a therapeutic alliance with a patient who needs to make a health behavior change.

  • Use communication skills from motivational interviewing to work collaboratively with patients to identify a a specific health behavior change goal as the focus during the counseling session.

  • Identify a patient's current readiness to change a health behavior problem and select the appropriate steps and skills of motivational interviewing to use based on that level of readiness.

  • Evoke participation by patients in exploring their motivations, ambivalence, or resistance to making a health behavior change.

  • Apply motivational interviewing techniques in collaborative planning with patients to address substance use or other health problems.

  • Adapt motivational interviewing skills to medical settings.


Professional Practice GapsSubstance abuse is fairly common, occurring in approximately 20% of primary care patients (Madras et al., 2009). In 2014, around 8.1 percent of Americans had a substance use disorder (CBHSQ, 2015). Brief interventions in the medical setting have been shown to reduce these problems, for instance, reducing alcohol use and follow-through with treatment (Babor et al, 2007; Madras et al., 2009). Despite the demonstrated effectiveness of these interventions, the reality is that few primary care providers are routinely providing substance use screening or intervention with their patients (Roche and Freeman, 2004; D'Amico et al., 2005). Interventions that go beyond basic screening are even less common than screening: Most patients for whom substance abuse was identified in a national survey of 7,371 patients did not receive appropriate follow-up by their health care provider (D'Amico et al., 2005). In our needs analysis interviews with 8 addiction specialists, all agreed that primary care providers need more training in counseling skills for use in brief interventions; primary care providers interviewed expressed an interest in learning structured techniques that they could fit into busy practices (CTI, 2009). Motivational interviewing is a set of structured counseling skills that has been shown to be one of the most effective means of motivating patients to change addictive behavior (Miller and Rollnick, 2012). Motivational Intrviewing has been used successfully in primary care settings as the brief intervention phase of addiction treatment (Rahm et al., 2014). Ideally, all physicians would know motivational interviewing or other effective counseling skills, feel competent using them, and use them routinely for brief interventions for substance abuse in primary care patients. Training primary care providers in motivational interviewing will help address these knowledge, competence, practice, and outcome gaps between current practice and the ideal (Carroll et al., 2006). References
Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28(3): 7-30. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18077300 Accessed on: 2014-07-28.
Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL, Polcin D, Snead N, Woody GE, National Institute on Drug Abuse Clinical Trials Network. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 2006; 81(3): 301-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16169159 Accessed on: 2014-07-29.
Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. HHS Publication. 2015; SMA 15-4927, NSDUH Series H-50: . Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm
Clinical Tools Inc. Needs analysis evaluation for: Online Skills Training for Primary Care Physicians on Substance Abuse.. NIDA Contract No. HHSN271200800038C. 2009.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.