How Motivational Interviewing Supports Behavior Change
Substance use among teenagers carries substantial risks. It can impair cognitive development, increase the likelihood of dangerous behavior, and contribute to health problems later in life. Although the Centers for Disease Control and Prevention (CDC) reports declining rates of recent alcohol use and stable rates of recent marijuana use among high school students over the past decade, overall rates of substance use among teens remain high.
To engage teenagers who use alcohol, marijuana, or both in discussions about use, experts have increasingly turned to motivational interviewing (MI), a person-centered approach more akin to a communication style than to therapy. Notably, MI depends on collaboration and empowerment. By prompting responses that allow teens to identify and resolve their ambivalence about behavior change, MI helps increase their intrinsic motivation for change.
MI centers on five principles. Providers express empathy through reflective listening, identify discrepancies between participants’ goals and behaviors, avoid arguments and confrontation, adjust to participants’ resistance to change rather than work against it, and encourage self-efficacy and self-directed change. In these interactions, participants—not providers—decide whether and how to begin making behavior changes.
The challenge is how to discuss substance use with at-risk teens. 3C Institute is tackling this challenge in two new courses, WebCHAT and SBIRT (Screening, Brief Intervention, and Referral to Treatment) in Schools.
WebCHAT, an MI-based online course designed in partnership with Karen Chan Osilla, PhD, and the RAND Corporation, helps new student drivers understand the potential consequences of using marijuana and alcohol together and driving or riding with someone who has been using these substances. In line with other MI providers, WebCHAT acknowledges both the pros and cons of using, and it presents information about using and driving in a non-judgmental way.
What sets WebCHAT apart are its role plays, which take the form of short vignettes. These exercises, acting as gateways to a broader educational message, encourage teens to choose responses to scenarios that make the most sense for them. After imagining themselves in these scenarios, teens rate on a scale of 1–10, from not at all willing to extremely willing, their perceived ability to carry out those responses in their everyday lives and their confidence to do so. The course then invites teens to reflect on why they selected their responses. Why did they choose this number rather than a lower number? What might move them toward a higher number? This self-reflection helps teens articulate both their ambivalence about and motivation for change.
Role plays and personal agency also feature prominently in SBIRT in Schools, an online course that 3C Institute is developing with the National Center for School Mental Health and the Maryland Behavioral Health Administration in collaboration with Central East MHTTC, the School-based Health Alliance, and the Mosaic Group. For this training, the audience comprises school-based counselors, social workers, psychologists, nurses, and other health providers. SBIRT in Schools teaches school-based staff how to integrate MI into their screening and intervention sessions while also providing MI-based strategies for approaching students who use substances. As with WebCHAT, SBIRT in Schools seeks to elicit change talk from teens by providing opportunities to talk about both the enjoyable and unenjoyable aspects of use. Identifying the discrepancies between their goals and behaviors helps teens take an important step toward making their own decisions about behavior change.
Of course, MI’s usefulness extends beyond the substance use and abuse spectrum. MI informs many of our clients’ courses covering such wide-ranging behavioral health topics as teachers’ well-being and diabetes prevention. Because MI focuses on the power of individuals to direct their own personal change, its underlying principles can apply to almost any behavioral health-based intervention.