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Katherine Gonzalez, Eliana SanMartin, Naily Camaraza, Monica Yacoub, Veronique Luces

Introduction

Motivational interviewing (MI) is a commonly used intervention approach to promote reduction or cessation of substance abuse. Occupational therapy practitioners can use motivational interviewing to help individuals with substance abuse disorder reduce the following maladaptive behaviors:

• Using large amounts or for longer time than intended
• Persistent desire or unsuccessful attempts to cut down or control use
• Great deal of time obtaining, using, or recovering
• Fail to fulfill major roles (work, school, home)
• Persistent social or interpersonal problems caused by substance use
• Important social, occupational, recreational activities given up or reduced
• Use in physically hazardous situations
• Use despite physical or psychological problems caused by use

Theory

The transtheoretical model consists of five stages to change maladaptive behaviors and maintain positive behaviors. Edith could benefit from this model by planning how she will reduce negative behaviors. She will identify consequences related to her negative behaviors and will commit to healthier habits.

Evidence

According to Dunn, Deroo, and Rivara (2001), motivational interviewing (MI) has a significant effect on substance abuse behaviors. In addition, Barrowclough, et. al., found that MI improved interventions for individuals with substance abuse disorders and other comorbid psychiatric disorders. The high risks associated with substance abuse has led to concerns about the intervention approaches used for these patients. Motivational interviewing led to increased goal-directed behavior. This study found that implementing MI led to patients decreasing their use of substances and alcohol.

Case Study

Edie is a 35-year-old woman aspiring to become an actress. Acting has always been a part of Edie’s life, and she has been casted in a few recurring roles on prime time television programs. Unfortunately, she has not been able to break through as the serious actress she so passionately wishes to become. In the past, she has failed to show up to auditions or has shown up hungover. After a “crazy night of debauchery”, she decided she was done with this life. She was referred by her 12-Step AA sponsor to see an occupational therapist in order to help her reach her goals.

Intervention Plan

Problem Statement:

Edie’s alcohol addiction puts her at risk for engaging in risky and promiscuous behaviors which hinders her ability to participate in meaningful occupations.

Short-Term Goals:

1. Edie will identify 3 risky behaviors that she would like to decrease within 2 weeks.
2. Edie will identify and commit to one leisure activity within 2 weeks.
3. Edie will move from preparation stage to action stage related to her risky behaviors within 2 weeks.

Long-Term Goals:

1. Edie will decrease at least 2 of these risky behaviors within 1 month.
2. Edie will move from the action stage to the maintenance stage related to her risky behaviors within 1 month.

Intervention Format:

Individual

Setting:

Edie will meet with the occupational therapist individually at an outpatient setting for 30 minutes 2x per week for 1 month.

Supplies:

None

Agenda:

• Meet Edie & develop rapport (5 min)
• Assess Edie’s readiness for change (2 min)
• Engaging in motivational interviewing of risky behaviors (18 minutes)
  • Potential open-ended questions
    • “Can you tell me about a recent situation in which you engaged in risky behavior?”
    • “How did you feel the day after?”
    • “Why do you want to reduce these risky behaviors ?”
    • “Tell me about some of these risky behaviors that your alcohol consumption brings out?”
    • “What is preventing you from being more successful in your acting career?”
  • Provide affirmations
    • “It sounds like you recognize what your risky behaviors are”
    • “You are willing to work hard to reduce your alcohol consumption”
    • “You are a strong and motivated person and together we will work on this”
    • “Everything you need to make this change is already within you”
  • Provide reflections
    • “It sounds like you’ve been drinking and are worried about the situations you are placing yourself in”
    • “You think that you should decrease your alcohol consumption in order to decrease these risky behaviors”
    • “It sounds like you are going to practice not going out as much with the people that influence your drinking”
  • Provide a summary of the discussion (5 min)

Documentation

S: “I was drunk all of the time, and my life was an absolute mess. I was hanging out with very scary and dangerous people, behaving in ways that I was horrified by. I realized I was done after one particular night that I had no idea where I woke up. I want to take control of my life again, I want to get back to the things I love.”

O: Client presented for 30-minute session focusing on her alcohol addiction using a motivational interviewing approach. Client demonstrated embarrassed affect and shamefulness when discussing the behaviors she would engage in while under the influence of alcohol.

A: Client presents with no control of her maladaptive and risky behaviors due to her addiction to alcohol. Client appeared to be in the contemplation stage of change and progressively advanced to the action stage during session. Client would continue to benefit from skilled OT services to help her continue advancing her readiness to modify risky behaviors and get back to her meaningful occupations.

P: Continue using motivational interviewing approach in sessions in order to have Edie engage in healthy and less hazardous behaviors and routines to increase her participation in meaningful occupations. Evaluate success in client’s altered behaviors and continue to enhance and improve when necessary. Client to see OT 2x per week for 1 month.

References

Barrowclough, C., Haddock, G., Tarrier, N., Lewis, S., Moring, J., O’brien, R., Schofield, N., McGovern, J., (2001). The American Journal of Psychiatry, 158 (10). Randomized Controlled Trial of Motivational Interviewing, Cognitive Behavior Therapy, and Family Intervention for Patients With Comorbid Schizophrenia and Substance Use Disorders. https://doi.org/10.1176/appi.ajp.158.10.1706

Dunn, C., Deroo, L., and Rivara, F., (2001). The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Society for the Study of Addiction to Alcohol and Other Drugs, (96). DOI: 10.1080/09652140120089481