Motivational Interviewing for Primary Care
Goal:

To teach primary care providers and medical students basic motivational interviewing techniques to motivate patients who are experiencing alcohol use, tobacco, and other addiction problems.

: 1 hr

After completing this activity participants will be able to:

  • Use several principles of motivational interviewing with primary care patients

  • Compare the effectiveness of motivational interviewing to traditional medical approaches to counseling primary care patients with substance abuse problems

  • Select the appropriate principles, techniques, and basic steps of motivational interviewing to meet the specific needs of primary care patients based on the current status of their substance abuse problems

  • Apply motivational interviewing techniques in typical circumstances encountered in primary care with patients who have alcohol, tobacco, or other substance use problems


Professional Practice GapsSubstance abuse is fairly common, occurring in approximately 20% of primary care patients (Mersy, 2003; Madras et al., 2009); ideally there would be no substance abuse. Brief interventions in primary care 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 (Dunn et al., 2001). It has been used successfully in primary care settings as the brief intervention phase of addiction treatment (Emmons & Rollnick, 2001). Ideally, all physicians would know motivational interviewing or other effective counseling skills, feel competent using them, and would routinely use them for brief interventions in order to reduce the frequency of 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., 2008).References
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.
Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioural domains: a systematic review. Addiction. 2001; 96(12): 1725-1742.
Emmons K, Rollnick S. Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74.
Recognition of alcohol and substance abuse. American Family Physician. 2003; 67(7): 1529-1532,1535-1536.
SAMHSA. Screening, Brief Intervention, and Referral to Treatment (SBIRT). SAMHSA. 2014. Available at: http://www.samhsa.gov/sbirt Accessed on: 2015-03-20.