How to Talk to Patients About Substance Abuse Treatment
Using Motivational Interviewing to Encourage Change
As a health care professional, your role is to collaborate with patients in regards to their state of health and wellness. Together, you search for clues and evidence to either identify or rule out potential health risks and discuss strategies to enhance wellness. Understanding your patients' lifestyles as well as details about how they manage stressors, such as career, home, family or personal set-backs, is customary during an annual health check-up. But are you adequately addressing the elephant in the exam room?
"Let's face it talking to patients about substance abuse can be tricky. Whether real or perceived, there are disincentives for doctors to talk with their patients about substance abuse, including time constraints and our society's aversion to awkward encounters," says Dr. John Larson, Corporate Medical Director, Gateway Alcohol & Drug Treatment. "Yet, skipping the topic entirely is a huge disservice to your patients who depend on you to help keep them healthy."
Bear in mind, there are plenty of myths about substance abuse and rehab that actually perpetuate avoidant behavior from patients who need help remaining sober, including:
- A person can't be forced into treatment, and has to have the desire to change for treatment to be work.
- Addiction treatment didn't work in the past, so there's no point in trying again.
- Overcoming addiction is merely a matter of willpower. People can choose to stop using drugs if they really want to change their lives for the better.
Help Inspire Self-Directed Change in Others
To overcome misperception as well as the societal stigma of substance abuse with your patients', it's important to set a positive tone from right off the bat. Simply advising patients to change if a problem is revealed often is unrewarding and ineffective. That's why Gateway recommends using techniques of Motivational Interviewing (MI) to promote self-directed change. In fact, a recent meta-analysis* of 72 studies found that MI outperformed traditional medical advice-giving in 80% of the studies.
To clarify, Motivational Interviewing is an open-ended, non-confrontational approach for interacting with persons who are unsure, uncommitted or ambivalent about changing. The spirit of MI, which is prioritized over technique, includes partnership, acceptance, compassion and evocation…or P.A.C.E.:
- Partnership refers to collaborating with patients on their journey of exploration and decision-making.
- Acceptance involves acknowledging and respecting patients' inherent worth or ability within and as ultimate decision makers.
- Compassion involves demonstrating commitment and behavior supportive of patients' best interests.
- Evocation encompasses the use of reflections, open-ended questions and non-judgmental exploration to facilitate exchanges in which patients elicit their concerns and reasons for change.
Trying to impose motivation upon patients makes it less likely they will change. Rather, it's the role of the patient to make needed changes in MI; and your responsibility as a physician is to educate and empower your patients to make well-informed decisions that satisfy their own personal health needs.