Motivational Enhancement Therapy (MET) for Substance Abusers
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Motivational enhancement therapy is an effective intervention for individuals with an addiction to nicotine, alcohol, or illicit drugs. This is a form of limited-contact, non-confrontational, non-judgmental psychotherapy. It produces rapid internal change and improves the client’s engagement with addiction treatment.
In combination with cognitive-behavioral therapy, MET has been successfully used to treat people with a dependence on marijuana. This type of combined treatment is a comprehensive approach with proven success. MET has been found to be less effective in people who abuse cocaine or heroin or in adolescents with a history of multi-drug abuse. MET does not produce a change in the addict’s drug use. Rather, it makes the drug abuser more engaged and motivated to seek treatment and get sober.
Table of Contents:
- What is Motivational Enhancement Therapy?
- What is a MET Session Like?
- Motivational Enhancement Therapy Techniques
- MET for Substance Abuse Treatment
- Comprehensive Approach to Addiction Treatment
Motivational Enhancement Therapy: Definition and Overview
Motivational enhancement therapy is a type of counseling which is designed to help people who are ambivalent or unsure about seeking help for drug or alcohol abuse. In other words, MET helps addicts overcome their resistance to change. It encourages engagement with treatment through quick, internally motivated change. It is not a stepwise guided recovery process. Rather, it consists of an initial battery followed by four sessions of limited-time therapy. The therapist explores the substance abuser’s motivation and focuses on invoking an internal change in unhealthy behaviors.
Developed in 1993 as part of Project MATCH, motivational enhancement therapy was an initiative of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). MET caters primarily to people with substance abuse problems. It helps create an inner willingness to beat addiction. The techniques employed in this form of psychotherapy are based on the principles of motivational interviewing and counseling. A structured therapeutic approach involves assessing the addict’s behaviors and providing systematic feedback according to guidelines developed by the NIAAA.
MET takes a direct, client-centered approach. It teaches the client cessation strategies for self-destructive behaviors as well as coping mechanisms for difficult situations. It addresses the addict’s ambivalence and motivation to seek treatment for negative behaviors despite their effect on health, work, family, and social life.
MET therapists help addicts to view their behavior and become empowered to make changes objectively. Clients are taught how to deal with high-risk situations. The therapist monitors and reviews changes in behavior. As the sessions progress, the addict is encouraged in the commitment to abstinence from illicit substances.
MET is a treatment that motivates a substance abuser to change and improves engagement with treatment. It does not produce a change in drug abuse habits or unhealthy drinking patterns. While motivational enhancement therapy has been proven to be effective in treating alcohol addiction and marijuana dependence, the results are mixed for people who abuse hard drugs such as cocaine and heroin.
What Happens During a MET Session?
This is a relatively brief therapy designed to motivate change. A comprehensive assessment is performed during the initial motivational enhancement therapy session, followed by two to four one-on-one sessions with a therapist. During the initial session, the therapist obtains and evaluates information and sets goals to fight substance abuse. During later sessions, the addict is provided with structured feedback, perspective, and positive reinforcement to stay clean. Motivational enhancement therapy addresses the addict’s sense of powerlessness over the problem. The emphasis is on personal choice and control. The goal of MET is to help the addict achieve self-set goals and develop a healthy focus in life away from addiction.
The addict first receives feedback on the initial assessment. This compares the client’s behavior to that of the general population. Clients are encouraged to discuss their concerns. The therapist then encourages a discussion about substance abuse and elicits motivational statements. In subsequent MET sessions, the recovering addict’s motivation is strengthened. A plan to change thoughts and behaviors is developed. The client sets short-term and long-term goals and identifies behaviors that may interfere with these goals.
Rather than prescribing treatments, the client is encouraged to come up with solutions. The therapist works with the substance abuser to develop a plan for change. Initial progress is reviewed at subsequent sessions.
Key Components, Principles, and Techniques of Motivational Enhancement Therapy
The primary goal of treatment is to raise awareness about problematic behaviors and increase the individual’s intrinsic motivation to change. In other words, addicted people learn to change their thoughts and behaviors which drive their addiction. MET therapists teach the client how to adjust self-defeating thoughts and gain confidence in the ability to change. Ultimately, this allows a person with substance abuse issues to pursue behavior change and stay sober. The five key components included in a motivational enhancement therapy manual are:
Empathy: This stage of MET psychotherapy establishes trust. The therapist engages in reflective listening in an environment where the addict feels accepted, supported, and respected. There is no direct confrontation. The addict is made to realize that there is more to them than destructive behaviors. The therapist listens to the addict and reflects back on the thoughts expressed with slight modifications. This encourages the addict to elaborate on their thoughts and understand the behavioral changes that are necessary.
Discrepancy: Clients are encouraged to discuss their recovery goals with the therapist, who recognizes and outlines the task ahead. In this way, the discrepancy between the current state and desired state is established. This aids in recognizing which behaviors are hindering the client in achieving their goals. In turn, this provides an incentive for behavior change. MET emphasizes that bridging the gap between the client’s current lifestyle and the desired lifestyle requires time and commitment.
Arguments: MET therapists do not engage in arguments with an addict or attack or judge them. The focus is on positive, reinforcement statements, rather than negative observations. Attacking an individual with a drug dependence problem often results in resistance to change and defensiveness. The underlying belief is that arguments are counterproductive. Motivational enhancement therapy employs gentler methods to raise awareness of problematic behaviors and the changes necessary to get clean.
Resistance: MET recognizes that some resistance will remain. The approach is to roll with any residual resistance instead of directly confronting it. Resistance is diffused by going along with what the addict is saying and listening reflectively without judgment. MET therapists understand that change is difficult. Although the approach appears counterintuitive, it helps make the addict less defensive and more likely to stay in therapy and complete treatment.
Self-Efficacy: Clients are encouraged to be self-aware, to analyze their competence, and to understand they have the ability achieve their goals. The therapist encourages recovering addicts in their capability to make changes and successfully undertake the actions necessary to fight addiction. Clients learn that they have the power to change and the skills necessary to achieve their addiction recovery goals.
Motivational Enhancement Therapy for People with Addiction Problems
Who can benefit from MET? This type of therapy has been shown to help people with an addiction to alcohol and illicit drugs. It is also useful for individuals with eating disorders, gambling problems, and anxiety. In fact, there is evidence to suggest that high-risk individuals, such as young adults with a diagnosis of HIV, may benefit from motivational therapy to stimulate positive behavioral changes. This form of therapy is particularly effective in people with a strong resistance to change.
MET for substance abuse problems is usually completed over a period of few weeks. Addicts may be asked to bring a confidant to the initial sessions. The presence of a family member or trusted friend helps the substance abuser talk honestly about themselves and their addiction.
No single therapy approach is effective for individuals with addiction. Every person struggling with substance abuse faces unique challenges in terms of recovery from addiction. Project MATCH compared the effectiveness of motivational enhancement therapy to the 12-Step Program and cognitive-behavioral therapy. The project studied the effect of these therapies on drinking patterns, compliance with therapy, and functional status for a period of one year after completion of treatment. MET was found to be effective in helping addicts break out of the vicious cycle of substance abuse and become motivated to change with the help of their loved ones.
The MET approach is critical in helping addicts overcome their uncertainty about making changes in destructive behaviors. This motivation to change is vital for one of the most difficult aspects of addiction recovery – adjusting thoughts and behaviors.
Combined Treatment with MET and Other Modalities
Motivational enhancement therapy can be a stand-alone treatment; however, it is often provided in combination with other forms of psychotherapy during the addiction treatment process. In fact, MET is frequently a type of pre-treatment to improve an addict’s motivation before starting more specific therapies, such as cognitive-behavioral therapy or dialectical behavior therapy. During other psychotherapies, motivational enhancement therapy is used to reinforce change.
- Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-2
- Motivational Enhancement Therapy (MET) (Problem Drinkers), http://lib.adai.washington.edu/dbtw-wpd/exec/dbtwpub.dll?BU=http%3A//lib.adai.washington.edu/ebpsearch.htm&TN=EBP&QY=Find+AccessNo=16&RF=Full+Display&DF=Full+Display&NP=3&RL=1&DL=0&XC=/dbtw-wpd/exec/dbtwpub.dll&AC=QBE_QUERY&CS=0
- Paul Crits-Christoph, Robert Gallop, Christina M. Temes, George Woody, Samuel A. Ball, Steve Martino, Kathleen M. Carroll, The Alliance in Motivational Enhancement Therapy and Counseling as Usual for Substance Use Problems, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829757/
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