Brief Motivational Intervention is effective in reducing opiate abuse in many populations, especially with patients with co-occurring conditions (co-morbidity) (Barrowclough et al., 2010). Opiate abuse and addiction is a growing problem in the United States and in the top 3 most abused categories of both illegal and prescription drugs worldwide. A great percent of the prison population in the United States are incarcerated directly or indirectly due to addiction and opiate addiction is one of the leading addiction problems within the prison population. BMI has been found very effective in working with inmates and ex-convicts and helping them overcome addiction and avoid re-incarceration (Forsberg et al., 2011). BMI’s can be used effectively to move someone through the stages of change and in the early stages of recovery, even while detoxing (Berman et al., 2010).
Opiate Abuse a Growing Problem
Opiate abuse is a significant and growing problem with both (Illegal) street drug and (Prescription) drug users. Opiate dependence is a huge economic burden as it raises healthcare cost, work absenteeism, social/welfare costs, crime, incarceration & death rates, and lowers productivity and quality of life (Doran, 2008). The United Nations in a recent report estimated that nearly 80 million people abuse Opium, Heroine, or opiate based substances worldwide (Doran, 2008). The World Health Organization (WHO) estimates the harm from opiate use at 11,200,000 disability-adjusted life-years (DALYs). Death rates due to HIV, overdose, and suicide are greatly increased by opiate use disorders (Doran, 2008).
It is estimated that 60% of all prison inmates are incarcerated for drug related crimes. This population of abusers are more resistant to change and yet their success in being rehabilitated and not returning to jail or prison may be directly correlated to their recovery from addiction. Opiate use disorder is one of the leading causes of drug related crime (Forsberg et al., 2011).
Brief Motivational Intervention (BMI)
Brief Motivational Intervention (BMI) is an evidence-based practice for treating Opiate use disorders. Motivational Interviewing or intervention is a interviewing or conversational style defined as a person-centered, humanistic, and collaborative method of guiding an opiate user to elicit and strengthen their motivation to change (Miller & Rollnick, 2009). Although many behavioral and pharmacological interventions have a high efficacy they come at a high economic cost and still involve lost opportunities or a decreased quality of life. BMI’s have similar effectiveness without such a high cost since they can be part of normal health and behavioral care and can motivate change to a level far deeper and better than most other intervention options (Doran, 2008).
In a recent study conducted in an urgent care clinic that regularly treated opiate and other addictions. They separated treated patients into groups that in group 1) Received Motivational Interviewing (a client-centered approach to counseling that helps clients overcome their ambivalence or lack of resolve for behavioral change through brief intervention sessions), and group 2) Those that received Motivational Enhancement Therapy (MET) that incorporated structured assessments and follow-up sessions for personal feedback regarding assessment findings. Both were done in a collaborative and supportive setting, where trained counselors elicited motivation to change from the client rather than through direction or persuasion. The heroin abusers using both methods of MI had results of 40.2% abstinence compared to 30.6% found in the more formal drug intervention programs that patients were being referred to before the study. The conclusion was that BMI may help patients achieve abstinence from heroin effectively at the point of medical service (Bernstein et al., 2009).
Early studies on using BMI back in the 90’s were inconclusive but did see marked increases in self-efficacy and increased motivation. Later studies begin to find marked higher effectiveness in specific population’s responses to MI and opiate use disorder with co-occurring conditions is one of those populations (Saunders et al., 1995).
Specific BMI Effectiveness
BMI works with various populations of addicts, helps support motivation while in detox and is very effective for patients with Dual Diagnosis/Co-occurring Conditions. In a study that explored using BMI during detox it was found to be a good fit where patients were not yet ready for other counseling models due to impaired cognition and lack of commitment to recovery. BMI’s not only fit into the short time periods the providers had face to face with patients but showed great effectiveness in moving patients through the stages of change and preparing and motivating them to seek out continued recovery resources (Berman et al., 2010).
In co-morbid situations where addiction was co-occurring with behavioral health issues, using Cognitive Behavioral Therapy (CBT) with BMI was found to be much more effective than CBT alone (Barrowclough et al., 2010). The efficacy of HARM reduction with dual-diagnosis cases, or addiction with co-occurring depression, anxiety, bi-polar disorder, and other disorders was greatly enhanced for addicts and their families using BMI (Laker, 2007).
The effectiveness of using BMI for the inmate population has been extensively tested in Sweden. The inmate population is very similar to that in the U.S. as far as percent of addiction related convictions, substance use in jail, and return to use after release from jail. The opiate use disorder problem is also almost identical percentage-wise. The study concluded that prison staff could be effectively and consistently trained to use BMI skills, that the use of BMI made a difference with improved trust and relations in between workers and inmates, and that BMI lowered opiate abuse in prison, after release, and lowered recidivism (Forsberg et al., 2011).
Strategies for Using BMI for Opiate Use Disorders
The most effective use of BMI with opiate use disorders is consistent use across the stages of readiness and using specific strategies for each population of opiate addiction,
BMI is most effective if used regularly by trained staff (Doran, 2008, Forsberg et al., 2011). Use by frontline staff during medical checkups, social services & behavioral health contacts, during detox, and even with controlled populations like prison inmates can greatly motivate opiate use disorder patients to be motivated to change (Doran, 2008, Forsberg et al., 2011, Bernstein, 2009, Berman et al., 2010).
Brief Motivational Intervention can be very effective in reducing opiate abuse in many populations. BMI’s is effective moving addicts through the stages of change, it helps while detoxing patients, in the early stages of recovery, with co-occurring conditions (co-morbidity), and even in working with inmates and ex-convicts and helping them overcome addiction and avoid re-incarceration (Barrowclough et al., 2010, Forsberg et al., 2011, Berman et al., 2010).
There is certainly enough evidence based findings to increase the use of BMI on its own in the medical and social service industry. It also appears that adding BMI and the person centered principles of MI would work together with and greatly enhance the effectiveness of all other forms of intervention, treatment, and counseling (Doran, 2008).
Barrowclough, C., Haddock, G., Wykes, T., Beardmore, R., Conrod, P., Craig, T., Tarrier, N. (2010). Integrated motivational interviewing and cognitive behavioral therapy for people with psychosis and comorbid substance misuse: randomized controlled trial. British Medical Journal, 341(7784), 1-12. doi:10.1136/bmj.c6325
Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77(1), 49-59.
Berman, A. H., Forsberg, L., Durbeej, N., Källmén, H., & Hermansson, U. (2010). Single-session motivational interviewing for drug detoxification inpatients: Effects on self-efficacy, stages of change and substance use. Substance Use & Misuse, 45, 384-402. doi:10.3109/10826080903452488
Doran, C. M. (2008). Economic evaluation of interventions to treat opiate dependence: A review of the evidence. Pharmacoeconomics, 26(5), 371-393. doi:10.2165/00019053-200826050-00003
Forsberg, L. G., Ernst, D., Sundqvist, K., & Farbring, C. A. (2011). Motivational interviewing delivered by existing prison staff: A randomized controlled study of effectiveness on substance use after release. Substance Use & Misuse, 46, 1477-1485. doi:10.3109/10826084.2011.591880
Laker, C. J. (2007). How reliable is the current evidence looking at the efficacy of harm reduction and motivational interviewing interventions in the treatment of patients with a dual diagnosis? Journal of Psychiatric and Mental Health Nursing, 14, 720-726. doi:10.1111/j.1365-2850.2007.01159.x
Saunders, B., Wilkinson, C., & Phillips, M. (1995). The impact of a brief motivational intervention with opiate users attending a methadone programme. Addiction, 90, 415-424. doi:10.1111/j.1360-0443.1995.tb03788.x
Fritz and Laura Perls started the first Gestalt Institute in their Manhattan apartment, and Fritz Perls began traveling throughout the United States in order to conduct Gestalt workshops and training.
In 1960 Fritz Perls left New York and moved to Los Angeles, where he started to offer workshops at Esalen Institute in Big Sur, California, in 1963. Perls became interested in Zen during this period, and incorporated the idea of brief awakenings into his practice. He also traveled to Japan, where he stayed in a Zen monastery. Eventually, he settled at Esalen and even built a house on the grounds.
- The core of the Gestalt Therapy process is enhanced awareness of sensation, perception, physiological feelings, emotion and behavior, in the present moment.
- Relationships are emphasized, along with contact between ones true self, the environment you are presently in, and the connections with others in our lives.
THE GESTALT PRAYER
I do my thing and you do your thing.
I am not in this world to live up to your expectations,
And you are not in this world to live up to mine.
You are you, and I am I,
and if by chance we find each other, it’s beautiful.
If not, it can’t be helped.
(Fritz Perls, “Gestalt Therapy”, 1969)
Richard Bandler, John Grinder, Robert Dilts and others studied with Fritz Perls for several years in the late 60’s and early 70’s. As Richard Bandler and John Grinder developed Neuro Linguistic Programing (NLP) in the early 70’s they modeled many of their systems upon Perls work as well as the therapeutic work of Virginia Satir and Milton Ericksen (The father of Hypnotherapy). Bandler and Grinder also drew upon the theories of Dilt’s, Gregory Bateson, Alfred Korzybski and Noam Chomsky, particularly transformational grammar, as well as ideas and techniques from the teachings of Carlos Castaneda.
Combining the Transformational Skills & Tools from NLP, the Awareness achieved through Gestalt Therapy, and the “will to meaning” gained through Victor Frankl’s Logo-Therapy and other Humanistic & Existential approaches to therapy with Cognitive Behavioral Therapy (CBT) that has proven to be so effective with changing behavior and overcoming addiction, one can bring about huge shifts in awareness and mental processes that support deep and lasting changes in behavior and life.
- Gestalt Prayer (mindbeatz.wordpress.com)
- The Esalen Connection: Fifty Years of Re-Visioning Madness and Trying to Transform the World (madinamerica.com)
Statistics show that there is a far higher than average rate of drinking among college students, especially binge drinking. Using the Stages of Change to assess how ready a college student with a problem drinking pattern is to changing their behavior, but more importantly using motivational interviewing techniques as a brief intervention method to interrupt and change unhealthy drinking patterns was the focus in a recent study at Syracuse University (Carey, Henson, Carey, & Maisto, 2007). The efficacy of Brief Motivational Interventions (BMI) was investigated and evidence indicated that (BMI’s) reduce risky alcohol use (Carey, Henson, Carey, & Maisto, 2007).
In this study the authors hypothesized that Brief Motivational Interventions would be more effective when: 1) They were ready, according to Prochaska’s (Stages of Change) stages. 2) They had better self-regulation skills. 3)They had more awareness in social comparison. 4) They had lower present time perspective and higher future time perspective. 5) That women would be more effected by (BMI’s) (Carey, Henson, Carey, & Maisto, 2007).
The study proved that readiness for change and better self-regulation had a great effect on one’s ability to reduce the number of drinks and reduce blood alcohol content but there was no direct correlation to the use of (BMI’s) as the intervention, it was just simply that they were better at self-regulating and they were ready to change (Carey, Henson, Carey, & Maisto, 2007).
The students that were more aware of social comparison were not affected by (BMI’s), that over time their social awareness would most likely reduce consumption but not due to the intervention (Carey, Henson, Carey, & Maisto, 2007). What I found most interesting is the student’s that did not have good future time perspective were affected more by (BMI’s) than those that did. Like the intervention caused them to think of future negative consequences they had never thought of before (Carey, Henson, Carey, & Maisto, 2007). The last hypothesis that women would be more affected by the interventions was found to not be true (Carey, Henson, Carey, & Maisto, 2007).
The most important finding is that Brief Motivational Interventions will promote the reduction of drinking regardless of the student’s readiness for change (Carey, Henson, Carey, & Maisto, 2007).
In the second study reviewed the authors were exploring if (BMI’s) would have a similar effectiveness in lowering college problem gambling as it did in lowering risky drinking patterns (Petry, Weinstock, Morasco, & Ledgerwood, 2008). The study showed high rates of almost pathological gambling in college students and that 23% gamble weekly or more, and that gambling levels may be effected by Motivational Enhancement Therapy (MET) and Cognative Behavioral Therapy (CBT) interventions (Petry, Weinstock, Morasco, & Ledgerwood, 2008).
The study like the Syracuse University study on problem drinking showed that if problem gamblers where to be identified and if (BMI’s) were used it would significantly lower gambling for up to 9 months in as high as two thirds of the population (Petry, Weinstock, Morasco, & Ledgerwood, 2008).
Based on the findings of these two studies colleges need to explore the use of regular (BMI’s) for these two problem populations. The students would be more effective in school and many negative side effects from problem drinking and gambling would be reduced. As was mentioned in the study the first thing would be to identify the students currently experiencing these problems (Petry, Weinstock, Morasco, & Ledgerwood, 2008). Using the stages of change to identify those that are ready for change, and finding the student’s that already have better self-regulation skills would by the process of elimination help in identifying the remaining students with these problems that may be most affected by (BAC’s) (Carey, Henson, Carey, & Maisto, 2007).
Carey, K. B., Henson, J. M., Carey, M. P., & Maisto, S. A. (2007). Which Heavy Drinking College Students Benefit From a Brief Motivational Intervention? Journal of Consulting and Clinical Psychology, 75(4), 663-669. doi:10.1037/0022-006X.75.4.663
Petry, N. M., Weinstock, J., Morasco, B. J., & Ledgerwood, D. M. (2009). Brief motivational interventions for college student problem gamblers. Addiction. doi:10.1111/j.1360-0443.2009.02652.x