People who struggle with substance use disorder usually have a difficult time committing to treatment at first. It isn’t about lack of desire to change; often, the impact of addiction has become catastrophic by the time treatment is needed. There are hundreds of reasons people with addiction might be reluctant to make the leap into recovery, even when they are well-aware that they need to do it. Motivational enhancement therapy can help someone struggling with the decision to get sober.
What is motivational enhancement therapy? To define motivational enhancement therapy (MET), we must look at the purpose of the modality. MET is not meant to directly treat substance use disorder; it is a methodology to help people with addiction make the decision to quit using. Similar to motivational interviewing (MI) treatment, MET helps people with addiction to identify their “why” for quitting, figure out what stands in the way and the factors that would influence the decision to quit.
Benefits of Motivational Enhancement Therapy in Addiction Treatment
Motivational enhancement therapy for substance abuse, as well as MET for eating disorders, can be a practical means of getting the necessary help sooner; it helps people work through the barriers to change. MET can be helpful for a variety of conditions in which an indifference for change gets in the way of recovery.
Goals of Motivational Enhancement Therapy
There are several underlying goals of motivational enhancement therapy. The treatment provider’s focus is on the process that is required for change. As anyone who has dealt with addiction knows, recovery doesn’t happen until the person is ready for it. When someone agrees to enter treatment for addiction because they were coerced by others, the treatment is usually not effective. Change must be intrinsically motivated.
MET helps people who are indifferent move toward readiness to change; it is a method to assist in the transition.
- Expressing Empathy
Rather than using guilt and shame as a tactic for motivation, the use of empathy with people who are struggling with addiction is far more effective. MET focuses on empathy for the person struggling with addiction, which helps lower defense mechanisms that might otherwise get in the way of change.
- Acknowledging Perception Versus Reality
An important part of motivational enhancement therapy is the recognition of one’s own perceptions and the ways this may differ from the reality of the situation. The introduction of other perspectives and perceptions can help create cognitive dissonance, which is a powerful internal motivating factor.
- Avoiding Arguments
In MET, arguments about changing behaviors are considered futile. Instead of arguing about the reasons for change, motivational enhancement therapy avoids arguments and instead encourages people with addiction to come up with their own pros and cons for staying with the current behavior.
This method increases the alliance between therapist and client and increases the likelihood of progress. The wisdom of this lies within the understanding that arguing with the person who is struggling with addiction doesn’t work; it simply increases the wall of defense between provider and client and increases the investment in protecting the addiction.
- Accepting Resistance
A key factor in MET is accepting resistance rather than fighting it. As one contemplates a huge decision such as entering recovery, it is natural to experience feelings of resistance to change. Resisting change is a natural part of all major life decisions, and recovery is no exception.
The benefit of using MET is the exploration of that resistance; what does it mean to you to consider changing right now? How would staying the same impact your life, versus making this change? Accepting resistance as part of the process reinforces the reality that recovery is a decision that only the person dealing with addiction can make; it is difficult, and there are pros and cons to that decision.
- Believing in Oneself
Motivational enhancement therapy is an empowerment modality. It removes judgment, coercion and guilt from the therapy room and replaces it with a powerful truth; this decision and readiness for change must begin from within the individual.
MET empowers people to believe in their own self-efficacy and ability to make this choice to improve their life. A core belief in oneself can help bolster one’s readiness for change, and this is facilitated through the respectful and empowering aspect of motivational enhancement therapy.
Stages of Motivational Enhancement Therapy
Part of the wisdom of motivational enhancement therapy lies in the understanding of the stages of change. MET and the stages of change are closely interwoven since the modality is based around the knowledge that people make life changes in a gradual way.
The pre-contemplative stage of change is when an individual does not recognize that there is a need for change. There is no readiness at this stage, and change is not likely to occur because the person doesn’t feel there is a need for it.
This stage occurs when one recognizes that there may be a need for change. The contemplation stage is an important piece of the process because it is the beginning of the honest conversations one must have with themselves before real change can occur.
When one has come to terms with the need for change, the next step in the process is making the determination that it needs to happen; it begins to take shape in the individual’s mind that this is the path toward improving one’s life and that it won’t happen unless one is committed to doing it.
The action phase of the stages of change is when the honest internal conversations have been had, the determination for change has been decided and the actual change is imminent. During this phase, plans have been established and the actual “doing” begins. It is common for emotions to be mixed during this crucial phase; feelings of excitement, fear and anticipation are often experienced, as well as elation, self-doubt, and anxiety.
The final stage of the change process is maintenance. This part of the process requires planning, diligence and plenty of support. Maintenance with substance abuse recovery involves recognizing triggers, understanding one’s own addict-thoughts that try to undermine sobriety, and having the support of peers in recovery as well as support from loved ones. Maintenance is the life-long attention one must pay toward staying on track with recovery.
Related Treatments and Therapies
Motivational enhancement therapy and cognitive behavioral therapy are closely related forms of treatment. MET should be used in conjunction with other modalities such as acceptance and commitment therapy (ACT), Dialectical Behavioral Therapy (DBT) or Internal Family Systems (IFS) approaches.
MET is a method of moving through ambivalence about treatment and preparing for change, and other treatment methods must be used to support the process.
Key Points: Motivational Enhancement Therapy
- Motivational enhancement therapy (MET) is a useful treatment tool for helping people move out of indifference to prepare for change.
- MET is not a treatment modality that can stand alone; it should be used with other evidence-based treatments to support people’s change process.
- The five stages of change are an important piece of the process in MET and can help guide the next steps in treatment and readiness for change.
- Motivational enhancement therapy has been shown as an effective intervention strategy for people struggling with alcohol, nicotine and marijuana addiction.
Recovery is a process that requires support and commitment. The Recovery Village Palm Beach at Baptist Health uses MET and other evidence-based treatment options to help you in your journey to recovery. If you are feeling ready to make a change relating to your substance use, reach out for help today.
National Institute on Drug Abuse. “Motivational Enhancement Therapy (Alcohol, Marijuana Nicotine).” Accessed September 15, 2019.
Crits-Christoph, P., Gallop, R., Temmes, Christina, et al. “The Alliance in Motivational Enhancement Therapy and Counseling as Usual for Substance Use Problems.” The National Institutes of Health, December 2009. Accessed September 15, 2019.