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Monday, April 17, 2017

Motivational Enhancement and Behavioral Strategies for the Treatment of Substance Use Disorders

motivational enhancement substance abuseResearch on emotion, cognition, and motivation in recent years has demonstrated the closely related interacting nature of these constructs as a means of better understanding addiction and improving clinical modalities of treatment. There is growing evidence for the existence of disruptions in emotional, behavioral, and motivational processes that exist in a variety of mental disorders including substance use related disorders. It is important to consider the relationships among cognition, emotion, behavior, and motivation as well as the neurobiological processes involved when developing and implementing effective behavioral and psychological treatment methods.

Substance use disorders have gained increasing clinical attention in the study of cognition, emotion, behavior, and motivation, and considerable research has focused more specifically on the motivational factors impacting the etiology and treatment of substance use disorders. More recent research has focused on ways in which to enhance motivation amongst individuals seeking substance use treatment, sustaining positive change, and avoiding relapse following the completion of treatment. Lack of motivation frequently characterizes individuals early in recovery from substance use disorders and is typically used to explain the failure of individuals to comply, follow through with, and complete treatment.

In order to address the complexities of motivation that exist for individuals suffering from substance use disorders, it is important to embrace new concepts of motivation. Motivation is important for change, it is multidimensional, it is dynamic and fluctuating, it is influenced by social interactions, it can be modified, and it can be enhanced by specific modalities of treatment. Through the integration of these basic tenets of motivation, we can broaden our understanding of motivation and addiction as well as approaches to behavioral and psychological treatment modalities that promote positive sustainable change. Research has shown that motivation-enhancing approaches to treatment improve participation and positive treatment outcomes for those suffering from substance use disorders. 

Behavioral modification and motivation enhancement therapies can be especially effective in using positive reinforcement to promote engagement by rewarding goal directed activities which in turn can lead to positive changes in cognition and emotional processing. These treatment approaches specifically focus on the interactions between cognitions, emotional processing, and motivational constructs. This is further supported by neuroimaging that has shown marked improvements in brain functioning related to cognition, emotion, and motivation in individuals who have received motivation enhancement and behavioral based therapies.

As psychological treatment approaches have matured, theories and relevant research findings that incorporate motivation enhancing strategies and motivational methods have become increasingly utilized in a variety of settings. There is a growing shift from a focus on client deficits and limitations to a greater emphasis on identifying and enhancing client strengths and competencies as primary principles of motivational counseling. Such approaches focus on affirming the client, enhancing self-efficacy, offering support, and encouraging positive change in order to enhance positive emotion and motivation.

Because motivation and personal change are intimately linked, effective treatment must not only consider the psychological constructs of motivation, but also how to create optimal conditions for positive lasting change. The stages of change model provides a helpful framework within which to conceive various levels of motivation for change. These stages include: pre-contemplation, contemplation, preparation, action, and maintenance with each stage characterized by varying states of motivation, cognition and action oriented behaviors. The study of cognition, emotion, and motivation provide important insight into how people change, barriers to change, and individualized approaches to change allowing treatment providers to tailor services to the unique needs of the individual. Identifying an individual’s particular stage of change provides a context within which to conceptualize goal directed behavior, cognitions, and motivation. Change is a process characterized by various states of multidirectional motivation and varying levels of readiness to change that must be taken in to account when designing a treatment approach.

A popular treatment approach utilized to enhance motivation particularly amongst substance use populations includes motivational interviewing strategies. Theses strategies often act as interventions to initially engage clients in treatment as a means of instilling motivation at the outset of treatment. This treatment technique has also shown to increase motivation throughout the course of treatment for individuals suffering from substance use disorders. While motivational interviewing shows promising results, it is important to note that it is most effective when coupled with maintaining an empathic and supportive motivational style.

Through linking the emerging views of motivation, cognition, and emotion along with motivational enhancement based strategies, behavioral modification, the varying stages of change, a practitioner can design and implement appropriate treatment approaches that target the specific deficits characteristic of substance use disorders. Through the combination of motivational techniques and behavioral strategies, one can create an innovative approach to enhance motivation, increase emotion and behavioral regulation, and diminish unhealthy cognitive biases thereby promoting goal achievement and enhancement in self efficacy.

Motivation is what propels individuals to make changes in their lives. Unfortunately, this construct is often deregulated in individuals suffering from addiction and psychological dysfunction in addition to the prevalence of cognitive biases and deficits in emotional regulation. It is clear that these psychological constructs have an interactive and reciprocal relationship in the etiology, manifestation, and maintenance of substance use disorders and that it is difficult to distinguish their respective influences. Nevertheless, basic research on these constructs and integration of related theory informs more effective and more comprehensive approaches to the treatment of psychopathology and substance use disorders. Professionals must consider the interactive relationship between behaviors, cognition, and emotion in order to enhance motivational processes along with the application of existing theoretical frameworks and therapeutic interventions. When such approaches are taken there appears to be much promise for the overall efficacy of a variety of motivational enhancing therapies that challenge cognitive biases and promote sustainable positive change for individuals recovering from addiction.

Marie Tueller, MEd, LPC
CCR-OTC Blog

April 14, 2017

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