Motivational Interviewing for Substance Use: Mapping Out the Next Generation of Research

Since the landmark paper by William R. Miller, “Motivational Interviewing with Problem Drinkers” (1983), Motivational interviewing (MI) has been established as an efficacious clinical approach for treating a range of behavioral problems (Miller & Rollnick, 2013). Some of the largest treatment effects for MI have been observed for substance use disorders (Schumacher & Madson, 2014). In the past 30 years, interest in and use of MI have surged within substance use treatment settings as well as other contexts (e.g., health promotion) and within multiple professions (e.g., medicine, social work, psychology). Studies have demonstrated MI's effectiveness in randomized trials across a range of clinical contexts (Lundahl & Burke, 2009). More recently MI scholars have shifted attention to its theoretical underpinnings and the evolution of a causal theory about how MI works. In outlining a theory of MI, Miller and Rose (2009) hypothesized two major components: relational and technical, which subsequently have guided the research, practice and teaching of MI (Miller & Rollnick, 2013). The first component relational – is foundational to MI and includes person-centered counseling traditions, such as being empathic, nonjudgmental, autonomy-supporting and affirmingwith clients. Clinicians relate to their clients inways that build a safe, trusting, and engaging environment for clients to ponder behavioral change (Moyers, 2014). The second presumed component of MI – technical – occurs when clinicians intentionally elicit client arguments for or against change (Magill et al., 2014). The technical component ofMI involves a directional approach in which clinicians selectively attend to and purposively elicit and elaborate discussions about healthy changes. (Schumacher & Madson, 2014). The intended outcome of clinicians intentionally guiding the conversation in this way is to minimize clients' need to defend their prior decisions (called “sustain talk”) and encourage clients to discuss their own needs, wants, desires, and reasons for change (called “change talk”) (Glynn & Moyers, 2010; Miller & Rollnick, 2013). According to Miller and Rose (2009), increases in client change talk and resolution of sustain talk predict client commitment to change and ultimately underpin steps taken to achieve behavior change. Both components, relational and technical, are hypothesized as intertwined and necessary elements inMI. In addition to outlining a causal theory of MI, Miller and Rose (2009) underscored several areas for future research. Specifically, they suggested that more research was needed to: (a) better understand under what conditions MI is effective, (b) test the technical hypothesis in relation to client outcomes, and (c) identify effective and durable ways to train clinicians in MI. In this paper we provide a brief update of progress on these three key questions and describe papers included in this special issue.