Motivational Interviewing and Harm Reduction

Motivational Interviewing and Harm Reduction

Motivational Interviewing helps clients to articulate their ambivalence about their addiction. It can help the client decide to take the first step towards reducing the harm their addiction is causing this is where Harm Reduction interventions are appropriate. Finally, ongoing support groups can provide the clients with social support and camaraderie during the first years of recovery.

Motivational Interviewing

Motivational Interviewing is a client-centered counseling style that prompts behavioral changes by helping clients to explore and resolve the ambivalence they feel about stopping their addiction. Motivational Interviewing is focused on achieving goals set by the client: motivation to change is elicited from the client and not imposed.

Motivational Interviewing believes that direct persuasion is not an effective method for resolving ambivalence. While it's hard to avoid the desire to offer direct help and advice, this approach often increases resistance. It is the client's responsibility and task to verbalize, articulate and resolve their ambivalence with the aid and support of their therapist.

Motivational Interviewing believes that readiness to change is not a client trait, but a fluctuating product of interpersonal interaction. This causes therapeutic relationship to be more like a partnership or companionship rather than one in which the therapist leads the client to treatment.

Harm Reduction

Harm Reduction is a set of strategies that reduces the negative consequences of drug use. It incorporates the strategies of safer and managed use, as well as traditional abstinence. Harm Reduction meets the substance abuser "where they are," addressing conditions of using along with the use itself.

Because Harm Reduction reflects the specific needs of an individual's there are no universal guidelines. However, there is a set of principles. The client:

  • Accepts illicit drug use is a part of the world and chooses to work to minimize its harmful effects rather than simply ignoring it.
  • Understands drug use as a complex, multifaceted phenomenon that encompasses behaviors from severe abuse to abstinence.
  • Establishes quality of the individual and community life and well-being as the first goal, not the cessation of all drug use.
Harm Reduction offers a non-judgmental, non-coercive provision of services and resources to people who are substance abusers. Harm Reduction advocates that all people with addiction or a history of use routinely have a voice in creating programs and policies designed to serve them. It empowers the person themselves as the primary agent to reduce the harm of their drug use and encourage them to share information and support each other.

Harm Reduction recognizes that the reality of life stressors make people vulnerable to and affect the capacity for dealing with drug-related harm.

Harm Reduction does not attempt to minimize or ignore the real harm and dangers of using substances.

Harm Reduction is not immediate abstinence. Rather it seeks to help abusers reduce the most harmful consequences of their continued abuse as the first step of full recovery.

Stages of Change in Addiction Treatment

Prochaska and Di Clemente identified five stages a person passes through during a recovery process. These stages can take can place with or without help from formal treatment providers. People move through these stages at different rates. They can remain at one stage for a considerable period of time or cycle back to earlier stages. Most people recovering from addiction cycle through the stages many times before achieving a stable change in behavior and mindset.

The Stages of Change are:


is characterized by the people not considering their behaviors now or in the future. They believe that there is no problem; they are unaware that they have to change, as well as they are unaware that they need any assistance with this matter. People in this stage have not really experienced adverse consequences from their substance abuse use.


is characterized when people become aware that there is a problem with their substance use. People in this stage are ambivalent and somewhat "on the fence". People are still actively using substances, but they might weigh the pros and cons about reducing their use or even cutting back sometime in the future. They are open to gathering information, seek out assistance, or even speak to a professional. It is uncommon for individuals to vacillate in this stage for years. Motivational Interviewing techniques can be helpful at this stage.


is reached when the people think that the advantages of changing their behavior and the adverse consequences outweigh any positive features of continuing to use substances. Their commitment is strengthened, more specific planning for recovery takes place, (i.e.: need to go to treatment). They might still be using substances, but are ready to quit. They are making goals for themselves and telling others about their plans to reduce or change their behaviors. Motivational Interviewing and Harm Reduction techniques can be very helpful at this stage.


is reached when the individuals choose a plan for recovery and begin to implement it and pursue it. Habits are being modified; there might be a change in certain environments they travel to; drastic lifestyle changes are being made; and physiological effects of withdrawal might be present. This phase also has people re-evaluating their own self-image in light of their commitment to recovery. This phase can last from 3 to 6 months following the incident where they last used. Motivational Interviewing, Harm Reduction, Exposure Response Therapy, and support groups can be helpful at this stage.


is reached when the individuals are sustaining the efforts, and they make gains. They are into maintaining their sobriety as well as trying to prevent any old behaviors that lead to relapse. They learn to protect themselves against triggers and certain high-risk situations that might cause then to use again. This stage needs to be sustained for a minimal period of 6 months to several years in order for the individual to be considered "fully" recovered. Exposure Response Therapy and support groups can be helpful at this stage.