Executive Summary and
Recommendations
T
his TIP is based on a fundamental
rethinking of the concept of motivation.
Motivation is not seen as static but as
dynamic. It is redefined here as purposeful,
intentional, and positive—directed toward the
best interests of the self. Specifically, motivation
is considered to be related to the probability that
a person will enter into, continue, and adhere to
a specific change strategy. This TIP shows how
substance abuse treatment staff can influence
change by developing a therapeutic relationship
that respects and builds on the client’s
autonomy and, at the same time, makes the
treatment clinician a partner in the change
process. The TIP also describes different
motivational interventions that can be used at all
stages of the change process, from
precontemplation and preparation to action and
maintenance, and informs readers of the
research, results, tools, and assessment
instruments related to enhancing motivation.
The primary purpose of this TIP is to link
research to practice by providing clear
applications of motivational approaches in
clinical practice and treatment programs. This
TIP also seeks to shift the conception of client
motivation for change toward a view that
empowers the treatment provider to elicit
motivation. These approaches may be especially
beneficial to particular populations (e.g., court-mandated offenders) with a low motivation for
change.
Despite the preponderance of evidence
supporting the efficacy of motivation-focused
interventions, their use in the United States has
occurred primarily in research settings. One
obstacle to their implementation may be
ideological: low motivation, denial, and
resistance are often considered characteristic
attributes of those diagnosed with substance
abuse disorders. The cognitive–behavioral
emphasis of motivational approaches, however,
requires a different perspective on the nature of
the problem and the prerequisites for change.
This approach places greater responsibility on
the clinician, whose job is now expanded to
include engendering motivation. Rather than
dismissing the more challenging clients as
unmotivated, clinicians are equipped with skills
to enhance motivation and to establish
partnerships with their clients.
The Consensus Panel recommends that
substance abuse treatment staff view motivation
in this new light. Motivation for change is a key
component in addressing substance abuse. The
results of longitudinal research suggest that an
individual’s level of motivation is a very strong
predictor of whether the individual’s substance
use will change or remain the same.
Motivation-enhancing techniques are associated
with increased participation in treatment and
such positive treatment outcomes as reductions
in consumption, higher abstinence rates, better
social adjustment, and successful referrals to