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1. Motivational Enhancement Therapy (MET) (Problem Drinkers)

Developers:
Miller, William R, Zweben, Allen, DiClemente, Carlo C, Rychtarik, Robert G. (University of New Mexico Departments of Psychology and Psychiatry (Miller); University of Wisconsin Department of Social Work (Zweben); University of Maryland Department of Psychology, (DiClemente); University at Buffalo Research Institute on Addiction (Rychtarik))

Summary:
Motivational Enhancement Therapy (MET) is a systematic intervention approach for evoking change in problem drinkers. It is based on principles of motivational psychology and is designed to produce rapid, internally motivated change. This treatment does not attempt to guide and train the client, step-by-step, through recovery, but instead employs motivational strategies to mobilize the client's own change resources. MET consists of four carefully planned and individualized treatment sessions. The first two focus on structured feedback from the initial assessment, future plans, and motivation for change. The final two sessions, at the midpoint and end of treatment, provide opportunities for the therapist to reinforce progress, encourage reassessment, and provide an objective perspective on the process of change.

MET is grounded in the transtheoretical model of how people change addictive behaviors, with or without a formal treatment. In this model, individuals move through a series of stages of change as they progress in modifying problem behaviors. Each stage requires certain tasks to be accomplished, and certain processes to be used in order to achieve change. The stages are:

  • PRECONTEMPLATION (people not considering changing their problem behavior);
  • CONTEMPLATION (entails the individuals beginning to consider both that they have a problem and the feasibility and costs of changing that behavior);
  • DETERMINATION (the decision is made to take action and change);
  • ACTION (the individual begins to modify the problem behavior; this stage normally continues for 3-6 months);
  • MAINTENANCE (sustained change);
  • If these efforts fail, a RELAPSE occurs, after which the individual begins another cycle.

The MET approach addresses where a client currently is in the cycle of change, and assists the person in moving through the stages toward successful sustained change. The counselor seeks to develop a discrepancy in the client's perceptions between current behavior and significant personal goal; emphasis is placed on eliciting from clients self-motivational statements of desire for and commitment to change. The working assumption is that intrinsic motivation is a necessary and often sufficient factor in instigating change.

MET requires fewer therapist-directed sessions than some alternatives. It may, therefore, be particularly useful in situations where contact with problem drinkers is limited to few or infrequent sessions (e.g. in general medical proactive or in employee assistance programs).

Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence.

Miller WR, Zweben A, DiClemente CC, Rychtarik RG. Project MATCH Monograph Series, Vol. 2 ; DHHS Publication No. 94-3723.) Rockville, MD: NIAAA, 1994.

Download manual: http://lib.adai.washington.edu/pubs/matchmonograph2.htm

Intervention Details:

Population studied:Adults; Project MATCH participants
Drug studied:Alcohol dependence; Alcohol problem drinking (not severe dependence)
Therapy format:Individual
Therapy type:Cognitive-behavioral; Motivational enhancement
Setting:Outpatient; Aftercare

Noteworthy:

  • CES score of +189 in Miller et al. (2003) review of treatment outcome research (rank=2)

Supporting References:

  1. Carroll KM, Farentinos C, Ball SA, Crits-Christoph P, Libby B, Morgenstern J, et al. (2002). MET meets the real world: design issues and clinical strategies in the Clinical Trials Network. Journal of Substance Abuse Treatment, 23 (2). 73-80.
  2. Carroll KM, Libby B, Sheehan J, Hyland N. (2001). Motivational interviewing to enhance treatment initiation in substance abusers: an effectiveness study. The American Journal on Addictions, 10. 335-339.
  3. Miller WR. (1995). Motivational enhancement therapy with drug abusers. Accessed on line on 10/24/03 from http://www.motivationalinterview.org/clinical/METDrugAbuse.PDF.
  4. Miller WR, Mount KA. (2001). A small study of training in motivational interviewing: does one workshop change clinician and client behavior. Behavioural and Cognitive Psychotherapy, 29. 457-471
  5. Miller WR, Rollnick S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: The Guilford Press.
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