Americans are fond of using labels to describe who they are and what’s important to them. As a result, when asked who he is, a man might respond that he’s a father, a golfer or an excellent barbeque chef. A woman might respond that she’s a mother, a knitter or a cat lover. These labels can spark a conversation and make introductions a little easier, but they can also come to define a person’s identity, helping them to understand their habits, their preferences and their place in the world. Unfortunately, people who abuse drugs or alcohol may come to embrace the label of “addict.” Everything they do revolves around their addiction, and all of their hobbies and secret loves may pale in importance when the addiction is also in play. This may be especially true of people who have mental illnesses as well as addictions, as they may lean on their substances of abuse to keep their mental health in check.
For example, in a study in the journal Schizophrenia Bulletin, researchers found that 40 percent of people with schizophrenia who were studied also abused substances.
It’s likely these addictions made symptoms of schizophrenia even more difficult to control, and it’s likely that people like this experienced even more misery due to their addictions. Even so, researchers found that most people they interviewed weren’t motivated to quit their substances. In a way, they’d accepted their identities as addicts, and they were resistant to the idea of change.
Motivational Enhancement Therapy, when used properly, may help people accept the idea that they need to enroll in treatment programs for addiction, mental illness or both. In some cases, the therapy may also help people to simply stop their substance abuse altogether, so they can then work exclusively on controlling their mental illness. With this therapy, people can find new labels for their lives, and they may even develop new identities in the process.
Motivational Enhancement Therapy, or MET, is based on the simple idea that people who have addictions or mental illnesses may have a deep-seated wish to change their lives for the better.
They may not really want to be addicts, and they may have a distant memory of what life was like before drug use began. The wish for sobriety may be buried under misconceptions, habits and fear, but exposing that kernel of change could allow it to grow stronger and stronger, until people feel willing and able to change their lives for the better.
Since this motivation to change is so weak and buried, traditional therapy techniques may not be effective in this population group. People who are pushed to change in Cognitive Behavioral Therapy sessions, for example, or those who are asked to take a leap of faith in exposure therapy sessions may want to make big differences, and they may be willing to face their fears directly. People with low levels of motivation may simply walk away from the idea of recovery if things move too quickly or they feel criticized or blamed for their habits and opinions. As a result, MET sessions tend to follow a predictable format that moves slowly, building upon each tiny step a person takes toward a robust recovery. No pushing, contradictions or challenges are allowed. Instead, people move slowly but surely toward their own solutions.
Additionally, many traditional therapy sessions are conducted in group settings, as this kind of therapy can allow professionals to:
- Treat many people at the same time
- Allow participants to practice their skills
- Demonstrate recovery through the participation of experienced clients
- Include clients in the recovery process of other people through discussions and mentoring
Some people aren’t prepared to work in these group settings, however, as they may feel as though they have nothing in common with other people who are in recovery. In fact, they may feel that other people in recovery are so different from them, with such advanced problems, that their own issues seem minimized. In a way, exposure to a group can inadvertently reinforce an addiction, allowing people to feel as though their own problems aren’t as severe as those issues they see around them. As a result, MET is typically provided in individual settings. A client works only with the therapist, focusing only on the problems that person has at that time.
While MET could be used in a variety of ways, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests that therapy traditionally follows a set schedule with predictable milestones set all along the way. In the beginning, therapy begins with an extensive series of questions that allow the therapist to determine how motivated the addicted person is to change.
The assessment might take hours to complete, and here, clients might be asked all sorts of questions regarding:
- How frequently they use or abuse substances
- What types of problems they’ve experienced due to those habits, both physically and mentally
- How often other members of the family use
- When the abuse started
- Future goals, plans and wishes
Clients might also be asked to take multiple tests that measure their physical and mental health. Urinalysis might also play a role, so therapists can determine what types of substances the person has used frequently.
When all of this testing is complete, practitioners schedule another meeting in which all of the test results are given to the client. The therapist might outline the damage seen, and ask the client for his/her opinion about that assessment. The therapist might also ask the client for feedback on those goals identified in testing, along with the client’s feelings about attaining those goals. This session helps the client and the therapist to define the achievements the client might want to bring to life, and in follow-up therapy, the mental health professional works to enhance the client’s motivation to make changes. Subtle statements like, “Maybe drugs really aren’t so good for me” might be worthy of exploration, and some clients might even be encouraged to take a one-day sobriety test, just to see how different their lives might be without substance abuse.
According to the NIAA, therapy like this is typically complete within 90 days, and family members might be asked to play a role. They may come to the early sessions, providing feedback of their own regarding the person’s habits and behaviors, and they might be encouraged to keep discussing the issue at home with the addicted person.
While many people provided with MET feel compelled to make changes or at least think about making changes, some people continue to believe that they have their addictions under control, and they may make negative statements throughout their therapy sessions, suggesting that they don’t need to be there or that the sessions aren’t helpful. Mental health professionals using MET are encouraged to simply “roll with” these statements, instead of contradicting them, and allow the therapy to move forward at its own pace.
Modifying for Dual Diagnosis
While MET has been extensively studied in people who have addictions to alcohol and other drugs, it hasn’t been rigorously applied to people who have mental illnesses complicating their recovery. These people may benefit from MET, but the studies of efficacy might be a little harder to find. One study on the issue, in the Journal of Substance Abuse Treatment, suggests that people who have these Dual Diagnosis issues need slight modifications to their therapy, so they can achieve the benefits without serious side effects.
Here, researchers suggest that people with mental illnesses may express symptoms of disordered thinking in their MET sessions. This disordered thinking can be harmful to the recovery process, but even so, practitioners shouldn’t correct the thoughts or identify the incorrect statements. Instead, they should allow those symptoms to float by completely unremarked upon. Similarly, people with Dual Diagnosis issues may need more statements of affirmation in therapy, allowing them to feel as though the therapist is listening and that progress is really being made. By making these minor modifications, researchers suggest, people with Dual Diagnosis issues may be able to benefit from MET.
Measuring the Benefits
Some experts suggest that MET is really best used as a way to help people see the need for care. For example, the National Institute on Drug Abuse suggests that MET can help engage addicted people in treatment, so they’ll walk into their treatment facilities ready to work and make sacrifices, but it’s not a therapy that can produce long-term changes in people who abuse drugs at high levels. This is an opinion that seems to ring true, as people with addictions often have layers and layers of dysfunction to peel away before they can develop a life that’s healthy, happy and productive. A simple 90-day course may just not provide the intensive help people need in order to change their lives. However, other studies have found that MET can be helpful for people, even if that’s the only form of therapy they get.
For example, according to the Substance Abuse and Mental Health Services Administration, people given three MET sessions lasting 50 minutes were compared to people who received standardized therapy for the same amount of time. The MET participants reduced their substance abuse levels during therapy, as did those in the other group, but only the MET participants maintained those reductions at the 12-week follow-up check.
This seems to suggest that MET produced long-term changes that people could apply in their lives. For some, it was intensely helpful.
If you think you might benefit from MET, or you have a family member or friend who needs help, please call us. We can help you to find a Dual Diagnosis treatment program that can help you to address the pain in your life and allow healing to begin. Please call to get started on your search.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.