Assessing Alcohol Problems Using Motivational Interviewing
For individuals in the U.S. & U.S. territories
In Assessing Alcohol Problems Using Motivational Interviewing, Dr. Linda Sobell demonstrates cognitive–behavioral motivational interviewing techniques for assessing a patient's alcohol use, and then she and Dr. Mark Sobell discuss this useful approach for working with individuals with substance use disorders. Motivational interviewing is a client-centered, directive method for eliciting intrinsic motivation to change by exploring and resolving a person's ambivalence to change using open-ended questions, reflective listening, and decisional balancing. This nonjudgmental, nonconfrontational interviewing style is designed to minimize a patient's resistance. The goal is to construct an interaction with patients so they feel comfortable discussing their risky or problem behavior.
In this session, Dr. Linda Sobell works with a young man with a history of problem drinking whose recent break-up with his girlfriend triggered increased risky alcohol use. Dr. Sobell assesses his readiness for change and then interviews him about triggers, behaviors, and cognitions associated with his drinking, emphasizing throughout that the patient has the choice to change, thereby empowering the patient.
Guided self-change (GSC) is a cognitive–behavioral motivational intervention developed in the mid-1980s and evaluated in several studies. This evidence-based approach combines a motivational interviewing therapist style with procedures intended to enhance commitment to change and maintenance of that commitment.
Consistent with a large body of research showing that many people resolve substance use problems on their own, and with a similarly large body of research demonstrating the efficacy of brief treatments for alcohol and some other drug problems, the approach is intended to help people help themselves. Thus, clients are provided with frameworks for evaluating their motivation, analyzing the functions of their substance use, and applying problem-solving procedures to generate and put into effect plans for resolving their substance use problems.
Although the approach was first developed for persons who had alcohol problems that are not severely dependent, over time the approach has been broadened to include more severe cases as well as cocaine, cannabis, and prescription drug abusers, cigarette smoking, gambling, and lifestyle and diet changes. It has also been used with adolescent and Hispanic (in Spanish) populations, and it has been found to be equally effective in group versus individual therapy format.
In terms of substance use disorder treatments, GSC as an empowering and brief treatment stands in strong contrast to traditional 12-Step approaches that require accepting that one has an addictive problem and following a specific recovery program (e.g., surrender to a higher power; lifelong attendance at self-help meetings).
The GSC approach was first developed for use with persons who had alcohol problems that were not severe. That is, although their use of alcohol had resulted in life problems or was at levels that put them at risk of problems, they were not physically dependent. Many such individuals see labels (e. g., "alcoholic," "addict") as stigmatizing and not fitting their case because many have more economic and social resources to call upon than persons with more severe problems. In contrast to more chronic cases, many less severely dependent will also typically retain a good deal of self-esteem and thus can be expected to be resistant to approaches that are confrontational.
The GSC treatment approach has two dominant themes. First, it is geared to minimize client resistance while strengthening their commitment to change. Second, it is an empowering approach that matches clients who want to take responsibility for planning and making changes in their lives. The approach is probably less well suited for clients who have borderline personality characteristics.
Linda Carter Sobell, PhD, ABPP, is professor and associate director of clinical training at the Center for Psychological Studies at Nova Southeastern University (NSU) in Ft. Lauderdale, Florida. She is also codirector of the Guided Self-Change Clinic at NSU. For 17 years prior, she was a senior scientist at the Canadian Addiction Research Foundation and a professor at the University of Toronto, Ontario, Canada. She received her PhD in psychology from the University of California at Irvine.
She is known nationally and internationally for her work on the assessment and treatment of addictions, particularly brief motivational interventions, the process of self-change, and assessment instruments including the timeline followback method. She is a motivational interviewing trainer (MINT) and holds a diplomate in behavioral psychology from the American Board of Professional Psychology.
She is on the editorial board of eight professional journals and is a fellow of the American Psychological Association (APA). She is past president of both the Association for Advancement of Behavior Therapy and the Society of Clinical Psychology (Division 12 of APA).
She has received several awards including the Norman E. Zinberg Memorial Award from Harvard University, the Betty Ford Award from the Association for Medical Education and Research in Substance Abuse, the Brady/Schuster Award for outstanding behavioral science research in psychopharmacology and substance abuse from Division 28 (Psychopharmacology and Substance Abuse) of APA, and the Association for the Advancement of Behavior Therapy's Outstanding Service Award. Her research has been supported by grants from several different federal agencies.
She has had extensive consultation and training experience, having given over 200 invited presentations and clinical workshops/institutes nationally and internationally. She has published over 250 articles and book chapters, and 6 books. Her two most recent books are Promoting Self-Change: Implications for Policy, Prevention, and Treatment (coauthored with H. Klingemann et al.; Kluwer Academic Publishers, 2001), and Problem Drinkers: Guided Self-Change Treatment (coauthored with M. Sobell; Guilford Press, 1993, 1996).
Her 30-year career is best characterized as a blending of science and practice.
Mark Sobell, PhD, ABPP, is currently professor at the Center for Psychological Studies at Nova Southeastern University (NSU) in Ft. Lauderdale, Florida. He is also codirector of the Guided Self-Change Clinic at NSU. For 16 years prior he was a senior scientist at the Canadian Addiction Research Foundation in Calgary and a professor at the University of Toronto, Ontario. He received his PhD in psychology from the University of California at Riverside.
He holds a diplomate in behavioral psychology from the American Board of Professional Psychology and is a fellow of the American Psychological Association (APA). He has had extensive consultation experience, having given over 160 invited presentations and workshops nationally and internationally.
He has published over 250 articles and book chapters, and 6 books. His most recent books are Promoting Self-Change: Implications for Policy, Prevention, and Treatment (coauthored with H. Klingemann et al.; Kluwer Academic Publishers, 2001), and Problem Drinkers: Guided Self-Change Treatment (coauthored with L. Sobell; Guilford Press, 1993, 1996). He was acting editor of the Journal of Consulting and Clinical Psychology, is associate editor of Behavior Therapy, and is on the editorial board of 5 other journals.
He is known nationally and internationally for his work on the assessment and treatment of addictions. For many years, a major focus of his work has been on developing brief cognitive–behavioral motivational interventions for people who have alcohol or drug problems that are not severe. More recently his research has focused on preventing alcohol exposed pregnancies. His research has been supported by grants from several different federal agencies.
In recognition of his research accomplishments, he has received the Distinguished Scientific Contribution Award from the Society of Clinical Psychology (Division 12 of APA) and the Jellied Memorial Award for outstanding contributions to knowledge in the field of alcohol studies.
His 30-year career is best characterized as a blending of science and practice.
- Sobell, M. B., & Sobell, L. C. (1996). Problem drinkers: Guided self-change treatment. New York: Guilford Press.
- Sobell, L. C., & Sobell, M. B. (2003). Using motivational interviewing techniques to talk with clients about their alcohol use. Cognitive and Behavioral Practice, 10, 214–221.
- Sobell, M. B., & Sobell, L. C. (2005). Guided self-change treatment for substance abusers. Journal of Cognitive Psychotherapy, 19, 199–210.
- Sobell, M. B., & Sobell, L. C. (2000). Stepped care as a heuristic approach to the treatment of alcohol problems. Journal of Consulting and Clinical Psychology, 68, 573–579.
- Klingemann, H., Sobell, L. C., Barker, J., Blomqvist, J., Cloud, W., Ellingstad, T. P., et al. (2001). Promoting self-change from problem substance use: Practical implications for policy, prevention, and treatment. Netherlands: Kluwer Academic Publishers.
- Sobell, L. C., Wagner, E., Sobell, M. B., Agrawal, S., & Ellingstad, T. P. (2006, in press). Guided self-change: A brief motivational intervention for cannabis users. In R. Roffman & R. Stephen (Eds.), Cannabis dependence: Its nature, consequences, and treatment. Cambridge, United Kingdom: Cambridge University Press.
- Cognitive–Behavioral Relapse Prevention for Addictions
G. Alan Marlatt
- Drug and Alcohol Abuse
William Richard Miller
- Mindfulness for Addiction Problems
G. Alan Marlatt
- Problem Gambling
Nancy M. Petry
- Relapse Prevention Over Time
G. Alan Marlatt
- Smoking Cessation
Bonnie J. Spring
- Drug Abuse: Origins and Interventions
Edited by Meyer D. Glantz and Christine R. Hartel
- Drug Abuse Treatment Through Collaboration: Practice and Research Partnerships That Work
Edited by James L. Sorensen, Richard A. Rawson, Joseph Guydish, and Joan E. Zweben
- Motivating Behavior Change Among Illicit-Drug Abusers: Research on Contingency Management Interventions
Edited by Stephen T. Higgins and Kenneth Silverman
- Nicotine Dependence: Understanding and Applying the Most Effective Treatment Interventions
Charles E. Dodgen
- Sensation Seeking and Risky Behavior
- Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders, Second Edition
Edited by Paige Ouimette and Jennifer P. Read