title: Dual Diagnosis Motivational Interviewing: a modification of Motivational Interviewing for substance-abusing patients with psychotic disorders.
abstract: Motivational Interviewing (MI) is a brief treatment approach for helping patients develop intrinsic motivation to change addictive behaviors. While initially developed to target primary substance using populations, professionals are increasingly recognizing the promise this approach has for addressing the motivational dilemmas faced by patients who have co-occurring psychiatric and psychoactive substance use disorders. Unfortunately, this recognition has not lead to a clear explication of how MI might be adopted for specific diagnostic populations of dually diagnosed patients. In this article we describe how we have applied the principles and practices of MI to patients who have psychotic disorders and co-occurring drug or alcohol use problems. Specifically, we provide two supplemental guidelines to augment basic MI principles (adopting an integrated dual diagnosis approach, accommodating cognitive impairments and disordered thinking). We present recommended modifications to primary MI skill sets (simplifying open-ended questions, refining reflective listening skills, heightening emphasis on affirmation, integrating psychiatric issues into personalized feedback and decisional balance matrices). Finally, we highlight other clinical considerations (handling psychotic exacerbation and crisis events, recommended professional qualifications) when using MI with psychotic disordered dually diagnosed patients.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA. steve.martino@yale.edu
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
authors.forename: Kathleen
authors.initials: K
authors.lastname: Carroll
authors.forename: Demetrios
authors.initials: D
authors.lastname: Kostas
authors.forename: Jennifer
authors.initials: J
authors.lastname: Perkins
authors.forename: Bruce
authors.initials: B
authors.lastname: Rounsaville
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D003419:Crisis Intervention; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D009042:Motivation; D017410:Practice Guidelines as Topic; D011614:Psychotherapy, Brief; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome