Maintaining motivation and compliance

Enhancing motivation has a place not only at onset, but throughout the clinical contact. Treatment aimed only at enhancing motivation was for most measures equal to cognitive-behavioural therapy, and intensive intervention aimed at linking patients with AA. (25 Randomized controlled studies have shown the advantage of motivational interviewing over traditional supportive therapy. (1°26) The style of the opening interview using motivational interviewing techniques has already been discussed. The patient is encouraged not to forget the harm that drinking caused and the benefits of abstinence, but the losses and problems of being sober are not denied. Strategies for maintaining abstinence emerge from collaborative dialogue, and are owned by patients rather than offered as advice from the clinician. If medication is part of the treatment plan, unwanted effects are actively enquired into, and are recognized and not dismissed, and remedies are sought. Any discrepancies that patients reveal between their present view of themselves and how they would like to be, or between what patients say they believe and how they actually behave, are used as a fulcrum for shifting attitudes and testing alternative strategies. These techniques were elaborated by Miller and Rollnick (3) and enshrined as motivational enhancement therapy (2Z) by Project MATCH (see below).

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