Table 1.

Motivational Interviewing Intervention for Patients with Depression and Hazardous Drinking or Drug Use

Format

45-minute in-person session, as soon as possible after study enrollment

20-minute phone “booster” session, approximately 10 days after in-person MI session

20-minute phone “booster” session, approximately 14 days after initial booster

MI approach

Evocative, exploring patient's own reasons for change; empathic and nonjudgmental

Collaborative, meeting patients at their current level of motivation/phase of change

Directive, gently guiding the patient in discussion of alcohol and drug use

Key MI strategies, adapted for patients with depression

Open-ended questions to evoke patients’ goals and values, particularly related to mood and other depression symptoms

Reflective listening, strategically emphasizing “change talk” such as patient-generated reasons to decrease drinking and other drug use

Summarizing, e.g., reviewing pros and cons of patient's current drinking and drug use patterns

Developing discrepancy between goals/values and current behaviors, especially potential discrepancies between current use patterns and goals such as improved energy and functioning

Rolling with resistance, acknowledging positive aspects of substance use, such as temporarily heightened mood or forgetting of problems

Supporting self-efficacy, noting patient's efforts and successes such as mental health treatment-seeking and medication adherence

Offering information about substance use and depression, e.g., impact on symptoms and medication effectiveness – in an MI-consistent manner (ask what patient already knows, ask permission to give additional information, tell brief information, ask for patient's thoughts/feelings in response to this new information)