Substance use may provide relief, pleasure, connection, routine or a way of coping, while also creating health, relationship, financial or other difficulties. MI makes room for both sides of this experience.

Understanding sustain talk does not mean agreeing that nothing should change. It helps the practitioner understand what change might cost from the person’s perspective.

The focus of an MI conversation should be clear and ethically considered. Depending on the service and person’s goals, conversations may involve abstinence, reducing use, treatment engagement, safer use or other harm-reduction changes.

Empowerment matters here. The practitioner can have concerns and professional knowledge without pretending that the person has no agency.

The evidence deserves careful wording. The 2023 Cochrane review included 93 studies with 22,776 participants. Compared with no intervention, MI may reduce substance use in the short term. Compared with assessment and feedback, it probably produces small reductions at medium and longer follow-up. Compared with treatment as usual or another active intervention, it may make little or no difference. The review also highlights substantial variation between studies and uncertainty in parts of the evidence base.

This makes fidelity and quality of delivery important when interpreting research labelled as Motivational Interviewing.

Training can draw directly on engagement, harm reduction, relapse, treatment and change conversations encountered by substance use practitioners.

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