Motivational Interviewing
Oftentimes what propels veterans forward in their recovery is the cognitive dissonance created between who they were and how they acted before substance addiction and how they act now. Conversation steered in this direction, fueled by MI, can enhance a veteran’s motivation to change and ready the veteran to change behaviors. Listen to the veteran’s account of loved ones and remember the names of these important family members and friends. Weave into the conversation the names of these loved ones when the veteran makes statements about becoming a better son/father/grandfather or daughter/mother/grandmother. These references make the goal concrete . A loved one can even be a pet; and for some, the desire to be a more competent and reliable pet owner can be a strong motivation. Give the veteran an opportunity to describe his or her strengths and bask in a self-description. In recovery, it is critical to identify strengths that can be built on to sustain recovery.
Veterans who are confronting a substance use disorder may approach the practitioner with a “fix it for me” attitude as a mental inventory is being taken of all of the negative consequences (eg, homelessness, legal issues, or unemployment). Getting the veteran to take ownership of the problem and the solution is key.
I don’t promise to fix things, instead I engage the veteran in problem-solving. I offer to team up with the veteran in this process, and I promise my best efforts but not outcomes. I avoid giving advice and work to empower the veteran to make sound decisions. Veterans who make their own decisions feel as though they have more control over their lives.
Working with the substance use disorder population is challenging but rewarding when a practitioner can embrace some of the paradigms described in this article. Practitioners may need to do some cognitive reframing within their own thinking, as I described in this article, to become more effective in the field and to help avoid burnout.
