Most substance abuse patients have a perception that change is too scary or impossible.

For a substance abuse patient, they tend to struggle more because making a change seems like the impossible dream.

The idea of not using drugs again is always at heart of the patient who is really working on sustaining sobriety. The trick to managing any chronic disease requires significant lifestyle-related accommodations.

The adage “perception is everything” is true.

Perception can be cloudy for someone who is diagnosed with substance use disorder making change difficult. It takes a true transformation of self-worth and a new awareness of hope to develop a new perception of life overall. Substance abuse has a way of changing the way a patient sees the world.

For family members and friends who are trying to help find themselves feeling helpless and hopeless every time another relapse takes place. Working helping the patient to consider a new perception which will require change is first addressed by understanding how the patient sees self and others.

“If the doors of perception were cleansed everything
would appear to man as it is: infinite.”

-William Blake

Motivational interviewing is based on the principles of motivation psychology…. its goal is to develop internally motivated desires for change in clients (Miller & Rollnick, 2012).

Motivational interviewing

In the spirit of motivational interviewing (MI) the patient will feel a sense of partnership and collaboration. They will feel a sense of acceptance, compassion, and evocation which will feel very “unnatural” in the beginning.

New Roads Behavioral Health | Changing the Perception of Change With Substance Abuse PatientsMI is a person-centered goal oriented approach for facilitating change by exploring & resolving ambivalence (Miller, 2008).

To evoke change, MI considers a facilitative approach to communication which evokes change.

Patient-Centered model studies have demonstrated improved clinical outcomes and quality of service when the patient feels a sense of partnership with the help of a integrated health team. Research has also shown improved self-management skills for patients with chronic conditions.

Research indicates decreased depression and substance use remission rates from 42% to 71% (Katon, et al., 2008).

Principal’s of MI

Principal #1- Empathy

The power of empathy, the first principal of MI, allows the patient to have a sense of being understood when health care providers present with warmth, friendliness, affirmation, and genuine care.

Consider that over 70% of change occurs because of a therapeutic “helping relationship” which is trust based and focused on the individual’s feeling of safety, both physically and emotionally.

Carl Rogers said,

“In science when you begin to get somewhere, you find that the principle is quite simple but has enormous implications and is not easy to discover. I feel that we have made progress in client-centered therapy in approaching some of the truth of what happens in the process of change and how it can be facilitated. And to try to help people to grasp that and begin to try it out, experience it, and finally come to live it in more than just the therapeutic hour – that’s what training is all about.”

Principal #2- Discrepancy

The second principal of MI is developing discrepancy because the motivation for change occurs when people “perceive” a discrepancy between where they are and where they want to be. Values and beliefs are key factors to establishing for the patient what has meaning for them and how to keep a heart of purpose for life.

Simply making a list of all of the reasons the patient enjoys using drugs and reflecting discrepancy of all the things that are taken away from the equation because of using drugs. The patient comes up with the list of things both positive and negative this process alone can shift perception and push the patient forward to make needed changes.

Remember that when “we come up with the idea” we are convinced that we are capable of fulfilling our dreams and reaching our goals. If someone tells us what we need to do, then our perception remains stuck, and the rebellious child appears.

Below is an example of an exercise about alcohol/drug use:
The patient will consider these questions – what are some good things about my use and what are some challenges.

  1. Good things about my use are:
  2. Good things about changing my use are:
  3. Not-so-good things about my use are:
  4. Not-so-good things about changing my use are:

Principal #3- Self-efficacy

The third principal of MI is to support self-efficacy. Self-efficacy occurs when the patient feels like they can change.

The accountability is on the patient’s terms to carry out the change. When the patient feels like the provider believes in them on many occasions the patient’s ability to change becomes a self-fulfilling prophecy.

Principal #4- Resistance

The fourth principal of MI is to learn to roll with resistance.

Resistance is almost always guaranteed that during the change cycle when working with substance use disorder clientele. It is that resistance that may begin an argument between the provider and the patient as to why the patient should change.

When the patient feels like the provider is telling them how to change this “advice giving” style of conversation/counsel will only cause the patient to “dig in their heels.” However, a simple reflection focused on expressed feelings is an effectual way to encourage the patient.

  • For example, “You’re angry about being sent here.”
  • An amplified reflection might be necessary, e.g., “You’re furious about being sent here.”
  • A double-sided reflection is also effective, e.g., “On one hand you like the way things are; and on the other hand, there is part of you that would like to make a change.”

The double-sided reflection begins to place accountability back on the patient as they consider the cost and benefits of making a change. Utilizing these techniques can break down resistance and help a patient make positive changes.

Traditionally, substance abuse counselors were trained in a model of intervention that included confrontation to break down the client’s denial of his or her addiction.

There are always places for confrontation, however, when a patient who has a substance use disorder is considering change the patient’s mechanisms are fully entrenched in a fight or flight response. What happens in most cases with this type of intervention is a noted increase in denial and resistance.

Research has revealed that when making a decision to change something in our life that each of us will go through the stages of change.

The stages of change for substance abuse patients are:

  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse

For example, If the patient in treatment relapses, they will find themselves going back through the stages of contemplation, preparation, and action. This reentry into the change cycle will not happen if the patient becomes stuck or demoralized because of the relapse.

Engaging and supporting the patient to move through the stages of change will help to contribute to the baby-steps on a difficult journey commitment to change.

There are also other ways to help with patient substance abuse…. Music. Learn more about the influence of music and substance abuse here.

Are you a substance abuse patient? Get help today and start making the changes that you want in your life. Call our admissions team today: 888-358-8998

Cinthia McFeature, PhD


Arkowitz, H., Westra, H.A., Miller, W. R., & Rollnick, S. (2008). Motivational interviewing in the treatment of psychological problems. New York, NY: Gilford Press.
McFeature, B. & Herron-McFeature, C. (2017). Integrated health: Heartpath practitioner assessment and interventions for the trauma-exposed patient. Melbourne, FL: Motivational Press, Inc.
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press.