Motivational Interviewing

As we continue the data collection portion for the rate of substance abuse of patients admitted to the emergency department, I have found myself experiencing a disconnect with the way patients were referred to various agencies. There was something impersonal and probably ineffective about handing a patient that has a history of substance abuse a green piece of paper with phone numbers to various clinics around Birmingham. However, these issues regarding drug and alcohol addiction would probably have never been addressed had we not been there. So I suppose this only highlights the real issue of addiction as being a medical condition that is so negatively stigmatized that it does not warrant the appropriate attention from health care professionals.
This past week Dr. Karen Ingersoll from The University of Virginia came and spoke to the interview team of the project. Dr. Ingersoll has traveled internationally speaking about Motivational Interviewing techniques for patients suffering from substance abuse issues. Here are some of the main takeaway points I learned from her lecture:

1.)Your perceived disposition on the problems being experienced by the patient are critical in developing a rapport.  Pressed speech and conveying negativity at the patient only puts a blockade that that is often times permanent.

2.)The client should have experienced some sort of sense of autonomy at the end of the interview. Having the patient state what they could do to combat issues they dislike about their condition can be actually be empowering.

3.) By providing guidance instead of making threats and attempting to strike fear in the heart of the patient, you can leave the patient with a positive experience that they will think about later on down the road. An example of this would be a doctor making the statement, "If you don't quit drinking you're gonna kill yourself or someone else!" versus "Come and see me in a few weeks if you find yourself unable to control your drinking at a level that we just discussed would be appropriate for you, and we'll get you some more help." The patient knows he could kill himself or other people....it's been drilled in his or her head since they took the D.A.R.E program in the third grade.

4.) Once an issue with addiction has been established, ask permission to pursue a route that will eventually lead the patient to better there lives. The 12-Step program and abstinence is not the most appropriate option  for everyone having difficulty with depression.

In the days to come I look forward to implementing what I've learned and following up with patients that I've spoken with in the emergency room.