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Do They Have To �Bottom Out?�

Most approaches to intervention with an alcoholic assume that the motivation to cooperate with recovery must emanate primarily from within the drinker. (Perhaps reflecting the old notion that an alcoholic had to “bottom out” before they would accept help). Treatment failures were largely attributed to lack of motivation, resistance or denial – flaws in the individual’s personality. In 1983 W.R. Miller at the University of New Mexico developed a process of motivational interviewing which emphasized that motivation for change can be facilitated by the interviewing techniques of the therapist. This was an early effort to define and demonstrate an intervention model that combined known principles of psychology to assist the drinker to progress through the internal changes needed to change behavior. Thus, rather than giving advice, labeling, moralizing, or warning of consequences, the therapist led the client toward self-evaluation and motivation to change. A variety of techniques for affirmation, awareness building, and alternative choice-making were employed. The goal was not “treatment” but moving the individual from unmotivated to a readiness to change.

This innovative interviewing strategy was an important development because it offered a testable alternative to the traditional model that saw lack of motivation and denial as client personality traits. Motivational interviewing suggested that properly trained therapists could elicit positive change in a client and intervene earlier in the progress of his/her drinking problem.

(Miller, W.R., Motivational interviewing with problem drinkers. Behavioral Psychotherapy 11: 147-172, 1983,)

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