MOTIVATIONAL INTERVENTION AS APPLIED TO SYSTEMS CHANGE: THE CASE OF DUAL DIAGNOSIS

Abstract

The concept of motivational interviewing is based on helping individual clients build and sustain a commitment to reach and carry out a decision to change. In this paper, the motivational interviewing model is applied to systems change. Different stages of involvement and readiness to change are identified within systems which closely resemble those found in individuals. When applied to a system, we call this process “Motivational Intervention.” In this paper, the motivational intervention model is applied to a psychiatric system of health care delivery where large numbers of psychiatric patients are found to also have substance use-related problems. Several Italian health districts invited the authors to present a series of lectures and workshops in order to facilitate the incorporation of substance user treatment into existing psychiatric services. Using the motivational intervention model to determine where the system was in the process of change, we then identified the tasks necessary to facilitate further change.

• Dual diagnosis
• Motivational interviewing
• Motivational intervention
• Change
• Sequential treatment
• Parallel treatment
• Integrated treatment

RESUMEN

El concepto de intervención motivacional está basado en ayudar a los clientes individuales a construir y mantener un compromiso para alcanzar y llevar a cabo una decisión de cambio. En este artículo, el modelo de intervención motivacional se aplica a los sistemas de cambio. Diferentes estadios de preparación y predisposición al cambio se identifican dentro de sistemas que se parecen a los que encontramos en individuos. Cuando lo aplicamos a un sistema, el proceso se denomina “Intervención Motivacional.” En este artículo, el modelo de intervención motivacional se aplica a sistemas psiquiátricos sanitarios, en los cuales un gran número de pacientes psiquiátricos tienen asimismo un problema de abuso de substancias. Varios distritos sanitarios italianos invitaron a los autores a presentar una serie de lecturas y seminarios para facilitar la incorporación del tratamiento para abuso de substancias en los servicios psiquiátricos existentes. Si utilizamos el modelo de intervención motivacional para determinar en qué momento del proceso de cambio se encuentra el sistema, podemos entonces identificar las tares necesarias para facilitar cambios futuros.

RÉSUMÉ

Le concept de Motivational Interviewing est fondé sur le fait d’aider un client à construire et maintenir l’engagement d’atteindre et porter exécution un décision de changement. Il s’agit ensuite de prévoir le changement et de le mettre en pratique. Dans cet article nous appliquons ce modèle de motivational interviewing à des systemes de changement. Une fois que ces concepts sont réstructures et appliqués à un système, nous appelons ce procédé “Motivational Intervention.” En l’occurrence, cette Motivational Intervention est appliquée à un système psychiatrique de santé concernant un grand nombre de patients psychiatriques rencontrant un problème d’abus de substance qui souvent n’a pas été identifié ou traité. Réalisant la nature et l’étendue du problème, plusiers centres de santé italiens nous ont invité à présenter et développer le sujet lors d’une série de conférences et workshops dans le but de faciliter le traitement de ces patients double diagnostic. Nous avons utilisé comme guide le modèle de motivational intervention pour déterminer où se situait le système dans le procédé de changement et quelles tâches étaient réquises pour faciliter de plus amples changement.

Additional information

Notes on contributors

Joel Solomon

Joel Solomon, M.D., is Clinical Associate Professor of Psychiatry at the Columbia University College of Physicians and Surgeons, in New York. He received his medical degree from the University of Lausanne. He has a longstanding committment to education, research, and treatment regarding the relationship between psychiatric and “substance abuse” problems. He has published numerous books and articles on this subject. He is currently in private practice of psychiatry in New York City and consults to many American and international public, private, and Major League sports organizations.

Angelo Fioritti

Angelo Fioritti, M.D., is Director of Mental Health and Drug Abuse programs of the Azienda USL Rimini in Italy. In this position, his major task is to promote integration between Mental Health and Drug Abuse services. He received his degree in Psychiatry at the University of Bologna, where he is currently Adjunct Professor of Psychiatry. His scientific interests focus on the organization of psychiatric services, mainly with regards to the most serious patients. He is the author of several publications about dual diagnosis, forensic psychiatry, and case management/assertive community treatment.