Reducing Stigma Education Tools (ReSET) > 02. Effective Communication

02. Effective Communication

MODULE 2 | SECTION 2 OF 5

Pre-Course Information

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Learning objective

Develop improved communication skills, including motivational interviewing, for
interacting with patients with OUD.

Barriers to effective communication with our patients about OUD can include our own bias and stigma, but it is important to remember that our patients may be reluctant to tell us what they need help with because of self-stigma.

Self-stigma

There are many barriers to open communication about substance use. In the previous section, we covered some ways in which stigma and bias can affect communication, and self-stigma can impede patients participating in treatment or long-term recovery.1

Shame makes it hard for our patients to speak with us about the problems they are facing, but there are effective ways of engaging our patients in these conversations.

“When a person feels accepted for who they are and what they do—no matter how unhealthy—it allows them the freedom to consider change rather than needing to defend against it” – The paradox of change – (White, 2011; Rogers, 1957)

How do I have an effective conversation with my patient about opioid use disorder?

Motivational interviewing (MI) is an evidence-based method of communication that has been well studied and offers a patient-centered approach to these conversations.

Some people may think of MI as a tool used to get people to change. It is more useful to think of it as a tool to engage with someone in a way that can establish a relationship which can facilitate change. MI is based in the concept of positive regard for the other 

individual and approaching them in a nonjudgmental way. It is rooted in trust, respect, and understanding of the other person’s perspective. It provides a guided method of communication that increases the probability of change by eliciting strengths and finding intrinsic reasons for change. This means that our patients have the answers and the reasons to change, but there is often ambivalence about change that needs to first be overcome.

 

 

 

You can practice motivational interviewing through practicing five general principles:

 

  1. 1- Express empathy through active and reflective listening.
  2. 2- Develop discrepancy between patients’ goals or values and their current behavior.
  3. 3- Avoid arguments or confrontation.
  4. 4- Adjust to patient resistance rather than opposing it.
  5. 5- Support self-efficacy and optimism.

How do I use motivational interviewing when I am talking to a patient about substance use?

ASK PERMISSION

To start a conversation using the principles of MI, start by asking permission. By asking permission, you are showing respect for the other person and avoiding the pitfall of “lecturing.”

“I notice that you are here for treatment of an abscess from injecting heroin. Is it alright if I talk to you about your heroin use?”
“You mentioned that you have run out of your prescription opioids early. May I ask you about your opioid use?”

EXPLORE THE INDIVIDUAL’S REASONS AND MOTIVATIONS TO CHANGE… OR NOT TO CHANGE

Use open-ended questions to elicit the patient’s thoughts and feelings about their substance use. Be open to ambivalence about change– ask questions that get at both the positives and negatives of change.

“People often use opioids because it helps them in some way. What are the good things about taking opioids?”
“What are the downsides to using opioids?”

Explore the patient’s goals and values. Motivation to change is strengthened by the recognition of the difference between the current situation and the desired situation. Reflect back to the patient what they have expressed about their current situation and their goals or values. Ask about specific reasons they would like to change.

“What would be different if you were not using heroin?”
“How does heroin use affect your life?”
“What concerns do you or your loved ones have about your opioid use?”

EXPLORE READINESS TO CHANGE

Inquire how interested in making a change the person is, and explore how confident they feel about being successful in making that change. Consider with them what strategies or resources could help them feel more confident in being successful making a change.
“What would help you feel more confident that you can make that change?”
“How important is it to make a change in this today?”
“How confident are you that you will be able to cut down or stop using if you decide to?”

REFERENCES

  1. 1-Hammerlund, R., K. A., Luce, L., Mulligan, L., & Ward, K. M. (2018). Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug and alcohol-use disorders. Subst Abuse Rehabil, 9, 115-136. doi:10.2147/SAR.S183256
  2.  
  1. 2-Providers Clinical Support System. Motivational Interviewing: Talking with Someone Struggling with Opioid Addiction – PCSS. Providers Clinical Support System. https://pcssnow.org/resource/motivational-interviewing-talking-with-someone-struggling-with-opioid-addiction/. Published October 24, 2017. Accessed December 28, 2019.
  2.  
  1. 3-Flynn HA. Setting the Stage for the Integration of Motivational Interviewing With Cognitive Behavioral Therapy in the Treatment of Depression. Cognitive and Behavioral Practice. 2011;18(1):46-54. doi:10.1016/j.cbpra.2009.09.006

 

  1. 4-Miller WR, Rose GS. Toward a theory of motivational interviewing. American Psychologist. 2009;64(6):527-537. doi:10.1037/a0016830

 

  1. 5-Kaplan S, Elliott H. Using Motivational Interviewing to Meet Core Competencies in Psychiatric Resident Training. Academic Psychiatry. 2011;35(1):46-50. doi:10.1176/appi.ap.35.1.46

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