Van Horn, D. H.A., & Bux, D.A. (2001). A pilot test of motivational interviewing groups for dually diagnosed inpatients. Journal of Substance Abuse Treatment, 20, 191-195.

MI Group 1: The Inner Struggle

Written Exercise: Pass around sheets of paper with the statement, “It will be really hard for me not to use when…” along with pens/pencils. Have patients write down or think about a response to complete the sentence.

Rationale: Most people here in the hospital realize that they may have a problem with drinking or drug use, and that they may need to stop using. At the same time, though, alcohol and drugs have a very important place in people’s lives, and people are used to having them around. People often have an especially hard time avoiding using when they are faced with a situation that reminds them of the things they liked about drugs or alcohol, or when they find themselves missing certain things about their drug of choice. At times like this many people in the early stages of recovery might not be 100% sure they can or even want to give up using altogether. We have found that it is often helpful to bring some of those things out into the open, so you can take a hard look at the things that might tempt you back to using, as well as the reasons for getting or staying clean. Often this helps people deal better with cravings or temptations to use.

Exercise:

Introduction: “You may have seen in cartoons how when someone is being tempted to do something wrong, they have a little devil on one shoulder telling them to go ahead and do it, and a little angel on the other telling them why they shouldn’t. We are going to pretend that’s happening here. The situation is that you have been out of the hospital for a couple of weeks and have been staying clean, but you are in a situation where you are feeling really tempted to use right now. There is a little devil on one shoulder telling you all the reasons why you should use, and a little angel on the other telling you why you shouldn’t. The devil is really persistent, so you have to answer him, not just ignore him. Your job is to argue with the devil and use the angel to help you win the argument.”

Structure: Role-play including three participants; the person in recovery, the “devil” and the “angel.” Other group members may chime in as needed. Use the situation the participant identified as especially difficult for him/her in the role-play to make it more realistic. Devil goes first; negatives/counterpoints should directly address/dispute the positives as well as provide substantive evidence for the negative viewpoint.

Debriefing: When debriefing, be sure to elicit all three participants’ feelings about the experience, especially the person in the “devil” role.

Notes: The goal of this exercise is to build skill in addressing and refuting any positive thoughts/memories the patient may have about use.