Addictions Case Study: Part 3 - Treatment Plan

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CHAPTER 13

Planting Seeds

A mediocre farmer grows crops; a good farmer grows soil.

—Japanese proverb1

What if, despite your best efforts, there just doesn’t seem to be any change talk to evoke? What if you don’t find any motivational seeds in the soil

for you to nourish? Some people really aren’t ambivalent about their cur- rent situation. Even though they may be aware that others are concerned, it could be that they haven’t even thought about changing, or perhaps they have given up and see no point in trying. This is called the precontempla- tion stage in the transtheoretical model of change.

In our experience, people who at first seem to be unmotivated (in pre- contemplation) often are not. Underneath they are ambivalent. Part of them knows that a change would be a good idea, but they have been defending themselves against such thoughts and perhaps against caring people who tell them why they ought to change and how to do it. If there is some ambiv- alence to be found, then good listening, engaging, and evoking strategies may well encourage change where prior persuasion has not.2

But let’s assume that there genuinely is no ambivalence to unearth. In this case, your fixing reflex might prompt you to try convincing or con- fronting:

“But can’t you see that . . . ?” “Don’t you care that . . . ?”

You might be inclined to argue, warn, or persuade. Such confrontation is notoriously ineffective in changing behavior. Within families or other close relationships, it can turn into pleading, nagging, or threatening.3

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Planting Seeds 215

Another temptation might be to give up. In addiction treatment, people who were judged to be unmotivated or in denial were sometimes told to go away, continue drinking or using, and come back if and when they had “suffered enough.” Families were also advised incorrectly that there

was nothing they could do until their loved one was ready to change.4 Now we know better. Motivation for change is not something residing inside the person that can be measured like a fuel gauge. Motivation can be nurtured in relationships, and doing so is part of your job as a helper.

If someone truly seems to have no ambivalence about what concerns you, you can try planting some seeds that may sprout later. Such seeds are more likely to grow in the soil of a trusting relationship. The engaging skills of MI are important here—asking open questions with curiosity, lis- tening with empathic acceptance to people’s perspectives, acknowledging and affirming their autonomy and strengths. You may also be able to offer information that will raise some doubt about the status quo, doing so in a way to open up consideration rather than shutting it down.5 In essence, you are hoping to create some ambivalence.

Exploring What the Person Already Knows

Before introducing new information, explore what people already know but perhaps have not integrated into their choices. Such a challenge arose in a prenatal care clinic talking with pregnant women who were still drink- ing alcoholic beverages.6 The fixing reflex temptation, of course, would be to lecture them about the very real harms that can come to an unborn child exposed to alcohol in utero. Instead, the staff began by asking the women what they already knew about drinking during pregnancy. As it turned out, the mothers already knew much of what would have been in the lecture, but now they were voicing it themselves. You will again see here the ask–offer–ask structure (described in Chapter 11) as a way of planting seeds.

NURSE: So tell me, what do you know about the effects of alcohol when you’re pregnant?

Ask

MOTHER: It relaxes you?

NURSE: Yes, you can feel some relaxation; but what do you know about the harmful effects of alcohol on you or your unborn child?

Offer

Ask

Confrontation is notoriously ineffective in changing behavior.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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MOTHER: Oh, I don’t know. I’ve heard that your baby can be born small or early, like if you smoke.

NURSE: That’s right! Babies exposed to alcohol in the womb are often born small, and sometimes they never catch up in size.

Offer

MOTHER: Really. Like they stay smaller. NURSE: Yes, it happens. Does that concern

you? Offer, ask

MOTHER: Yes, I guess so. I heard they are born smaller but not that they stay that way.

NURSE: What else do you know? Ask MOTHER: Something about it could affect the

baby’s brain, like their intelligence. NURSE: Uh huh. That’s a real possibility, too.

There is a whole range of permanent things that can happen, called fetal alcohol effects. I can tell you more about those if you want. You do look concerned about that.

Offer

Ask

MOTHER: I want my baby to be healthy. Change talk NURSE: Yes, of course you do. So do I.

The intent here is not to scare or shame the mother. You’re exchanging information. Fear and shame tend to shut people down rather than opening up to uncomfortable information. The hope is to help her integrate what she already knows, hearing herself say it aloud in the presence of a compassionate com- panion. The engaging skills of MI remain important here in how you respond as people have these uncom- fortable conversations.

Exploring What Others Know

If other people in a person’s life are expressing worry even though the cli- ent is not, you can ask with curiosity why they might be concerned, and then listen well. Here is a segment from a first interview with a man whose wife was threatening separation because of his drinking.7 He personally perceived no problem with his drinking, so I (Bill) explored what concerns his wife might have. This is a few minutes into his first interview, and I was having no luck evoking any change talk from Peter.

Fear and shame tend to shut

people down.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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Planting Seeds 217

BILL: I don’t really want to get stuck on the “problem” label because sometimes that’s difficult, and people get stuck in “Well, I don’t have a problem” or “I do have a problem.” I’m more asking you just to tell me about your drinking, anything you’ve noticed about it, and maybe what are the things that she comments on, also—what are the things that she’s concerned about? Open question

PETER: Well, one of the things that I can tell you there is she’s always telling me that, she tells me that I always have a drink in my hand of some kind. When we’re together that’s sort of the way she sees me, is that I would have a drink in my hand. And she even went so far as to tell me one time that if I were to have my portrait painted with some kind of object that would really sort of sum up me, you know, like kings have their portraits done with scepters and that kind of thing, that I would have like a beer can in my hand. She told me that once, and I got upset at that. I laughed at it, but then later on, the more I thought about it, the more I got upset about it, and she seems to think that I’ve always got one, and that bothers her. She says she’s tired of seeing me that way.

BILL: One of her concerns, it sounds like, is amount, just kind of how often you drink, or how often it’s there.

Reflection

PETER: She tells me all the time that I drink too much—too much, and she always told me too much before she picked up the “alcoholic” thing and started telling me that. I think she was afraid to tell me that, and so the first part was just, “Too much, too much, too much.”

BILL: Or it sounds like maybe it built to a point that she felt like she wasn’t getting through, and this is the bigger gun, you know. “Well, maybe you’re an alcoholic.”

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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PETER: Oh yeah, yeah. BILL: And in fact, you’re listening now, so . . . PETER: Yeah, I was surprised when she said

that, because it did come out of the blue, and she never had used that word before.

BILL: Now why would she think that? Any idea what else, besides the amount of drinking, is she responding to?

Open question with curiosity

PETER: She probably thinks that it runs in my family. I was always told by my dad that my grandfather, his father, had a problem with alcohol, and she knew that because she’s been around my folks enough for some of the talk about that to have rubbed off on her, maybe. And so she would tell me things like, “Well, you know it runs in your family, and so look at you. You’re drinking too much and so it runs in your family, and you’re an alcoholic.”

BILL: So some things she’s worried about are the amount of your drinking, and then there seems to be a family history of some kind, and that is associated with some increased risk, so maybe she’s worried about you in that regard, too. What else might she be noticing, do you think?

Starting a bouquet

Offering information

PETER: (pause) Other than that, I don’t know what she’d be noticing. I’ve never been in any real trouble because of it, or anything like that, you know, so it’s not like there’s any big deal that happens, like I come home raging drunk and tear up the house, or anything like that, or fall down the stairs, or something like that. I’ve never had anything like that happen to me, so there’s no really big thing that goes on.

BILL: Not public events. You’re not identified as having a problem by other people. Other people don’t say to you, “Gee, I’m worried about you.”

Reflection

PETER: She’s one of the two people that’s told me that, she thinks that I’ve got a

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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Planting Seeds 219

problem. Only two people have told me that. None of my friends have ever told me that. I’ve never heard anything from my colleagues at work about that. Nobody’s ever said, “Hey, Peter, maybe you’ve got a problem” or something like that. She’s the one that harps on it all the time.

BILL: And the other one was the priest? [Peter previously told me that his wife had spoken with their parish priest who expressed concern.]

Closed question

PETER: Ah well, three if you count the priest. The priest told me that, and my grandmother, when she was alive, used to tell me that. But that was when I was in college. I was kind of rowdy in college, and she didn’t approve of that, and she mentioned some things to me about my drinking when I was in college, but she and my wife are the only ones in the family that ever told me anything like that.

BILL: And is she the one who was married to the grandfather who had a problem with alcohol?

Closed question

PETER: Right. BILL: OK, so she naturally had some sensitivity

and some concerns in that area. You were drinking more in college than now, you think?

Closed question

PETER: No, I don’t think so. BILL: About the same? Closed question PETER: Ah boy. No, maybe more now. That

would be a possibility, that maybe I drink more now. Back in college it was like at parties and stuff.

This interview with Peter took place even before I had met Steve Roll- nick in 1989, and I recognize rough spots. When I listen to my more recent samples of MI, I continue to see room for improvement, but it’s encourag- ing to see progress over time.

Interviewing someone about others’ concerns is done with curiosity

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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220 a dEEPEr diVE inTo Mi

and interest. Be careful not to be thinking “gotcha” in this situation. Ask- ing closed questions—which I was doing too much of here—can lend a feeling of being cross- examined. It’s not about catching people, getting them to “admit” or feel bad. The conversation is already potentially uncom- fortable. As with the nurse example above, the hope is to help Peter inte- grate what he already knows but had compartmentalized in a “no prob- lem” mental box. MI can help people to rethink, reconsider, open up to new perspectives. Some helpers seem to believe that people will change if they can just feel bad enough about themselves. As discussed earlier, it is

much easier to take in potentially threatening information when experiencing acceptance. In MI you are inviting people to look in the mir- ror in an atmosphere of safety and acceptance and to allow what they see to change them.

FOR T HER A PIS T S: Beware Pathologizing

Those of us trained in mental health professions are appropriately schooled in all the things that can go wrong in psychological function- ing. We memorize diagnoses and their symptoms and we study ways to help people recover. Fair enough.

Be careful, though, not to overinterpret clients’ reluctance about change. Ambivalence is a normal human response to deviations from the familiar. For decades in the 20th century, the addiction treatment field was mired in inaccurate but entrenched beliefs that people with substance use disorders were rife with immature and pathological defense mechanisms. Very normal client reluctance that is just one- half of ambivalence was interpreted as resistance, rationalization, and denial. Unfortunately, the prescribed response was to argue and con- front aggressively, which predictably led to more “resistance,” thus confirming the diagnosis. In our own first two editions of Motivational Interviewing, we labeled as “resistance” what we now recognize as sustain talk and discord.

It has long been known that observers tend to attribute what other people do to stable, dispositional traits, whereas the actors themselves perceive that they are reacting to situational factors.8 Trained as defi- cit detectors, we can naturally attribute client behavior to pathological internal causes. Among the things that 40 years of experience with MI have taught us is that client in- session behavior is interactive and can quickly change depending on what we are doing as therapists. It has become clear that “resistance” and “denial” can often be dialed up and down like the volume on a radio depending on the therapist’s

MI can help people open up to new perspectives.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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Planting Seeds 221

behavior. So can motivation for change. So when you begin to make stable, internal attributions of what a client is doing, step back and consider how you may be contributing to it.

Offering Your Own Expertise

So far, we have discussed developing ambivalence by exploring what your client already knows or what significant others think.9 As a trusted helper, you can also offer your own expertise—what you see and what you know about it. You can also express your own concern as an opinion. Sometimes empathic advice from a credible source is enough to trigger change.10 Here’s an example.

FRIEND 1: I notice that your feet are really swollen.

FRIEND 2: Yeah, that’s why I’m wearing sandals.

FRIEND 1: What do you think is going on? Open question FRIEND 2: It’s been really hot outside and I’ve

been in the sun. FRIEND 1: Maybe it’s just the heat or some

sunburn. Reflection

FRIEND 2: It doesn’t hurt. I’m fine. FRIEND 1: Well, I’m concerned for you. Is it

OK if I tell you why? Asking permission

FRIEND 2: OK, but I’m fine really. FRIEND 1: I’m not a doctor or anything, but

I do think you should have that looked at. This isn’t the first time I’ve seen your feet swelled up like that, and it might be something more serious. I’ve seen swelling like that when people have heart problems. It’s up to you, of course [emphasizing autonomy], but I hope you’ll get it checked. I care about you.

Gathering Information and Giving Feedback

Yet another way to develop ambivalence when people seem to be unambiv- alent is to gather more information. Here your goal is to foster the person’s openness to finding out more without making a commitment. Using MI,

Empathic advice from a credible source can

trigger change.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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you can encourage the person to learn more, and the AOA method is a good way to go over such information if the person is willing. Again, this should be done within the context of a trusting, nonjudgmental relationship where you have taken time to engage and allow the person to experience that talk- ing to you is safe.

For example, we developed and advertised a free “drinker’s check- up” for people who wondered whether their alcohol use might be harming them.11 The check-up included a range of measures— questionnaires, blood tests, and cognitive tests—that are sensitive to the early harmful effects of heavy drinking. We made it clear that this was not a treatment program and that what they did with the information they would receive was up to them. This kind of feedback can be particularly engaging for people because, rather than general facts, it provides personal information about their own health. After the check-up, we gave them feedback relative to norms in an AOA style, always listening to the drinker’s own perspectives. Virtually everyone coming for the check-up received potentially concerning results. An unanticipated lesson from these studies: if you wonder whether alcohol is harming you, it probably is.

Here is an example of a feedback session after the check-up. Given the amount of information to be conveyed, the interviewer necessarily does more talking than is usual in MI. A key is how the interviewer responds when a client objects to or disagrees with the information provided.

INTERVIEWER: You will remember reconstructing a calendar of your drinking, and we used that information to calculate the number of standard drinks you have in a typical week. A “standard drink,” by the way, contains half an ounce of pure alcohol. That’s about 10 ounces of beer, 4 ounces of wine, or 1¼ ounce of liquor, depending on the proof or strength. What you reported for a usual week adds up to 19 standard drinks. Based on national survey data, that puts you at the 98th percentile for adult American women. In other words, if you randomly picked 100 American women, you would be drinking more than 97 of them. You look surprised by that. Does it surprise you?

Offering information

Ask

CLIENT: Yes! That can’t be right. I don’t drink that much.

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Planting Seeds 223

INTERVIEWER: It’s not what you expected to hear.

Reflect

CLIENT: I remember the calendar, and maybe I overestimated.

INTERVIEWER: You might have said more than you actually drink in a typical week.

Reflect

CLIENT: I don’t know about that. I guess 19 sounds reasonable, but I certainly don’t drink more than most women, or they’re lying about how much they drink.

INTERVIEWER: It doesn’t make any sense to you. When you compare yourself to other women, it seems like you don’t drink more than they do.

Reflect

CLIENT: The women I know drink pretty much like I do. Maybe I drink more than some of them.

INTERVIEWER: Among the women you think of, your drinking doesn’t seem unusual.

Reflect (continuing the paragraph)

CLIENT: That’s right. Nobody looks at me like, “You’ve having another one?” How do they do those surveys?

INTERVIEWER: They are confidential in- person or phone interviews, often using a method like the calendar you saw.

Offering information

CLIENT: So they might not be telling the truth like I did.

INTERVIEWER: Possibly. You were honest in what you said, and it just doesn’t make sense to you. You can’t figure it out.

Affirm and reflect

CLIENT: Maybe my friends drink more than most?

INTERVIEWER: Could be. The national surveys include women of all ages, and quite a few women don’t drink at all.

Offering information

CLIENT: Oh, I see. So if you only compare me to women who drink . . .

INTERVIEWER: Good point! You’d be around the 94th percentile for American women drinkers.

Offering information

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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224 a dEEPEr diVE inTo Mi

CLIENT: Wow. Really? INTERVIEWER: Yes. Most drinkers do have far

less. Well, let’s take a look at the next result.

The interviewer didn’t disagree or argue but responded patiently and listened well, letting the client make sense of this new information.

We thought that the drinker’s check-up might prompt people to seek treatment, and so we provided a list of available local programs. Almost no one went for help. Instead, most of them substantially reduced their alcohol use on their own after the check-up, by about half on average.12 A computer-based version of the check-up produced similar results.13 This check-up intervention was subsequently called motivational enhancement therapy, which is essentially MI plus personal feedback.14 Similar MI-based check-ups have been successfully applied in addressing marijuana use,15 problem gambling,16 health behavior change,17 HIV risk reduction,18 mari- tal19 and family functioning, and children’s behavior problems.20 When ini- tial motivation for change seems to be slim, adding check-up feedback gives you something to talk about in an MI style and may enhance perceived need and efforts for change.

Reframing

Reframing (previously mentioned in Chapter 7) suggests a potentially dif- ferent meaning for information that a person already knows. We often do this in passing, in a matter-of-fact way without much emphasis. It can be offered as a reflection:

CUSTOMER: My wife is always bugging me about sitting around on the couch so much. It’s like she thinks I’m lazy. I just like to relax, but it’s nag nag nag to get up and do something.

BARBER: She really cares about you.

You don’t insist on a different interpretation, you just offer it. An opportunity for reframing often arose during feedback interviews

after the drinker’s check-up. Based on reconstruction of their recent alcohol use, many participants were hitting very high levels of intoxication that few drinkers reach, yet felt little effect. They were usually quite aware of this, and regarded it (as drinkers often do) to be immunity from harm.

COUNSELOR: OK. So there’s one reason for concern (in a calm matter-of- fact tone).

CLIENT: What? What do you mean?

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Planting Seeds 225

COUNSELOR: Oh, well what do you know about alcohol tolerance?

CLIENT: I can hold my liquor better than most people.

COUNSELOR: Right—that’s tolerance, which puts you at higher risk than most people.

CLIENT: Higher risk? Of what?

COUNSELOR: Medical illness and addiction to alcohol. Should I explain why?

CLIENT: Yes!

COUNSELOR: Tolerance is like not having a smoke alarm. You drink enough to do real damage to your body, but you don’t feel it. Most people have a built-in warning system that says “enough” or “too much,” but you don’t seem to have it.

More could be said about tolerance from the available science, but that’s about enough to plant a seed unless the client wants to know more.

Yes, sometimes there seems to be no ambivalence to explore. Don’t despair, blame, or give up. You may not have much leverage as a helper, but often you can gently plant some seeds for the future. At least avoid doing harm. If you find that your efforts are evoking defensiveness and counter- argument, then you’re in the situation of causing the person to defend the status quo (sustain talk), and persisting in this may close down any fur- ther consideration of change. You may even hear some discord, suggesting potential damage to your relationship. First, do no harm. Leave the door open for future ambivalence.

PERSON A L PERSPEC T IV E : Feedback and Change

In a way, what MI does is to trigger self- regulation.21 Think of a ther- mostat that is set at a desired normal temperature. If the room tem- perature gets too high or too low, systems kick in to restore it back to normal. People work like that, too. We compare where we are with where we’d like to be, and that’s where personal feedback can be use- ful. We have notions about what’s normal, and if we get information that things are out of range and not OK, it can activate intention for change and efforts to self- regulate.

Think about stepping on a scale to gauge your weight. It’s a bit of immediate feedback that could prompt behavior change. People with diabetes check their blood sugar regularly to know if it’s in the desired range. Sometimes getting new information is enough to initiate change. Receiving a new diagnosis, for example, may motivate adjust- ments in health behavior.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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Sometimes the problem is that ideas of what’s normal get out of whack. We tend to compare our own behavior with that of people who are close to us, so if you hang out with people who are outliers, extreme seems normal. Norm correction—accurate information about what actually is normal—can also prompt change.22

Tread gently, though. Depending on how you present it, feedback or new information can raise defensiveness and shut down consider- ation. It matters what you do, and it matters how you do it.

—Bill

K E Y C O N C E P T S

• Developing ambivalence • Norm correction • Self- regulation

K E Y P O I N T S

• When there seems to be no motivation, developing some ambivalence can be a first step toward change.

• Sometimes exploring or reframing what the person already knows (or what significant others know) can plant seeds for change.

• Gathering more information can give you something to talk about, and you can share your own expertise and concern in an MI-consistent way.

Notes and References

1. Johnson, W. (2008). Gardening at the dragon’s gate: At work in the wild and culti- vated world. Bantam, p. xiv.

2. Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta- analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137–160.

Miller, W. R., Meyers, R. J., & Tonigan, J. S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, 688–697.

3. Meyers, R.  J., & Wolfe, B. L. (2004). Get your loved one sober: Alternatives to nagging, pleading and threatening. Hazelden Publishing and Educational Services.

4. There is now a large body of research on working through family members and con- cerned significant others when their loved one seems unwilling to seek help.

Barber, J. G., & Gilbertson, R. (1997). Unilateral interventions for women living with heavy drinkers. Social Work, 42, 69–78.

Kirby, K. C., Marlowe, D. B., Festinger, D. S., Garvey, K. A., & McMonaca,

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Planting Seeds 227

V. (1999). Community reinforcement training for family and significant others of drug abusers: A unilateral intervention to increase treatment entry of drug users. Drug and Alcohol Dependence, 56(1), 85–96.

Smith, J. E., & Meyers, R. J. (2004). Motivating substance abusers to enter treatment: Working with family members. Guilford Press.

Smith, J. E., & Meyers, R. J. (2023). The CRAFT treatment manual for sub- stance use problems: Working with family members. Guilford Press.

Thomas, E.  J., Santa, C., Bronson, D., & Oyserman, D. (1987). Unilateral family therapy with spouses of alcoholics. Journal of Social Service Research, 10, 145–163.

5. Miller, W. R. (2022). On second thought: How ambivalence shapes your life. Guil- ford Press.

6. Handmaker, N. S., Miller, W. R., & Manicke, M. (1999). Findings of a pilot study of motivational interviewing with pregnant drinkers. Journal of Studies on Alco- hol, 60, 285–287.

Handmaker, N. S., & Wilbourne, P. (2001). Motivational Interventions in pre- natal clinics. Alcohol Research and Health, 25(3), 219–229.

7. Interview 11 from Miller, W. R., Rollnick, S., & Moyers, T. B. (2013). Motiva- tional interviewing: Helping people change (DVD series). The Change Companies. www.changecompanies.net/products/motivational- interviewing- videos.

8. Nisbett, R. E., Caputo, C., Legant, P., & Marecek, J. (1973). Behavior as seen by the actor and as seen by the observer. Journal of Personality and Social Psychology, 27(2), 154–164.

Watson, D. (1982). The actor and the observer: How are their perceptions of causality divergent? Psychological Bulletin, 92(3), 682–700.

9. In prior editions, we have called this “developing discrepancy” between the status quo and a client’s important goals and values.

10. Miller, W. R., & Moyers, T. B. (2021). Offering information and advice. In Effec- tive psychotherapists: Clinical skills that improve client outcomes (pp. 109–118). Guilford Press.

11. Miller, W.  R., Sovereign, R.  G., & Krege, B. (1988). Motivational interviewing with problem drinkers: II. The Drinker’s Check-up as a preventive intervention. Behavioural Psychotherapy, 16, 251–268.

12. Miller, W. R., Benefield, R. G., & Tonigan, J. S. (1993). Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. Jour- nal of Consulting and Clinical Psychology, 61, 455–461.

13. Hester, R. K., Squires, D. D., & Delaney, H. D. (2005). The drinker’s check-up: 12– month outcomes of a controlled clinical trial of a stand-alone software program for problem drinkers. Journal of Substance Abuse, 28, 159–169.

See also Stormshak, E.  A., Seeley, J.  R., Caruthers, A.  S., & Cardenas, L. (2019). Evaluating the efficacy of the Family Check-Up Online: A school-based, eHealth model for the prevention of problem behavior during the middle school years. Development and Psychopathology, 31(5), 1873–1886.

14. Miller, W. R., Zweben, A., DiClemente, C., & Rychtarik, R. (1992). Motivational enhancement therapy manual: A clinical research guide for therapist treating indi- viduals with alcohol abuse and dependence (Vol. 2). National Institute on Alcohol Abuse and Alcoholism.

15. Stephens, R. S., Roffman, R. A., Fearer, S. A., Williams, C., & Burke, R. S. (2007). The Marijuana Check-up: Promoting change in ambivalent marijuana users. Addic- tion, 102(6), 947–957.

Walker, D. D., Stephens, R. S., Towe, S., Banes, K., & Roffman, R. (2015). Maintenance check-ups following treatment for cannabis dependence. Journal of Substance Abuse Treatment, 56, 11–15.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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228 A Deeper Dive into Mi

Walker, D. D., Roffman, R. A., Stephens, R. S., Wakana, K., Berghuis, J. P., & Kim, W. (2006). Motivational enhancement therapy for adolescent marijuana users: A preliminary randomized controlled trial. Journal of Consulting and Clini- cal Psychology, 74, 628–632.

Blevins, C. E., Walker, D. D., Stephens, R. S., Banes, K. E., & Roffman, R. A. (2018). Changing social norms: The impact of normative feedback included in motivational enhancement therapy on cannabis outcomes among heavy-using ado- lescents. Addictive Behaviors, 76, 270–274.

Stephens, R. S., Roffman, R. A., Fearer, S. A., Williams, C., & Burke, R. S. (2007). The Marijuana Check-up: Promoting change in ambivalent marijuana users. Addiction, 102(6), 947–957.

16. Hodgins, D. C., Currie, S. R., & el- Guebaly, N. (2001). Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69, 50–57.

17. DiClemente, C. C., Marinilli, A. S., Singh, M., & Bellino, L. E. (2001). The role of feedback in the process of health behavior change. American Journal of Health Behavior, 25, 217–227.

18. Carey, M. P., Braaten, L. S., Maisto, S. A., Gleason, J. R., Forsyth, A. D., Durant, L. E., et al. (2000). Using information, motivational enhancement, and skills train- ing to reduce the risk of HIV infection for low- income urban women: A second randomized clinical trial. Health Psychology, 19, 3–11.

DiClemente, R. J., Rosenbaum, J. E., Rose, E. S., Sales, J. M., Brown, J. L., Renfro, T. L., et al. (2021). Horizons and group motivational enhancement therapy: HIV prevention for alcohol-using young Black women, a randomized experiment. American Journal of Preventive Medicine, 60(5), 629–638.

19. Morrill, M. I., Eubanks- Fleming, C. J., Harp, A. G., Sollenberger, J. W., Darling, E. V., & Cordova, J. V. (2011). The marriage check-up: Increasing access to marital health care. Family Process, 50, 471–485.

20. Dishion, T. J., Brennan, L. M., Shaw, D. S., McEachern, A. D., Wilson, M. N., & Jo, B. (2014). Prevention of problem behavior through annual family check-ups in early childhood: Intervention effects from home to early elementary school. Journal of Abnormal Psychology, 42(3), 343–354.

Uebelacker, L. A., Hecht, J., & Miller, I. W. (2006). The family check-up: A pilot study of a brief intervention to improve family functioning in adults. Family Process, 45, 223–236.

Van Ryzin, M. J., Stormshak, E. A., & Dishion, T. J. (2012). Engaging parents in the family check-up in middle school: Longitudinal effects on family conflict and problem behavior through the high school transition. Journal of Adolescent Health, 50(6), 627–633.

21. Kopp, C. B. (1982). The antecedents of self- regulation: A developmental perspec- tive. Developmental Psychology, 18, 99–214.

Miller, W. R., & Brown, J. M. (1991). Self- regulation as a conceptual basis for the prevention and treatment of addictive behaviours. In N. Heather, W. R. Miller, & J. Greeley (Eds.), Self- control and the addictive behaviours (pp. 3–79). Maxwell Macmillan Publishing Australia.

Vohs, K. D., & Baumeister, R. F. (Eds.). (2016). Handbook of self- regulation: Research, theory, and applications (3rd ed.). Guilford Press.

22. Reid, A. E., Cialdini, R. B., & Aiken, L. S. (2010). Social norms and health behav- ior. In A. Steptoe (Ed.), Handbook of behavioral medicine: Methods and applica- tions (pp. 263–274). Springer.

Agostinelli, G., Brown, J.  M., & Miller, W.  R. (1995). Effects of normative feedback on consumption among heavy drinking college students. Journal of Drug Education, 25, 31–40.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-03-02 04:53:21.

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