Brief Description

Motivational Interviewing (MI) is a person-centered 

counseling technique for promoting behavior change. 

Initially developed for working with people with substance 

use disorders, it is now used in reducing risky behaviors and 

enhancing protective factors across a wide range of health and

social care contexts. Examples include physical activity 

promotion, weight loss, medication adherence, engagement 

with interventions, cancer self-care, sexual health promotion, 

gambling addiction treatment, and suicide prevention. The 

Substance Abuse and Mental Health Services Administration

(SAMHSA) also recommends MI as an outreach strategy in 

connecting with communities reluctant to engage in services, 

such as people experiencing homelessness. 

Is It a Good Fit for My Agency?

MI is a practice style and a conversational strategy rather than 

a program per se. Any community-based organization 

employing health or social service providers who routinely 

interact with service users on a one-on-one basis will benefit 

from some level of staff training in MI. Trainings provide 

skills that empower people to set individualized goals and 

draw out their strengths to help them meet those goals. All 

services that support people in avoiding risky behaviors and 

making healthy life decisions will benefit from this personcentered approach. Trainings of varying modality and 

intensity are available for a broad spectrum of practitioners 

ranging from specialized clinical treatment providers to 

diabetes educators, probation officers, and community 

outreach workers. MI has also been an effective tool in 

addressing vaccine hesitancy. 

Cultural Adaptability 

The central tenet of MI is teamwork between the person who 

uses services and providers. Practitioners are trained to first 

learn about the person’s situation and cultural context. This 

ensures services are effectively tailored to the person’s needs 

and strengths through interactions that empower them to make 

their own decisions. In other words, successful MI 

implementation relies on cultural responsiveness. Research

suggests that the approach, when implemented with fidelity,

has been successful in serving individuals of all ages, gender

identities, sexual orientations, health status, functional or

cognitive abilities, races, ethnicity, and history of trauma. 

How Does It Work?

By its nature, MI works differently depending on the type of 

service, the specific conditions of the service recipient, and the 

broader sociocultural context. All implementations share a set 

of four processes. First, the practitioner establishes rapport and 

forms a partnership with the person. Second, the practitioner 

collaborates with the person to set an agenda and identify 

goals. Third, MI skills are used to identify an individual’s 

strengths and reflect them back to help the person move 

toward his or her goals. Fourth, once the person has decided to 

effect change in their lives, the practitioner helps them plan 

action steps toward behavior change. 

All interactions are guided by principles of respect for the 

person’s right to self-determination, empathy, compassion, 

and affirmation of strengths and worth. A study reviewing the 

effects of MI on older adults suggests that this combination of 

strategies and values has proven effective in moving people 

from reluctance to—or ambivalence toward—changing their 

behavior to recognizing the need to change and acting on a 

plan for change. 

How to Learn More

There are a large number of textbooks, toolkits, and 

multimedia resources on MI, including brief videos that 

describe its core principles. The Motivational Interviewing 

Network of Trainers (MINT) is a good source for training 

materials, online and in-person trainings, and for finding 

onsite trainers for organizations. 

Motivational Interviewing

August 2021
Training Costs

In line with the variety of contexts where MI is utilized and 

with the range of practitioners who use the approach, there are 

multiple modalities and levels of training intensity with 

differing price points. Trainings range from online self-study 

materials to expert guided intensive multi-day courses and 

train-the-trainer strategies. A cost-effectiveness study

comparing three different strategies for training clinicians in 

community-based substance use disorder treatment programs 

calculated fixed costs plus variable costs for 8 clinicians as 

follows (original amounts in 2006 dollars updated to 2021 

dollars based on 32.44% inflation): 

 Self-study (textbook, videos, treatment manual, and a 

one-hour meeting with an expert): $8,133

 Expert-led (self-study materials, 15-hour workshop, 

and audiotaped practice sessions with expert 

feedback): $37,111

 Train-the-trainer (two clinicians from the 

organizations attend the expert-led training, 

additional 15-hour workshop to learn clinical 

supervision and conducting MI workshops, and 

3 monthly consultation calls): $65,185

All three strategies are feasible options depending on the size 

of the organization, type of services, and level of behavior 

change needed. For example, an organization with a large 

number of clinical practitioners and frequent staff turnover 

may find train-the-trainer to be the best option. For an 

organization with a relatively stable, small-to-moderate-size 

workforce providing non-clinical services such as health 

education, case management, or community outreach, selfstudy probably makes better sense. 

There are multiple organizations, some of them commercial, 

that provide high-quality trainings. In addition to MINT 

mentioned earlier, several professional associations 

(e.g., American Psychological Association) and national 

organizations (e.g., National Council on Mental Wellbeing) 

offer trainings of varying intensity. Some online trainings

offer discounted rates for organizations training multiple staff. 

Value of MI in Reducing Risk Factors

MI is a powerful tool in helping community-based 

organizations establish and maintain a person-centered service 

philosophy. There are hundreds of studies assessing the

effectiveness of MI in addressing a variety of behaviors in 

multiple population groups. For example,

 A review of studies testing its success among older adults

with acute and chronic health problems found evidence of 

effectiveness in reducing multiple risk factors, including: 

weight loss and improved adherence to weight loss 

programs; increased frequency and duration of physical 

exercise; decreased sodium intake; improved glucose 

control; decreased blood pressure; and smoking cessation. 

Reducing these risk factors are effective strategies for 

preventing metabolic syndrome which is associated with 

the leading causes of death. 

 A meta-analysis of the impact of MI interventions on 

substance use disorders, conducted by the Washington 

State Institute for Public Policy (WSIPP) found statistically 

significant improvements in treatment engagement, alcohol 

use disorders, illicit drug use disorders, and opioid use 

disorders. 

Costs and Benefits

 MI is an effective tool in lowering the risk of metabolic 

syndrome: A two-year study1 of over 170,000 people with 

and without metabolic syndrome found that the average 

healthcare costs of those with the syndrome were 1.6 

times higher than those without the syndrome. Each 

additional risk factor increases overall costs by 24%.

 In addition to the meta-analysis of program effectiveness, 

WSIPP also conducted a benefit-cost analysis of MI 

implementation. The results indicate that addressing

substance use disorders with MI interventions is highly 

cost-effective: A dollar per participant spent on MI is 

associated with a reduction of $23.05 in total social costs, 

including costs to the participant, to taxpayers, and 

indirect costs.

1 Boudreau et al. (2009). Health care utilization and costs by 

metabolic syndrome risk factors. Metabolic Syndrome and 

Related Disorders, 7(4). DOI: 10.1089/met.2008.0070

Adopting and Financing Motivational Interviewing