Three motivational models and the treatment of psychoactive substances addiction
Three motivational theories / models and studies verifying their efficacy in the field of substance abuse among adults are synthesized. Among them, Motivational Interviewing is the most common in the field of substance abuse treatment, mostly because of its practical orientation toward best practices favouring transformation of ambivalence. Frequently used as a brief intervention, Motivational Interviewing is more efficient than no intervention but is equivalent to recognized treatments. Self-Determination Theory is a general motivational theory, describing motivation as intrinsic or extrinsic, the latest being subcategorized by its self-determination degree. A context promoting autonomy and competence encourage motivation internalisation. Few studies applying this theory to the substance abuse field show that concepts emerging from self-determination theory help to predict some behaviours manifested before, during and after treatment, thus facilitating a better understanding of the motivation’s internalisation processes. Theory of Current Concerns stipulate goals quest as the key element underlying behaviour. Behaviour modification is essentially a goal modification. The goal choices are based on emotional benefits estimated from their anticipated realisation. Consequently, treatment (Systematic Motivational Counseling) is based on a systematic analysis of goals quests and their positive or negative interactions with substance use. Sparse studies give support to the treatment model. The three conceptual / clinical models are complementary. Motivational Interviewing proposes treatment strategies whereas Self-Determination Theory and Theory of Current Concerns offer global conceptual frameworks explaining the observed efficacy of Motivational Interviewing and proposing complementary clinical strategies. The three theories or models do not present oppositions and their integration in the substance abuse clinical practice would be worthwhile.