ABSTRACT
In this chapter we propose a protocol for integrating motivational dialogue into routine treatment of alcohol and drug dependence using a stepped care approach. In earlier chapters we have explored the evidence for using a motivational style of counselling problem drinkers as compared with a confrontational approach (see Chapter 1) and with a non-directive approach (see Chapter 8). In Chapter 5, Kadden and colleagues reviewed the evidence for using motivational interviewing as a stand-alone treatment with different substance problems in different permutations and as a treatment combined with other treatments. In this chapter we suggest a further integration whereby all interventions are delivered using a stepped care framework starting with assessment and simple advice and working up through increasingly intensive interventions. The point of this book, and the two final chapters in particular, is to demonstrate the potential benefits and the feasibility of delivering all these interventions in the style of motivational dialogue. It is a way of putting together all the evidence we have assembled into a logical interpretation and then into practice.
