In the 1970s, a number of psychologists emerged to challenge the paradigm that substance problems are a result of an innate disease condition. Major figures such as Alan Marlatt, the Sobells and Nick Heather demonstrated that problems could be understood, to a significant degree, as the product of faulty learning; this led to the development of a range of innovative interventions based on behavioural theories. Bill Miller was one of these revolutionaries. In a fascinating interview available free online, William White explores with Miller the extent of his work and his concerns.
Bill Miller is, of course, best known as the father of motivational interviewing but his contribution is much wider than this, as the interview demonstrates. Miller’s curiosity has led him to research such diverse areas as what makes some people more effective counsellors than others, the influence of AA on recovery outcomes, motivation, spirituality and recovery, transformational change experiences and community reinforcement approaches. His work is characterised by an insistence on basing ‘treatments’ on the evidence provided by rigorous research, grounded in a profound humanity as this sample of quotes from the interview shows:
- On empathy: ‘It is a respectful, hopeful, engaged kind of listening that brings out the best in people.’
- On the concept of rock bottom and motivation: ‘It’s not that people need to suffer severely; it’s that they need to decide.’
- On motivational interviewing: ‘I’m not sure it’s a “technology” as much as a way of being with people.’
- On relapse: ‘In good recovery… episodes of symptoms become shorter, less severe and more widely spaced. Perfection is the exception.’
This is the sort of article which, read over the lunchtime sandwich, can give hard-pressed practitioners inspiration for the afternoon to come. For those who have experienced problems themselves, it provides insights into the best that interventions can provide.
Let’s leave the final, and optimistic, note to Miller himself: ‘The good news in addiction treatment is that we now have a menu of evidence-based alternatives to try. If one thing is not working, try something else, or a combination of approaches.’
The interview is available at http://bit.ly/2c3WwZM
George Allan is chair of Scottish Drugs Forum. He is the author of Working with Substance Users: a Guide to Effective Interventions (2014; Palgrave).