This activity is designed to change: Competence, Performance.1hr(s)
Activity Format:

After reviewing this page, be sure to go back to the Activity page using the long, blue-green clickable button above, and look for a similar button for the next instructions.

Reminder: Spending more than 15 minutes on any page will result in being logged out. To keep from being automatically logged out, avoid bookmarking module pages. Instead, please be sure to always access the activity through the activity homepage, to ensure being able to progress through the modules correctly.

Overview

Goal: To train health care providers and students in primary care and other clinical settings in the basic motivational interviewing techniques to motivate people having substance use and other health problems to change behaviors in order to improve health.

Professional Practice GapsSubstance abuse is fairly common, occurring in approximately 20% of primary care patients (Madras et al., 2009). In 2014, around 8.1 percent of Americans had a substance use disorder (CBHSQ, 2015). Brief interventions in the medical setting have been shown to reduce these problems, for instance, reducing alcohol use and follow-through with treatment (Babor et al, 2007; Madras et al., 2009). Despite the demonstrated effectiveness of these interventions, the reality is that few primary care providers are routinely providing substance use screening or intervention with their patients (Roche and Freeman, 2004; D'Amico et al., 2005). Interventions that go beyond basic screening are even less common than screening: Most patients for whom substance abuse was identified in a national survey of 7,371 patients did not receive appropriate follow-up by their health care provider (D'Amico et al., 2005). In our needs analysis interviews with 8 addiction specialists, all agreed that primary care providers need more training in counseling skills for use in brief interventions; primary care providers interviewed expressed an interest in learning structured techniques that they could fit into busy practices (CTI, 2009). Motivational interviewing is a set of structured counseling skills that has been shown to be one of the most effective means of motivating patients to change addictive behavior (Miller and Rollnick, 2012). Motivational Intrviewing has been used successfully in primary care settings as the brief intervention phase of addiction treatment (Rahm et al., 2014). Ideally, all providers would know motivational interviewing or other effective counseling skills, feel competent using them, and use them routinely for brief interventions for substance abuse in primary care patients. Training primary care providers in motivational interviewing will help address these knowledge, competence, practice, and outcome gaps between current practice and the ideal (Carroll et al., 2006).
Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28(3): 7-30. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18077300 Accessed on: 2014-07-28.
Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL, Polcin D, Snead N, Woody GE, National Institute on Drug Abuse Clinical Trials Network. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 2006; 81(3): 301-12. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16169159 Accessed on: 2014-07-29.
Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. HHS Publication. 2015; SMA 15-4927, NSDUH Series H-50: . Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm
Clinical Tools Inc. Needs analysis evaluation for: Online Skills Training for Primary Care Physicians on Substance Abuse.. NIDA Contract No. HHSN271200800038C. 2009.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Mersy DJ. Recognition of alcohol and substance abuse. American Family Physician. 2003; 67: 1529-1532. Available at: http://www.aafp.org/afp/2003/0401/p1529.html Accessed on: 2013-10-24.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.

Educational Objectives:

After completing this activity participants will be able to:
  • Use a patient-centered, non-authoritarian, collaborative approach to establish a therapeutic alliance with a patient who needs to make a health behavior change.

  • Use communication skills from motivational interviewing to work collaboratively with patients to identify a a specific health behavior change goal as the focus during the counseling session.

  • Identify a patient's current readiness to change a health behavior problem and select the appropriate steps and skills of motivational interviewing to use based on that level of readiness.

  • Evoke participation by patients in exploring their motivations, ambivalence, or resistance to making a health behavior change.

  • Apply motivational interviewing techniques in collaborative planning with patients to address substance use or other health problems.

  • Adapt motivational interviewing skills to medical settings.

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.complies with the Standards for Commercial Support issued by the ACCME and requires disclosure of and resolution of any conflicts of interest for those in control of content.
Karen Rossie, RN, PhD (Research Scientist, Clinical Tools, Inc. )Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.
Disclosure: Has disclosed no relevant financial relationships.

Reviewers

Peter Friedmann, MD (Associate Professor of Medicine and Community Health, Brown Medical School)Dr. Friedmann is a primary care physician, ASAM-certified addictionist, and substance abuse researcher. He is a nationally recognized expert on screening for substance use disorders in medical settings, the organization of care for patients with addictive disorders, and the role of the primary care physician in the diagnosis and treatment of substance problems. He has given several invited presentations on buprenorphine in primary care and on substance abuse treatment in primary care. He is a course director for ASAM's buprenorphine training series, a member of ASAM's Buprenorphine Training Subcommittee and a mentor in the SAMHSA-funded Physician Clinical Support System (www.pcssmentor.org). He is also president-elect for the Association for Medical Education and Research in Substance Abuse (www.amersa.org).
Disclosure: Has disclosed no relevant financial relationships.
Timothy John McGrath, MD, MBA (Family Physician, Private Practice )Dr. McGrath is currently in private practice in Mebane, North Carolina. He earned his undergraduate degree at Drew University and his medical degree at the Medical College of Georgia. He completed his residency at the University of North Carolina at Chapel Hill, where he served as Chief Resident in the Department of Family Medicine. His interests include preventive medicine and disease modifying lifestyles, medical delivery systems, and medical economics. He is currently enrolled in the Kenan Flagler executive master of business administration program at UNC. Dr. McGrath is an active member of the NCAFP, AAFP, and AMA.
Disclosure: Has disclosed no relevant financial relationships.
Ted Diedrich, MSc (SBIRT Progarm Coordinator; PhD Student, Denver Health and Hospital Authority, Denver, CO University of Colorado at Denver)
Disclosure: Has disclosed no relevant financial relationships.

Review Dates

Content Review:Editorial Review:
Thu, 1/5/2017Mon, 1/9/2017

Modules in this Training Activity

  • Motivational Interviewing for Primary Care

Module Practice Gap References
BoiseCoE. Motivational Interviewing -- OARS Skills. BoiseCoE. 2012. Available at: https://youtu.be/_KNIPGV7Xyg Accessed on: 2015-10-06.
Butler C, Rollnick S, Cohen D, Russell I, Stott N. Motivational counseling versus brief advice for smokers in general practice: a randomized trial. BR J Gen Pract. 1999; 49: 611-616. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1316198/ Accessed on: 2013-10-25.
Carey KB. Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Mental Health Journal. 1996; 32: 291-306. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8790970 Accessed on: 2013-10-28.
Clinical Tools, Inc.. Motivational Interviewing. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Clinical Tools, Inc.. Motivational Interviewing: Managing Challenging Patient Behavior. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Community Care of North Carolina. CCNC Motivational Interviewing Resource Guide. . 2013. Available at: https://www.communitycarenc.org/media/files/mi-guide.pdf Accessed on: 2015-06-11.
Copeland L, McNamara R, Kelson M, et al. Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: A systematic review. Patient Educ Couns. 2015; 98(4): 401-11. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25535015 Accessed on: 2015-09-29.
DiLillo V , West DS. Motivational interviewing for weight loss . Psychiatric Clinics of North America . 2011; 34: 861-869. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22098809 Accessed on: 2015-05-27.
Emmons K, Rollnick S. Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11137778 Accessed on: 2013-10-24.
Engle B. Motivational Interview with "Resistant" Heavy Drinker. . 2012. Available at: https://youtu.be/eNfy-FVvnRs Accessed on: 2015-10-06.
Glynn LH, Moyers TB. Chasing change talk: the clinician's role in evoking client language about change. Journal of Substance Abuse Treatment. 2010; 39(1): 65-70. Available at: http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(10)00073-5/abstract Accessed on: 2015-10-06.
Ingersoll KS, Wagner CC, Gharib S. Motivational groups for community substance abuse problems. Mid-Atlantic Addiction Technology Transfer Center, Center for Substance Abuse Treatment. 2000. Available at: http://people.uncw.edu/ogler/MI%20Groups%20for%20Com%20SA%20Prog.pdf Accessed on: 2013-10-24.
Lundal B, Moleni T, Burke B L, et al. Motivational Interviewing in Medical Care Settings: A systematic review and meta-analysis randomized controlled trials. Patient Education and Counseling. 2013; 93(2): 157-68. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24001658 Accessed on: 2015-09-29.
Lyme A. Motivational Interviewing - Good Example. TheIRETAchannel. 2013. Available at: https://youtu.be/67I6g1I7Zao Accessed on: 2015-10-06.
Marlatt GA. Harm Reduction: come as you are. Addict Behav. 1996; 21: 779-88. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8904943 Accessed on: 2013-10-25.
Miller W. Motivational interviewing with problem drinkers. Behav Psych. 1983; 11: 147-172. Available at: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5845668 Accessed on: 2013-10-25.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. Applications of Motivational Interviewing Series. New York: Guilford Press.. 2012; 3rd edition: . Available at: http://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274 Accessed on: 2014-07-08.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior.. New York, NY; Guilford Press. 1991. Available at: http://www.amazon.com/Motivational-Interviewing-Preparing-Addictive-Behavior/dp/089862469X Accessed on: 2013-10-24.
Moyers TB. The Relationship in Motivational Learning. Psychotherapy (Chic). 2014; 51(3): 358-63. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25068193 Accessed on: 2015-09-29.
Pirlott AG, Kisbu-Sakarya Y, Defrancesco CA, et al. Mechanisms of Motivational Interviewing in Health Promotion: A Bayesian mediation analysis. Int J Behav Nutr Phys Act. 2012; 9(1): 69. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22681874 Accessed on: 2015-09-29.
Prochaska JO, DiClemente CC. Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research and Practice. 1982; 19: 276-288. Available at: http://psycnet.apa.org/journals/pst/19/3/276/ Accessed on: 2013-10-25.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. American Journal of Health Promotion. 1997; 12: 38-48. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10170434 Accessed on: 2013-10-25.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Rollnick S, Butler CC, Stott N. Helping smokers make decisions: the enhancement of brief interventions for general medical practice. Patient Educ Couns. 1997; 31: 191-203. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9277242 Accessed on: 2013-10-25.
Rollnick S, Mason P, Butler C. Health behavior change: a guide for practitioners. Churchill Livingstone. 2003. Available at: https://books.google.com/books?id=iWjZQAAACAAJ&lr= Accessed on: 2013-10-25.
Rollnick S, Miller WR. What is motivational interviewing?. Behav Cognitive Psychother. 1995; 23: 325-334. Available at: http://www.motivationalinterview.net/clinical/whatismi.html Accessed on: 2013-10-24.
Rosengren D, Wagner CC. Motivational interviewing: shall we dance? . In: Coombs R, ed. Addiction Recovery Tools: A Practitioner's Handbook. Sage Publications. 2001. Available at: https://us.sagepub.com/en-us/nam/addiction-recovery-tools/book9537 Accessed on: 2015-11-11.
Rounsaville BJ. Using motivational interviewing in routine care. Paper presented at: National Institute on Drug Abuse Conference--Blending Clinical Practice and Research. March 14, 2002. Available at: http://archives.drugabuse.gov/pdf/blending/Rounsaville.pdf Accessed on: 2010-06-15.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 . 7th Edition, Washington, DC: U.S. Government Printing Office. 2010. Available at: http://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf Accessed on: 2014-09-23.
van der Wouden JC, Rietmeijer C. Motivational Interviewing in the Medical Care Setting. Patient Education Counseling . 2014; 96(1): 142. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24856448 Accessed on: 2015-09-29.
Wagner C, Conners W. Interaction techniques. Mid-Atlantic Addiction Technology Transfer Center. 2003c. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Wagner C, Conners W. Motivational interviewing principles. Motivational Interviewing Website. 2003b. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Westar HA , Aviram A. Core Skills in Motivational Interviewing. Psychotherapy (Chic). 2013; 50(3): 273-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24000834 Accessed on: 2015-09-29.
Westra HA. Motivational interviewing in the treatment of anxiety . The Guilford Press. 2012. Available at: http://www.guilford.com/books/Motivational-Interviewing-in-the-Treatment-of-Anxiety/Henny-Westra/9781462525997 Accessed on: 2015-06-25.

Audience and Accreditation

Audience:

Health care professionals

TypeEst. TimeReleasedExpires
FBRC1 hr(s)12/3/1512/3/17
FBN1 hr(s)11/20/1510/31/17
FBCSW1 hr(s)12/3/1512/3/17
AMA PRA Category 1 Credit(s)™1hr(s)12/3/1512/3/18
FBM1 hr(s)12/3/1512/3/17
FAPA1 hr(s)12/3/1512/3/17
NYS OASAS1 hr(s)4/6/174/5/19
NBCC1 hr(s)3/16/163/16/19

Designation Statement: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education by Clinical Tools, Inc.. Clinical Tools, Inc. is accredited by the ACCME to provide continuing medical education for physicians.
FBRC Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 hour(s) of FBRC credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
FBN Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 hour(s) of FBN credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
FBCSW Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 hour(s) of FBCSW credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
AMA PRA Category 1 Credit(s)™ Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
FBM Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 hour(s) of FBM credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
FAPA Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 hour(s) of FAPA credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
NYS OASAS Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 hour(s) of NYS OASAS credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
NBCC Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1 clock hour(s) of NBCC credit. Clinical Tools, Inc. has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6161. Activities that do not qualify for NBCC credit are clearly identified. Clinical Tools is solely responsible for all aspects of the activity.
A letter of completion for up to 1 hour(s) is available for non-physicians.
A score of 70% on the post-test is required to complete the activity.
Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

Training Activity References
BoiseCoE. Motivational Interviewing -- OARS Skills. BoiseCoE. 2012. Available at: https://youtu.be/_KNIPGV7Xyg Accessed on: 2015-10-06.
Butler C, Rollnick S, Cohen D, Russell I, Stott N. Motivational counseling versus brief advice for smokers in general practice: a randomized trial. BR J Gen Pract. 1999; 49: 611-616. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1316198/ Accessed on: 2013-10-25.
Carey KB. Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Mental Health Journal. 1996; 32: 291-306. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8790970 Accessed on: 2013-10-28.
Clinical Tools, Inc.. Motivational Interviewing. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Clinical Tools, Inc.. Motivational Interviewing: Managing Challenging Patient Behavior. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Community Care of North Carolina. CCNC Motivational Interviewing Resource Guide. . 2013. Available at: https://www.communitycarenc.org/media/files/mi-guide.pdf Accessed on: 2015-06-11.
Copeland L, McNamara R, Kelson M, et al. Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: A systematic review. Patient Educ Couns. 2015; 98(4): 401-11. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25535015 Accessed on: 2015-09-29.
DiLillo V , West DS. Motivational interviewing for weight loss . Psychiatric Clinics of North America . 2011; 34: 861-869. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22098809 Accessed on: 2015-05-27.
Emmons K, Rollnick S. Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11137778 Accessed on: 2013-10-24.
Engle B. Motivational Interview with "Resistant" Heavy Drinker. . 2012. Available at: https://youtu.be/eNfy-FVvnRs Accessed on: 2015-10-06.
Glynn LH, Moyers TB. Chasing change talk: the clinician's role in evoking client language about change. Journal of Substance Abuse Treatment. 2010; 39(1): 65-70. Available at: http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(10)00073-5/abstract Accessed on: 2015-10-06.
Ingersoll KS, Wagner CC, Gharib S. Motivational groups for community substance abuse problems. Mid-Atlantic Addiction Technology Transfer Center, Center for Substance Abuse Treatment. 2000. Available at: http://people.uncw.edu/ogler/MI%20Groups%20for%20Com%20SA%20Prog.pdf Accessed on: 2013-10-24.
Lundal B, Moleni T, Burke B L, et al. Motivational Interviewing in Medical Care Settings: A systematic review and meta-analysis randomized controlled trials. Patient Education and Counseling. 2013; 93(2): 157-68. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24001658 Accessed on: 2015-09-29.
Lyme A. Motivational Interviewing - Good Example. TheIRETAchannel. 2013. Available at: https://youtu.be/67I6g1I7Zao Accessed on: 2015-10-06.
Marlatt GA. Harm Reduction: come as you are. Addict Behav. 1996; 21: 779-88. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8904943 Accessed on: 2013-10-25.
Miller W. Motivational interviewing with problem drinkers. Behav Psych. 1983; 11: 147-172. Available at: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5845668 Accessed on: 2013-10-25.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. Applications of Motivational Interviewing Series. New York: Guilford Press.. 2012; 3rd edition: . Available at: http://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274 Accessed on: 2014-07-08.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior.. New York, NY; Guilford Press. 1991. Available at: http://www.amazon.com/Motivational-Interviewing-Preparing-Addictive-Behavior/dp/089862469X Accessed on: 2013-10-24.
Moyers TB. The Relationship in Motivational Learning. Psychotherapy (Chic). 2014; 51(3): 358-63. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25068193 Accessed on: 2015-09-29.
Pirlott AG, Kisbu-Sakarya Y, Defrancesco CA, et al. Mechanisms of Motivational Interviewing in Health Promotion: A Bayesian mediation analysis. Int J Behav Nutr Phys Act. 2012; 9(1): 69. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22681874 Accessed on: 2015-09-29.
Prochaska JO, DiClemente CC. Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research and Practice. 1982; 19: 276-288. Available at: http://psycnet.apa.org/journals/pst/19/3/276/ Accessed on: 2013-10-25.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. American Journal of Health Promotion. 1997; 12: 38-48. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10170434 Accessed on: 2013-10-25.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Rollnick S, Butler CC, Stott N. Helping smokers make decisions: the enhancement of brief interventions for general medical practice. Patient Educ Couns. 1997; 31: 191-203. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9277242 Accessed on: 2013-10-25.
Rollnick S, Mason P, Butler C. Health behavior change: a guide for practitioners. Churchill Livingstone. 2003. Available at: https://books.google.com/books?id=iWjZQAAACAAJ&lr= Accessed on: 2013-10-25.
Rollnick S, Miller WR. What is motivational interviewing?. Behav Cognitive Psychother. 1995; 23: 325-334. Available at: http://www.motivationalinterview.net/clinical/whatismi.html Accessed on: 2013-10-24.
Rosengren D, Wagner CC. Motivational interviewing: shall we dance? . In: Coombs R, ed. Addiction Recovery Tools: A Practitioner's Handbook. Sage Publications. 2001. Available at: https://us.sagepub.com/en-us/nam/addiction-recovery-tools/book9537 Accessed on: 2015-11-11.
Rounsaville BJ. Using motivational interviewing in routine care. Paper presented at: National Institute on Drug Abuse Conference--Blending Clinical Practice and Research. March 14, 2002. Available at: http://archives.drugabuse.gov/pdf/blending/Rounsaville.pdf Accessed on: 2010-06-15.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 . 7th Edition, Washington, DC: U.S. Government Printing Office. 2010. Available at: http://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf Accessed on: 2014-09-23.
van der Wouden JC, Rietmeijer C. Motivational Interviewing in the Medical Care Setting. Patient Education Counseling . 2014; 96(1): 142. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24856448 Accessed on: 2015-09-29.
Wagner C, Conners W. Interaction techniques. Mid-Atlantic Addiction Technology Transfer Center. 2003c. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Wagner C, Conners W. Motivational interviewing principles. Motivational Interviewing Website. 2003b. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Westar HA , Aviram A. Core Skills in Motivational Interviewing. Psychotherapy (Chic). 2013; 50(3): 273-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24000834 Accessed on: 2015-09-29.
Westra HA. Motivational interviewing in the treatment of anxiety . The Guilford Press. 2012. Available at: http://www.guilford.com/books/Motivational-Interviewing-in-the-Treatment-of-Anxiety/Henny-Westra/9781462525997 Accessed on: 2015-06-25.
FundingInitial development of this activity was supported by a grant from the National Heart, Lung, and Blood Institute (#R44HL65885).