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PIONEERING PSYCHOLOGIST TO USE AWARD TO CONVENE "THINK TANK"
FOR LEADERS IN ADDICTION FIELD, RESEARCH THE SCIENCE OF SPIRITUALITY AND
RECOVERY
William R. Miller, Ph.D., Named Robert Wood Johnson Foundation
Innovator
(Princeton, NJ, July 23, 2003) - William R. Miller, Ph.D., who introduced a leading method used by clinicians to facilitate change in substance abuse, developed his highly effective technique by working with alcohol-dependent patients and, later, by role-playing with a group of Norwegian psychologists fresh out of graduate school. His technique became a treatment used by many clinicians, and has been disseminated worldwide.
What grew out of these experiences ultimately changed the way clinicians view the nature of substance abuse and its treatment - and led to Miller's development of motivational interviewing, a technique that involves helping patients to find their own motivations for change, and then to act on them. Now, Miller hopes to stimulate more new ideas by convening a brainstorming session on effective treatment with some of the world's leading experts in substance abuse treatment. In another study he plans to develop and evaluate a spiritual intervention to be used as part of treatment to promote recovery from addiction.
Miller, a distinguished professor of psychology and psychiatry at the University of New Mexico, contributed to a seismic shift in the scientific community's thinking on alcohol treatment by introducing a behavioral approach that differs dramatically from traditional models. His method, now widely known as motivational interviewing, is noteworthy for its brevity as well as its effectiveness.
Miller and four others recently received The Robert Wood Johnson Foundation's Innovators Combating Substance Abuse award as part of a program that recognizes leaders in the fields of substance abuse treatment, prevention, and policy development, and brings attention to their groundbreaking work. The program also provides an opportunity for awardees to undertake projects they might not otherwise be able to complete. Miller will use his award to sponsor a brainstorming session for leading innovators in substance abuse treatment and research, explore intervention through health care systems, and to conduct studies on how motivational interviewing has been used, as well as to research the connection between spirituality and recovery from addiction.
Bringing Together the Experts, Fostering Innovative Thinking
To foster innovative thinking, Miller plans to convene a conference in fall 2004 to "start over" with a blank slate and design effective treatment systems, he says. "Suppose we knew everything that has been discovered scientifically about addictions, but had no brand-name treatments or systems for addressing them. What approaches would follow from the science?" Experts will present concise reviews of scientific evidence, as triggers for "nominal group brainstorming" to generate clinical implications and innovations. "The nominal method tends to work better than group brainstorming, because everybody is actively engaged and responsible for doing their own innovative thinking."
Researching Motivational Interviewing, Spirituality and Recovery
Miller also plans to use his Innovators award to conduct a meta-analytic review of research on motivational interviewing, to create a practical model for substance abuse intervention that can be used in routine family practice and primary care, and to develop and test a spiritual adjunct to addiction treatment.
"For 50 years, clinicians have said spirituality is an important part of recovery, but we have very few clinical trials to address this," he notes. He has been impressed by efforts to incorporate spirituality into treatment for minority populations. "It occurs to me that we could also draw on historic Judeo-Christian traditions that are the heritage of a majority of Americans who seek treatment for substance abuse. There are thousands of years of experience with spiritual disciplines and healing." He plans to put together and test a voluntary spiritual component for treatment. "The key, I think, is not to install spirituality, but rather to evoke it."
Miller's thinking was particularly inspired by the Na'nizhoozhi Center in Gallup, New Mexico, which provides substance abuse treatment for Native Americans. "Out in back of the treatment center is a compound with a sweat lodge, teepee, and ceremonial grounds for singing, drumming and dancing -- central components of Navajo spirituality. Why not do something similar drawing on the Judeo-Christian disciplines of meditative prayer, contemplation, fasting, and spiritual direction?" He is also exploring parallels between motivational interviewing and the spiritual direction style of Thomas Merton.
Helping People Find Their Own Reasons to Change
The roots of motivational interviewing date back to 1973, when Miller was a clinical intern at the Wood (Milwaukee) Veterans Administration Hospital in Wisconsin. Working with alcohol-dependent patients there, he found his skills limited. "Knowing nothing about alcoholism, I had them tell me their stories," Miller says. "I just listened. Later, when I began reading descriptions of alcohol-dependent patients, and was surprised to find them characterized as difficult, defensive, hostile liars, incapable of making good decisions. Those were not the same people I had been meeting. I realized that much of the pathology attributed to alcoholics was a product of the way they were being treated."
Miller conducted a series of clinical studies focused on self-control training that resulted in positive outcomes for patients. But his next step proved even more significant: a sabbatical to Norway. While there as a visiting faculty member at an alcoholism treatment facility, Miller met weekly with a group of young psychologists whose line of questioning triggered ideas that would profoundly influence alcoholism treatment worldwide.
While role-playing cases, the psychologists posed provocative queries -- essentially asking Miller to explain his rationale for pursuing certain avenues with patients. "They required me to verbalize the underlying style, the decision rules that I had intuitively developed," Miller says. "I was putting into words what alcoholic patients had taught me to do. I kept notes and wrote the procedures down just so that we could remember them. I called it motivational interviewing because it was very focused on helping people to find their own motivations for change, and the counselor was more like a fascinated interviewer than an inquisitor or expert. I was particularly interested in having clients tell me why they should make changes -- those were the reasons that really mattered."
Miller next wrote a clinical description of this method, which was published in the journal, Behavioural Psychotherapy. In the meantime, he returned to New Mexico and continued his studies in motivational interviewing. He found that his method, initially intended as a prelude to therapeutic intervention, ended up serving as a treatment itself, producing surprisingly rapid results in changing drinking behavior. "We found a 50-60 percent reduction in drinking on average, with a single session" he says. "We had a phenomenon to understand: how such a brief intervention could possibly trigger this kind of change." In other studies, motivational interviewing has been compared with longer outpatient treatment methods, producing similar results.
Miller also found that he could predict treatment outcomes based on the therapist to whom a client had been assigned: the more empathic the therapist, the better the outcomes. "While they were conducting behavior therapy, the extent to which the therapists listened to their patients and reflected what they were hearing accurately was the best predictor of outcome," he adds.
A Successful Treatment Takes Off… Worldwide
On his next sabbatical, to Australia, Miller met Steven Rollnick, who told him that motivational interviewing had become common treatment for addictions in the United Kingdom. This development surprised Miller. Rollnick convinced him to write more on the subject and the two psychologists wound up co-authoring "Motivational Interviewing: Preparing People to Change Addictive Behavior" (Guilford Press, 1991), now considered a classic text that has been translated into Italian, Swedish, Chinese, German, Spanish, and Portuguese.
Motivational interviewing and its structured therapy partner, motivational enhancement therapy, have been tested in dozens of studies with alcohol and illicit drug dependencies, as well as with many other behavioral problems. Miller and Rollnick have now trained a worldwide network of more than 500 trainers , who in turn teach this method to others (www.motivationalinterview.org).
Miller is also known for his contributions to other areas of research, particularly his writings on spirituality and psychology. The implications of his work have been vast, particularly for treatment of alcohol problems, which affect about one in ten adults in America. His work has broadened perspectives on alcohol problems, making it possible to consider interventions in a wide range of settings, particularly within the health care system, in order to prevent the development of more severe, chronic alcohol dependence.
Innovators Combating Substance Abuse is a national program of The Robert Wood Johnson Foundation that recognizes and rewards those who have made substantial, innovative contributions of national significance in the field of substance abuse. Each award includes a grant of $300,000, which is used to conduct a project over a period of up to three years that advances the field. The program addresses problems related to alcohol, tobacco and illicit drugs, through education, advocacy, treatment and policy research and reform at the national, state and local levels. The Innovators program is run by a national program office at The Johns Hopkins University School of Medicine.
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NOTE TO LOCAL EDITORS: William Miller is a resident of Albuquerque, NM.
For additional information on the Innovators Combating Substance Abuse program, please visit the Web site: www.SAInnovators.org.
WILLIAM
R. MILLER, Ph.D.Innovator Combating Substance Abuse
William R. Miller, Ph.D., is Distinguished Professor of Psychology and Psychiatry at the University of New Mexico (UNM), where he joined the faculty in 1976. He has taught a wide range of subjects, including courses on alcoholism and abnormal psychology, and seminars on positive psychology and on self-fulfilling prophecies. His primary scientific interest is in the psychology of change, but his research spans the treatment of addictive behaviors, self-regulation, spirituality and psychology, motivation for change, and pastoral psychology. He has been a visiting scholar at the Oregon Health Sciences University, the University of New South Wales in Sydney, Australia, Stanford University, and the University of Bergen and the Hjellestad Clinic in Norway.
Miller has changed the way clinicians think about the nature of substance abuse disorders, their treatment and the means to effect change in patients. Early in his career, he emphasized that not all alcohol problems are severe and tested briefer interventions for mid-range problem drinkers. He developed a behavioral self-control training program, successfully testing it with less dependent problem drinkers.
Miller also re-conceptualized client motivation for change as the product not of personality, but of the interpersonal interaction of client and counselor. In 1983 he introduced the clinical method of Motivational Interviewing, designed to evoke clients' own intrinsic motivation for change. It was a stark contrast to the confrontational treatment methods of the time, and has since become one of the most widely used methods for treating addictions.
As an administrator, Miller has directed UNM's clinical psychology training program, managed a practice group (Behavior Therapy Associates), directed a large public substance abuse treatment program, and co-directed UNM's Center on Alcoholism, Substance Abuse and Addictions. He also chaired an Initial Review Group for the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the steering committee for NIAAA's multisite Project MATCH trial, and a Trans-Institute working group on Research on Spirituality and Health for the National Institutes of Health.
Miller has served as principal investigator for a number of research grants and contracts, for agencies as diverse as the Bureau of Indian Affairs, the Center for Substance Abuse Prevention, the Pew Charitable Trusts, the National Institute on Drug Abuse, and the U.S. Department of Education. His research has been recognized by the international Jellinek Memorial Award, and a career achievement award from the American Psychological Association's Division 50 (Addiction).
An author or editor of more than 40 books and monographs, Miller has been interviewed or quoted by both national and international broadcast and print media, including The New York Times, National Public Radio, ABC Nightline and Pravda. Among his books-under-contract are "Practical Psychology for Pastors" (3rd edition) for Prentice-Hall and "How to Control Your Drinking" (3rd edition) for Guilford Press. His poetry has appeared in several reviews and his photography has appeared in a publication by Prentice-Hall.
Miller earned his B.A. degree at Lycoming College, graduating magna cum laude. He majored in psychology and minored in philosophy. He attended graduate school at the University of Wisconsin at Madison, and earned his master's and doctoral degrees at the University of Oregon.
Miller is one of five individuals selected to receive The Robert Wood Johnson Foundation's Innovators Combating Substance Abuse award in 2003.
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A national program supported by The Robert Wood Johnson Foundation with direction and technical assistance provided by the Department of Psychiatry and Behavioral Sciences at The Johns Hopkins University School of Medicine.