Motivational interviewing is a collaborative way of discussing change when a person feels pulled in different directions. In addiction care, someone may want fewer consequences from alcohol or drugs while also fearing what change would involve. The conversation helps clarify the person’s own reasons, concerns, and possible next steps. It can be used within Swiss medical or counseling care, but it does not replace diagnosis, withdrawal assessment, or other treatment that is needed.
You do not have to arrive certain about a final goal. A useful first appointment can establish what you want to understand, what you are willing to consider, and which problems need attention now. The aim is a meaningful decision and a workable next step, rather than a performance of motivation for the clinician.
Ambivalence can contain several different concerns
SAMHSA’s guidance on enhancing motivation treats ambivalence as an understandable part of change. The practitioner explores the person’s perspective and reasons for changing, rather than interpreting uncertainty as a fixed character trait. Motivation is something to work with during care, not simply a condition that must already be met.
For example, someone might want to stop missing family activities but worry about losing a familiar social routine. Another person may accept that medication use has become difficult while fearing withdrawal or a return of the original symptoms. These concerns call for different information and support. Naming them separately makes the discussion more precise.
Before an appointment, write two short descriptions: what you would like to be different and what makes that change difficult to imagine. You do not need to balance the two into a final decision. Bring both to the clinician, including any concern that seems embarrassing or inconsistent with what other people expect you to say.
What the conversation is intended to do
SAMHSA’s motivational interviewing advisory describes four connected processes: building a working relationship, agreeing on a focus, drawing out the person’s reasons for change, and planning. The practitioner uses open questions, reflective listening, acknowledgment of strengths, and summaries to understand the person’s perspective.
In an appointment, that might mean first agreeing whether the most useful subject is alcohol use, missed appointments, medication concerns, or another issue. The clinician can then explore what matters about it before moving into a plan. If the focus does not match the concern that brought you there, say so; the agenda itself may need discussion.
A summary should help you recognize your own position more clearly. If it does not, correct it. For instance, you might explain that you are worried about a particular consequence rather than ready to accept every proposed treatment. A collaborative conversation leaves space for that distinction while still allowing the clinician to give clear medical advice.
Information and autonomy should work together
NIAAA’s brief-intervention guidance combines nonjudgmental feedback, discussion of personal reasons for change, and an agreed plan that can be reviewed later. It also emphasizes that a brief intervention alone is generally insufficient for moderate or severe alcohol-use disorder. Additional treatment should be considered according to need.
Ask the clinician to explain how the health information applies to your circumstances. A laboratory result, symptom, or medication interaction may need a medical explanation before it can inform a decision. If you disagree, identify what is unclear or unconvincing rather than feeling obliged to agree just to end the conversation.
Respecting choice does not require a clinician to say that every option is equally safe. The professional should explain a recommendation and its reasons, while recognizing the patient’s concerns and decisions. Our guide to shared treatment decisions explores how to make those roles explicit.
Importance and confidence are different questions
SAMHSA’s motivation guidance discusses both reasons for change and confidence in carrying it out. Someone can strongly want a different life while doubting that the proposed treatment is possible. Conversely, a change may seem achievable without yet feeling important. Treating those positions as identical can lead to an unhelpful plan.
Consider a person who wants regular treatment but cannot fit the appointments around childcare. Repeating the health consequences does not answer the practical obstacle. The useful discussion is whether the schedule can change, another service is appropriate, or support can be arranged. The person’s motivation should not be judged solely from the attendance problem.
Or consider someone who has attended several programs and is unsure that another will offer anything different. Ask the clinician to explain the proposed difference and how it will be evaluated. A clearer rationale and a defined review point may be more useful than an appeal to “try harder.”
Swiss entry routes can accommodate an exploratory discussion
The Swiss professional resource Praxis Suchtmedizin describes motivational interviewing as a way to strengthen a person’s own motivation to change problematic behavior, including substance use. Its focus on ambivalence is relevant when someone wants help understanding a problem but has not settled on a treatment goal.
The City of Winterthur’s addiction counseling service publishes an initial discussion and work with different goals, including reduced use or abstinence according to the situation. Berner Gesundheit describes counseling for substance-related and behavioral problems, including support for relatives. These are examples of routes for beginning a conversation, not claims that every appointment uses a particular MI protocol.
The FOPH support page links to resources for finding addiction services. Ask a local service whether it can help assess your concerns and discuss options before a decision about residential care. Confirm eligibility and the scope of the appointment rather than assuming a counseling service can also provide medical withdrawal treatment.
A first step can be specific without settling every later decision
A useful plan identifies an action the person understands and is willing to attempt. That might be attending a medical assessment, discussing medication options with a prescriber, arranging a follow-up consultation, or gathering information about a program. The action should have a purpose and a way to review what it achieved. Agree who will arrange it and whom to contact if the referral or appointment does not materialize.
| Unresolved concern | A useful next discussion |
|---|---|
| “I do not know whether this is an addiction.” | Arrange an assessment of the pattern, consequences, and treatment needs. |
| “I want change, but I fear withdrawal.” | Ask for medical evaluation before changing substance use or prescribed medication. |
| “I cannot leave home for a long stay.” | Explore clinically appropriate outpatient options and the reasons a different setting might be needed. |
| “A previous treatment was difficult.” | Review what happened and what a new proposal would change. |
| “My family wants a decision now.” | Clarify the patient’s goals, the family’s concerns, and the clinician’s immediate recommendations. |
Our addiction assessment guide can help prepare the clinical information. A first step should reduce uncertainty or address a current need, rather than become an administrative task with no clear connection to care.
Medical risk cannot wait for complete certainty about change
The NIAAA overview of alcohol-use disorder explains that withdrawal can be dangerous in a dependent person. If you are considering stopping alcohol or changing a sedative or other prescribed medicine, ask for medical assessment. Motivation to make a change does not establish that doing it alone is safe.
Tell the clinician what you are currently using and about previous withdrawal or emergency care. If an urgent health problem is present, it needs an appropriate response even while longer-term goals remain unsettled. For immediate medical danger in Switzerland, call 144, listed in official emergency guidance.
Relatives can contribute without conducting the treatment themselves
A family member may be able to explain observations, practical consequences, and the support they can realistically offer. They can also seek their own advice from services that work with relatives. An MI-informed clinical conversation should not be reduced to a script for persuading another person to accept a particular program.
If a joint appointment is proposed, agree on its purpose. The patient may want help explaining concerns or discussing household arrangements. The relative may need to describe limits on what they can provide. Ask the clinician how these perspectives will be heard and which subjects require separate appointments.
Where an employer, authority, or another party has required attendance, clarify what is mandatory, what choices remain, and what information will be reported. That transparency is necessary for understanding the situation. Do not assume that a general counseling appointment has the same confidentiality or reporting arrangements as a formal third-party assessment.
Return to the plan after a setback or a change in priorities
At follow-up, describe what actually happened after the conversation. Did the referral reach the intended service? Was the appointment manageable? Did a new concern emerge? A plan can be revised when its assumptions turn out to be wrong. The discussion should identify the obstacle rather than treating every difficulty as evidence that the person never wanted change.
If the person is ready for more structured treatment, connect the next step with the appropriate clinical approach. Our relapse-prevention therapy guide explains how goals can become an ongoing plan. Motivational interviewing is useful when it helps a person make an informed choice and connect that choice with care they can actually use.