Motivational Interviewing Guide for Cannabis

About This Guide

Motivational interviewing (MI) is widely recognized as the gold-standard conversational approach for working with clients who have cannabis use disorder (CUD) or who are ambivalent about changing their cannabis use. MI is a collaborative, person-centered method that elicits and strengthens a client's own motivation for change rather than imposing it from outside.

Research consistently shows that MI produces better outcomes than confrontational or purely educational approaches when addressing substance use, including cannabis. The handout below is designed for use with clients, while the therapist reference section that follows provides clinical guidance for your own preparation.

Therapist Reference: OARS Techniques for Cannabis Conversations

OARS is the foundational skill set of motivational interviewing. Below are cannabis-specific applications of each technique.

Open-Ended Questions

Open-ended questions invite exploration rather than yes/no answers. They help clients examine their relationship with cannabis on their own terms.

• "What role does cannabis play in your daily life?"
• "How has your cannabis use changed over the past year?"
• "What would your life look like six months from now if nothing changed?"
• "What have you noticed about your mood or energy on days you don't use?"
• "What prompted you to start thinking about your cannabis use?"
• "How does cannabis fit into your goals for yourself?"
• "What do you think you would miss most if you stopped using?"
• "What concerns, if any, have the people close to you expressed?"

Affirmations

Affirmations recognize client strengths and efforts. They build self-efficacy, which is especially important when clients feel stuck or ambivalent.

• "It takes courage to talk honestly about something this personal."
• "You clearly care about your health — that matters."
• "The fact that you noticed a pattern shows real self-awareness."
• "You managed to cut back once before. That tells me you have the ability to make changes when you decide to."

Reflections

Reflective listening demonstrates understanding and helps clients hear their own words back. Simple reflections repeat or rephrase; complex reflections add meaning or feeling.

• Simple: "So cannabis helps you unwind after work."
• Complex: "It sounds like cannabis started as a way to relax, but now it feels more like something you need just to get through the evening."
• Amplified: "So there is absolutely nothing about your use that concerns you at all." (Used carefully to elicit the client's own counterargument.)
• Double-sided: "On one hand, cannabis helps you sleep. On the other, you've noticed your memory and motivation aren't what they used to be."

Summaries

Summaries collect and reflect back what the client has said. They are especially useful at transitions in the conversation and when linking change talk from different parts of the session.

• "Let me see if I have this right. You started using cannabis in college to be social, but over time it became more of a daily habit. You've noticed it's affecting your motivation at work, and your partner has mentioned it too. At the same time, you're not sure you're ready to stop completely. Does that capture it?"

Rolling with Resistance: Common Client Statements and MI-Consistent Responses

When clients express resistance, the MI approach is to avoid arguing and instead use it as information about the client's perspective.

A meta-analysis of 17 randomized controlled trials found that motivational interviewing significantly reduced cannabis use frequency and related problems, with effects maintained at follow-up.

Gates PJ, Sabioni P, Copeland J, Le Foll B, Gowing L. Psychosocial interventions for cannabis use disorder. Cochrane Database of Systematic Reviews. 2016;(5):CD005336.