ASAM Criteria Unplugged: A conversation with Dr. William R. Miller

With around 50 years of experience in the field, Dr. William R. Miller is a pioneer in addiction treatment. To navigate the landscape of individualized care in treatment, we invited Dr. Miller to share his insights in a recent ASAM Unplugged Episode. 


Jump ahead:


The power of motivational interviewing in an intake interview


Dr. Miller sheds light on the importance of integrating motivational interviewing (MI) from the beginning of the treatment process. 

Intake interviews are an opportunity to begin building a therapeutic relationship with your client. Starting out with MI and active listening sets the stage for more effective interventions and successful outcomes. Open-ended questions and reflective listening, rather than a barrage of closed inquiries, helps clients feel understood and valued. When the client feels engaged in their own treatment and recovery, they are more likely to feel motivated to progress through the stages of change. 


Pro tip: Dr. Miller suggests the initial questions to engage your clients in their intake interview: 

  • “What brings you here?”
  • “Tell me a little about what’s happening in your life right now?” 
  • “What are you hoping we can help you with?”
As your client responds to these open questions, listen for change talk and reflect it back to your client. Once the initial intake interview is complete, continue using motivational interviewing techniques to engage with your client. This can help you adjust their treatment plan as needed. 


Note: MI techniques have been proven to be even more effective with minority populations.

Many people in minority groups are marginalized, oppressed and may not be used to inherently receiving respect from others particularly in authoritative positions. This often contributes to resistance to working with treatment staff. Using MI, accurate empathy, reflective listening and showing genuine interest in and respect for your clients is key. Because of these essential elements, MI has been shown to be effective when working with adolescents, people of different cultural backgrounds, involuntary clients and clients in group settings.


Essential elements of the therapeutic relationship


Based on research such as Project MATCH, we now know that treatment modalities don't definitively predict outcomes. Rather, it is the attitude and approach of the clinician, the therapeutic relationship, that has a significant, positive impact on retention of care and treatment outcomes.

Dr. Miller states motivational interviewing is an essential part of successful treatment outcomes. He adds that it can be visualized as a journey of trust and collaboration: “Can we take a walk together? Where are we going? What are the reasons for our journey? How can we get there together?”

Some key elements of a therapeutic relationship include: 

Expertise is the understanding that both client and clinician bring expertise to the relationship. The clinician has expertise in the field of addiction treatment, and the client has expertise on themselves. Together, this can help identify shared treatment goals. 

A collaborative approach deeply values the voice of the client. As a clinician, it may be tempting to think, “I can fix you” or “I know how to solve the problem.” However, trying to engage your client in this way often results in the righting reflex. The client will naturally push back and begin to voice their reasons not to change. 
Accurate empathy is an active effort to truly understand your client. It is the sincere, productive desire to get to the underlying feelings and motivations behind their words.



More from Dr. Miller

The entire second episode of our ASAM Criteria Unplugged series can be found here on our Fidelity platform.

Dr. Miller has also recently joined us for a webinar on his new fourth edition of Motivational Interviewing: Helping People Change and Grow.

Dr. Miller’s insights can also be explored in detail in the second edition of Treating Addiction, as well as his many other publications.