Substance misuse is not consistently addressed within the scope of routine medical practice. More than 90% of primary care physicians fail to diagnose substance misuse when presented with early symptoms of alcohol or drug misuse in an adult patient. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an integrated, evidence-based approach aimed at delivering early intervention in medical settings for drug and alcohol misuse. An integral component of SBIRT is motivational interviewing (MI), a brief, evidence-based, interventional practice that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI is a patient-focused conversation between a practitioner and a patient that reinforces a patient's motivation to make positive changes in any targeted health behavior. Due to ineffective training, MI is underutilized. The MI approach is very difficult to teach to practitioners who are accustomed to taking a directive approach with patients, asking closed-ended questions (which require yeso answers), and doing most of the talking. To implement MI and SBIRT widely, there is a critical need to improve the MI training process in graduate medical education.
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