Introducing Alcohol Monitoring with Motivational Interviewing
Alcohol monitoring can be a difficult subject for clients in early recovery. Hesitation, resistance, and fear of being judged are common. Dr. Janice Blair, PhD in Clinical Psychology, has decades of experience guiding families and clinicians through these conversations and emphasizes how motivational interviewing (MI) provides a practical framework.
She explains that MI involves three positions a helper can take: Directing, Guiding, and Following. “Relative to alcohol monitoring, Directing is typically done by someone in authority to ensure abstinence for people in safety-sensitive positions. Examples are Medical and Nursing Boards, the FAA (for those in the aviation field), and the Department of Child Services for parents. Those without mandating power, such as Health Care professionals and families, should be informed about the Readiness to Change Model, closely related to MI. In my experience, most clients are in the very early stages of change, and it takes time for treatment and abstinence to shift them from external to internal motivation.”
She notes that Soberlink provides this time and compares it to transformation: “I liken it to the caterpillar’s metamorphosis; treatment and testing are the cocoon.”
When clients are hesitant, Following and Guiding become the most effective approaches. “Getting the best plan in place means meeting clients where they are, which begins with following: active listening, empathy, and no judgment, evaluation, or advice. Guiding is a blend of the helper’s expertise, knowledge, and experience coupled with the client’s agency, responsibility, and what Buddhists call ‘Beginner’s Mind.’ This works well only when trust has been established, and both are aiming at the same goalpost.”
Tips That Reframe Monitoring as Supportive
Clients often see alcohol monitoring as punitive until the conversation shifts to empathy and solidarity. Dr. Blair points to a timeless truth: “Teddy Roosevelt said something so true that it remains the cornerstone of all therapies to this day. ‘People don’t care how much you know until they know how much you care.’ Foundational to any treatment or support is a solid understanding of the client’s suffering; it’s only in hearing their story that I get a clear picture of their ‘language,’ their insight and their readiness to change. Trust isn’t established until the client feels seen, heard, and understood.”
She stresses that education is equally important. “They must understand that their best efforts are being sabotaged by their current neurobiology. I teach them to differentiate the addicted brain (‘the Addict’) from their True Self. I experience the former as a terrorist intent on keeping the True Self hostage.” Helping clients externalize addiction reduces shame and builds clarity around why monitoring is supportive.
Dr. Blair explains how this shift reframes the testing process: “Valid testing gives addicts a life-saving Pause Button and a moment to think about the consequences of their next choice. Without that accountability, craving wins. Without an understanding of these basics, clients rarely come to see that these solutions are happening for them, not to them.”
The Role of Accountability in Motivation
Accountability strengthens recovery by creating stability during vulnerable early stages. “For decades, we’ve studied addicts in empirically-based mandated programs. They are required to undergo drug and alcohol testing, participate in recommended therapies, a facilitated group, and 12-step support, all for 3-5 years. Their success rates are overwhelmingly higher compared to those not tested and not following up with therapeutic recommendations. Especially for those in their early years, drug and alcohol testing is the most predictive factor of long-term sobriety.”
Monitoring works because it creates both structure and guardrails, but those guardrails are only effective if the results can be trusted. A system that leaves room for manipulation creates a dangerous false sense of security, undermining both treatment and family trust. That is why reliability is essential. Tools like Soberlink are designed to close these gaps: facial recognition confirms the right person is testing, tamper detection prevents device interference, and real-time results are automatically sent to designated parties. These safeguards mean clients cannot “cheat” the system, ensuring accountability is authentic. For clinicians and families, this level of integrity transforms monitoring from a checkbox into a true protective measure that promotes safety, progress, and peace of mind.
“Support and Accountability are the guardrails recovering addicts require. Following the professionally recommended plan until they are demonstrating ongoing recovery is necessary to avoid subsequent inpatient treatments. Demonstrating means you’re witnessing changes in their behavior, their thinking, and the manageability of their lives. Ongoing means a year or more at least.”
She adds that knowing results are visible changes behavior in real time. “Knowing someone will be notified if tests are positive or missed inherently prevents the addict from being on autopilot. Being in a conscious and intentional mind state is KEY.” Many clients describe relief when they know accountability is built in, with one sharing it felt like “a cop in my rearview mirror.”
Supporting Clients’ Goals Through Monitoring
At its core, alcohol monitoring is not about punishment. It supports clients’ intrinsic goals, such as rebuilding trust and creating structure after treatment. Dr. Blair explains, “Recovering addicts and their families share the same goals — a happy, productive, healthy life for the addict, and rebuilding trust and connection with each other. Like it or not, trust happens only with verifiable proof.”
Families often enter the process feeling hopeless. “Most have been through countless false starts and are depleted and afraid to let themselves hope. The rinse-and-repeat relapses and chaos are not anyone’s fault — they are caused by not having a good plan. This is a disease that takes the lives of most people who suffer from it unnecessarily, and primarily because people don’t know what works or where to turn. Experience and research have collectively developed a tried-and-true roadmap, and millions of people are living good lives today because of it. I’m one of them.”
When Resistance Turns Into Willingness
Clinicians often witness clients move from resistance to acceptance, but only when the right approach is used. Dr. Blair is direct: “I can’t think of a time when resistance-to-willingness happens without the MI approach. As a professional, I must stay in harmony with clients so as not to slip into my default mode of flood-them-with-data-and-fix-it. To the degree my focus is on watching and listening, I will pick up the signals of reluctance or willingness and adjust accordingly.”
This harmony makes space for the client’s True Self to emerge, while defenses soften. “Using MI tools, I can more easily differentiate the Addict from the True Self. I need to keep seeing through the defenses and pushback from my clients to that deeper part of them yearning to be freed. I’ve found their willingness to be directly proportional to the harmony I’m responsible for creating.”
Advice for Clinicians New to MI
For professionals new to motivational interviewing, Dr. Blair emphasizes collaboration and empathy. “Confrontation, coercion, threats, and disrespect would be seen as outrageous if it were any other disease. The research concurs that a controlling or punitive approach decisively sabotages the addict’s recovery. Recovery is a marathon, not a sprint, so empathic therapeutic alliance is a must.”
Monitoring should be framed as part of a compassionate plan. “Monitoring is an essential component of an informed, compassionate approach that gives the addict a way into the lifeboat.”
She also highlights the role of families in long-term success. “The addict’s chances of achieving and maintaining sobriety are vastly increased when the family is informed and themselves supported. We cannot give the addict anything we don’t have. Recovery is a team sport. There is no higher way to love a person suffering from addiction than to follow an informed, professionally guided roadmap to wellness. For everyone.”
Bringing It Together
Motivational interviewing tips, when combined with monitoring tools like Soberlink, help clients move from resistance to active engagement. They build trust, establish accountability, and create opportunities for lasting change. As Dr. Blair’s decades of work show, recovery is most successful when clinicians use empathy, structure, and collaboration to guide the process.
For treatment professionals interested in deepening these approaches, Soberlink offers Lunch and Learn sessions that explore how alcohol monitoring can be used as a supportive tool in clinical practice.