Executive Summary Motivation for change is a key component in addressing substance misuse. This Treatment Improvement Protocol (TIP) reflects a fundamental rethinking of the concept of motivation as a dynamic process, not a static client trait. Motivation relates to the probability that a person will enter into, continue, and adhere to a specific change strategy. Although much progress has been made in identifying people who misuse substances and who have substance use disorders (SUDs) as well as in using science-informed interventions such as motivational counseling approaches to treat them, the United States still faces many SUD challenges. For example, the National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2018) reports that, in 2017, approximately: • 140.6 million Americans ages 12 and older currently consumed alcohol, 66.6 million reported at least 1 episode of past-month binge drinking (defined as 5 or more drinks on the same occasion on at least 1 day in the past 30 days for men and 4 or more drinks on the same occasion on at least 1 day in the past 30 days for women), and 16.7 million drank heavily in the previous month (defined as binge drinking on 5 or more days in the past 30 days). • 30.5 million people ages 12 and older had used illicit drugs in the past month. • 11.4 million people ages 12 and older misused opioids (defined as prescription pain reliever misuse or heroin use) in the past year. • 8.5 million adults ages 18 and older (3.4 percent of all adults) had both a mental disorder and at least 1 past-year SUD. • 18.2 million people who needed SUD treatment did not receive specialty treatment. • One in three people who perceived a need for substance use treatment did not receive it because they lacked healthcare coverage and could not afford treatment. • Two in five people who perceived a need for addiction treatment did not receive it because they were not ready to stop using substances. Millions of people in the United States with SUDs are not receiving treatment. Many are not seeking treatment because their motivation to change their substance use behaviors is low. The motivation-enhancing approaches and strategies this TIP describes can increase participation and retention in SUD treatment and positive treatment outcomes, including: • Reductions in alcohol and drug use. • Higher abstinence rates. • Successful referrals to treatment. This TIP shows how SUD treatment counselors can influence positive behavior change by developing a therapeutic relationship that respects and builds on the client’s autonomy. Through motivational