# Virtual Agents for Alcohol Use Counseling: Exploring LLM-Powered Motivational Interviewing

arXiv: https://arxiv.org/abs/2407.08095 · HTML: https://mlsanity.com/paper/2407.08095/

## Key facts

- Cited by 17 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 5 of its 54 references that are in the map.
- First posted on arXiv 10 Jul 2024.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 5 of 5)

- [Training a Helpful and Harmless Assistant with Reinforcement Learning from Human Feedback](https://mlsanity.com/paper/2204.05862/) (2022)
- [Large Language Models Understand and Can be Enhanced by Emotional Stimuli](https://mlsanity.com/paper/2307.11760/) (2023)
- [Large Language Models Produce Responses Perceived to be Empathic](https://mlsanity.com/paper/2403.18148/) (2024)
- [Polaris: A Safety-focused LLM Constellation Architecture for Healthcare](https://mlsanity.com/paper/2403.13313/) (2024)
- [Gemini Goes to Med School: Exploring the Capabilities of Multimodal Large Language Models on Medical Challenge Problems & Hallucinations](https://mlsanity.com/paper/2402.07023/) (2024)

## Built on by (most cited first, 17 of 17)

- [Scaffolding Empathy: Training Counselors with Simulated Patients and Utterance-level Performance Visualizations](https://mlsanity.com/paper/2502.18673/) (2025)
- [Mitigating Response Delays in Free-Form Conversations with LLM-powered Intelligent Virtual Agents](https://mlsanity.com/paper/2507.22352/) (2025)
- [CAMI: A Counselor Agent Supporting Motivational Interviewing through State Inference and Topic Exploration](https://mlsanity.com/paper/2502.02807/) (2025)
- [Substance over Style: Evaluating Proactive Conversational Coaching Agents](https://mlsanity.com/paper/2503.19328/) (2025)
- [A Risk Ontology for Evaluating AI-Powered Psychotherapy Virtual Agents](https://mlsanity.com/paper/2505.15108/) (2025)
- [A Fully Generative Motivational Interviewing Counsellor Chatbot for Moving Smokers Towards the Decision to Quit](https://mlsanity.com/paper/2505.17362/) (2025)
- [Can LLMs Generate Behaviors for Embodied Virtual Agents Based on Personality Traits?](https://mlsanity.com/paper/2508.21087/) (2025)
- [Emotions, Context, and Substance Use in Adolescents: A Large Language Model Analysis of Reddit Posts](https://mlsanity.com/paper/2501.14037/) (2025)
- [Tailored Conversations beyond LLMs: A RL-Based Dialogue Manager](https://mlsanity.com/paper/2506.19652/) (2025)
- [HealthDial: A No-Code LLM-Assisted Dialogue Authoring Tool for Healthcare Virtual Agents](https://mlsanity.com/paper/2510.15898/) (2025)
- [When LLM Therapists Become Salespeople: Evaluating Large Language Models for Ethical Motivational Interviewing](https://mlsanity.com/paper/2503.23566/) (2025)
- [Controlled Yet Natural: A Hybrid BDI-LLM Conversational Agent for Child Helpline Training](https://mlsanity.com/paper/2509.16784/) (2025)
- [Initial Risk Probing and Feasibility Testing of Glow: a Generative AI-Powered Dialectical Behavior Therapy Skills Coach for Substance Use Recovery and HIV Prevention](https://mlsanity.com/paper/2602.08121/) (2026)
- [Benchmarking Motivational Interviewing Competence of Large Language Models](https://mlsanity.com/paper/2603.03846/) (2026)
- [COACH meets QUORUM: A Framework and Pipeline for Aligning User, Expert and Developer Perspectives in LLM-generated Health Counselling](https://mlsanity.com/paper/2603.08392/) (2026)
- [StoryMI: Steerable Multi-Agent Therapeutic Dialogue Generation](https://mlsanity.com/paper/2605.27393/) (2026)
- [MIThinker: A Plug-and-Play Policy-Optimized Thinker For Motivational Interviewing Counseling](https://mlsanity.com/paper/2606.29265/) (2026)

## Abstract (arXiv)

We introduce a novel application of large language models (LLMs) in developing a virtual counselor capable of conducting motivational interviewing (MI) for alcohol use counseling. Access to effective counseling remains limited, particularly for substance abuse, and virtual agents offer a promising solution by leveraging LLM capabilities to simulate nuanced communication techniques inherent in MI. Our approach combines prompt engineering and integration into a user-friendly virtual platform to facilitate realistic, empathetic interactions. We evaluate the effectiveness of our virtual agent through a series of studies focusing on replicating MI techniques and human counselor dialog. Initial findings suggest that our LLM-powered virtual agent matches human counselors' empathetic and adaptive conversational skills, presenting a significant step forward in virtual health counseling and providing insights into the design and implementation of LLM-based therapeutic interactions.