Step 1: Build Rapport
- Ask about his life and get to know Josh
- Ask permission to raise the subject of substance use
- Discuss Josh's substance use
Ask About Life
PROVIDER: So, just to help me get to know you a little better what kinds of things do you like to do for fun?
JOSH: Well you know, there's, like nothing to do in this town. I hang out with my friends.
PROVIDER: What kinds of things do you do when you hang out?
JOSH: We chill, play video games or whatever, some pickup football.
PROVIDER: You like to play video games and football with your friends. Are you on the school team?
JOSH: (animatedly) Yeah. Next year I should go varsity.
Ask About Life
PROVIDER: Seems like you had kind of an interesting night. How did you end up on the roof?
JOSH: I already told the lady at the desk doesn't your form, or whatever have that?
PROVIDER: Oh, I'd like to hear it from you.
JOSH: (sighs ) We were hanging out at a friend's place, partying, and some of us got in the hot tub and I thought it would be cool to if I could jump in from really high.
PROVIDER: Okay, when you say "partying," what do you mean?
JOSH: You know, drinking a few beers and having fun.
COACH: Notice how open-ended questions ("How did it happen?" "What do you mean?") encouraged Josh to open up. He seems reluctant to share too much, but don't give up!
Raise Subject
PROVIDER: I noticed you filled out the questionnaire about alcohol and other drug use - we ask all of our patients to complete that. Thank you for being honest on it. I'd like to talk with you for a few minutes about your responses. What do you think about that?
JOSH: Oh um okay, I guess.
JOSH THOUGHT: Ugh, I didn't think anyone would look at that thing. Maybe I shouldn't have been so honest
Discuss Use
PROVIDER: So, your questionnaire says you drink alcohol every week. About how many days a week do you drink?
JOSH: Look, am I gonna get in trouble for writing that stuff on the form? Or for telling you any of this stuff?
PROVIDER: Everything you tell me will be confidential unless I hear that you're harming yourself or someone else, or you tell me that you've been a victim of abuse. I'll keep our conversation about your alcohol use between us, unless you agree to include your parents.
JOSH: Okay.
JOSH: Once-maybe twice-a week. Just at parties.
PROVIDER: You never drink outside of a party.
JOSH: Yeah, there's no point really.
PROVIDER: And how long have you been going to parties where there was alcohol?
JOSH: I guess since the beginning of the year. The guys throw parties every weekend.
COACH: Confidentiality laws vary, so be sure to research the specific laws in your state.
Discuss Use
PROVIDER: When you drink, about how many drinks do you have?
JOSH: A couple of beers usually, sometimes a shot. Whatever's at the party.
PROVIDER: Okay, you have a couple 12-oz beers and sometimes a 1-oz shot of straight alcohol. Anything before the party?
JOSH: Nah, I'm usually at a game or something. Uh, it's the football team that throws the parties, so
PROVIDER: So, if you counted the beers and shots, about how many drinks is that in total?
JOSH: Umm I guess like, three or four?
COACH: Great job building rapport with Josh. He's now more open to discussing this topic with you, and you've learned a good deal about the realities of his use. You can move on to your next goal, discussing the pros and cons of substance use: