Step 2: Pros and Cons

• Elicit pros (what he likes about alcohol use)
• Elicit cons (what he likes less about alcohol use)
• Summarize pros and cons

Discuss Pros

PROVIDER: So, Josh, what are some things you enjoy about using alcohol?

JOSH: I dunno, I guess I like how fun it makes my friends and I. It's like, we loosen up and just say or do whatever we want.

PROVIDER: So it sounds like alcohol is a big part of the parties you go to.

JOSH: Yeah, everyone drinks at parties. That's what makes it fun.

COACH: By not responding negatively to Josh's pros, you're encouraging him to be more comfortable and honest.

Reflect

PROVIDER: So, none of your friends drink less than you or choose not to drink at parties.

JOSH: Well, I wouldn't say that. Some of my friends just drink a beer or two they keep it pretty chill.

COACH: This is a great example of an amplified reflection, which slightly exaggerates the adolescent's remarks ("No one drinks less than you") to encourage him to qualify his statement ("Well, some do").

Discuss Cons

PROVIDER: What are some things you like less about drinking?

JOSH: Well tonight wasn't the smartest decision.

PROVIDER: (reflecting) You think you wouldn't have jumped off the roof if you hadn't been drinking.

JOSH: Probably not. It sucks that I'm going to miss the next game.

COACH: Good job! Josh is starting to realize that there is a conflict with his drinking and his desire to play football.

Discuss Cons

PROVIDER: How might this injury affect your football playing?

JOSH: Doctor said I have to stay off of it for a good three weeks. I'm gonna have to miss a couple of games.
PROVIDER: Are you still on track to make varsity next year?
JOSH: Yeah, I can do extra training in the off-season.

COACH: Good job connecting the negative effects of drinking to something that's important to Josh.

Discuss Cons

PROVIDER: What are some other things you like less about drinking?

JOSH: Well I mean, I've had a bunch of hangovers.

PROVIDER: Has a hangover ever caused a problem for you?

JOSH: Yeah, I was too sick to play video games with my friends last weekend, and that sucked.

Discuss Cons

PROVIDER: Some teens have told me that when they drink, they've gotten into fights or said things that they regret the next day. Has anything like this happened to you?

JOSH: Um No.

PROVIDER: And what about your friends?

JOSH: Oh. Yeah! Some of my friends got in a fight a few weeks ago.

PROVIDER: After drinking.

JOSH: Yeah. (chuckles) They were pretty plastered.

PROVIDER: It's not uncommon for friends to get into fights like that when they're drinking. I hope no one got hurt.

JOSH: Ah, they were okay but it was pretty stupid.

COACH: Sometimes teens need help thinking of consequences. You discussed what you've seen in others instead of suggesting Josh has had particular experiences. He was receptive to this type of softened suggestion.

Reflect

PROVIDER: Your hangover affected your time with your friends.

JOSH: Yeah. They were waiting for me to log on for like, hours. One of them showed up at my house and woke me up I was trying to sleep the hangover off. And my stomach hurt. I couldn't even eat anything.

COACH: Your reflection of what Josh just said encouraged him to keep talking about the negatives of this experience. Discussing reasons for change is a form of change talk.

Summarize

PROVIDER: So, I just want to summarize what I've heard from you so far. On one hand you like how alcohol helps you and your friends have fun. You feel like not drinking alcohol at a party wouldn't be fun.

And on the other hand... You wouldn't have hurt your ankle if you hadn't been drinking. You won't be able to play football for three weeks, and will have to make up your training during the offseason. You've had multiple hangovers and recently had one so bad that you missed playing videogames with your friends. You have seen some of your friends get into fights when drunk.

PROVIDER: Did I get that right?

JOSH: Yeahwell it doesn't sound so great when you put it like that.

COACH: Summarizing lets Josh know you're listening and gives you another opportunity to reflect the cons that he has mentioned. Listing the cons last emphasizes them as you move to the next step of the brief intervention: providing feedback.

You've learned a lot about how Josh feels about his alcohol use, and you've started to help him realize the discrepancy between his values and his behavior. Next, give Josh some feedback about his substance use and discuss the information with him. You can build upon the consequences you explored with Josh to provide salient information - this will help further the discrepancy.