Step 4: Assess Readiness
- Make recommendation for abstinence
- Ask about readiness (0-10 ruler)
- Ask “Why not less?” to elicit change talk, or ask “What would have to change?” to identify barriers to change
Make Recommendation
PROVIDER: From a medical perspective, we know that drinking is harmful to your health, and it’s also illegal until you’re 21. And so from a professional view, I would say the best advice is to quit drinking, but of course the choice of what to do is yours. Would you consider quitting drinking for a while?
JOSH: Well, I dunno. I mean I guess I could, but that would be pretty boring. I don’t really want to.
PROVIDER: What do you think about cutting back on how much you drink?
JOSH: That’s probably not a bad idea. I shouldn’t get wasted like this again.
COACH: Given that it is illegal for teens to drink and the best health choice for them is abstinence, it is important to recommend quitting, framed from your perspective as a professional.
Use Readiness Ruler
PROVIDER: Okay, it sounds like you are not interested in quitting right now. How do you feel about drinking less when you’re at a party?
JOSH: That’s probably not a bad idea. I can’t get wasted like this again.
PROVIDER: Okay, And on a scale of 0-10, how ready are you to cut back on drinking? With zero being “not ready at all,” five being “somewhat ready to change,” and ten being “very ready to change”?
JOSH: I dunno, um... I guess I’m around a five. (looks down at his ankle) Well, maybe more of a six.
COACH: Recognizing that Josh is not interested in abstinence reinforces that the choice is his, without downplaying your original recommendation. You then explored his readiness for a different type of change. While abstinence is recommended for any teen, you can explore staying within safe drinking guidelines for older teens.
JOSH THOUGHT: It’s true I’ve got to get my act together. I can’t miss any more football if I want to make varsity next year
Reflect
PROVIDER: You like drinking with your friends, and you also realize that you could get seriously hurt again.
JOSH: Yeah, I don’t want to get that messed up again. And I guess I have heard of a lot of people ending up in the ER from drinking too much.
COACH: Good job using a double-sided reflection, which includes both the change talk and sustain talk exhibited by Josh. (“You like drinking with your friends, and you also realize you could get seriously hurt.”) Notice how you ended with change talk, leading to more discussions about his motivations for change.
Assess Readiness
PROVIDER: So, what made you choose a six and not a lower number, like a two or a one?
JOSH: Well, I really overdid it tonight. I have fun when I have fewer beers, without getting so messy and doing stupid stuff like this (gestures to his foot).
COACH: Phrasing the question this way (“Why not a lower number?”) elicited change talk by prompting Josh to think about why he feels ready to change. Great job exploring Josh’s readiness to change. Your next goal is to develop an action plan.