Step 4: 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.

Recommend Abstinence
PROVIDER: We've talked about a lot of things today relating to your smoking, and I'm wondering what you feel like would be a reasonable next step. You could continue smoking marijuana like you have been; you could decide to cut back; or you could decide to quit entirely. Speaking as a health professional, I recommend that you quit, but it's ultimately up to you. How would you feel about quitting?
EMILY: (wryly) I wish I could.
PROVIDER: So quitting is something you're open to.
EMILY: In theory.

Use Readiness Ruler
PROVIDER: If you had to rate your readiness to quit from zero to 10, where zero is not at all ready, and 10 is completely ready, where would you put yourself?
EMILY: Hm. Maybe like a five?

Assess Readiness
PROVIDER: What would have to change to get you to a higher number, like an eight?
EMILY: I don't know Like I want to quit. I want to get my grades back up, and I don't want to let my mom down. But if I do quit, like then what?

COACH: Asking "What would have to change to get you to a higher number?" or "Why didn't you pick a lower number?" are great ways of generating change talk and enhancing a teen's motivation to quit or cut back.

Reflect
PROVIDER: Even though you're not sure what it would look like, quitting is important to you.
EMILY: Yeah. (sigh) Yeah, no, I have to. I just... like What do I do? Do I just stop hanging out with my friends, and be home all the time and listen to my parents fighting? And, I mean (sigh) I guess, smoking's bad for me, but it helps, and I don't know what I'd do otherwise.

COACH: Emily wants to quit, but she has some concerns about how quitting would affect her life. Build her confidence by negotiating an action plan that addresses these concerns.