Common Mistakes in a Brief Intervention

This section includes examples of common mistakes made in a brief intervention.

Step 1: Build Rapport

Raising subject without asking permission
PROVIDER: I saw your answers to the substance use questionnaire about alcohol and drugs, and we need to have a talk about it.

TEEN: (rolls eyes and sighs) Here it comes...

COACH: Raising the subject this way ("We need to talk") is pushing your agenda, and it made her resistant. To motivate an adolescent to change, they need to be a willing participant in the conversation.

Recommending abstinence in the first step
PROVIDER: Speaking as a health professional, I recommend that you quit smoking marijuana.
TEEN: Look, I don't smoke at school, so I don't know why this is your problem.

COACH: Suggesting that TEEN quit is a good idea, but by bringing it up this early, you came off as
directive. If you overstep like this, an apology can help rebuild your relationship with the adolescent.

PROVIDER: I'm sorry, I don't mean to pressure you. I know this is a personal subject, and whatever you do here is totally up to you.
TEEN: Okay
PROVIDER: So, let's put this aside for now. If you want to talk later about cutting back or quitting, we can. For now, let's just go back to discussing your marijuana use a bit more.
TEEN: (sigh) Okay

Discussing the consequences of substance use in the first step
PROVIDER: How do you think being distracted in class relates to your marijuana use?
TEEN: (looks down)
PROVIDER: TEEN? (pause) Do you have any thoughts about that?
TEEN: (still looking down) I dunno

COACH: If you start the conversation with potentially sensitive questions like this one, teens may get uncomfortable. Try starting with concrete questions about their use, ideally using their screening results as a launchpad. You should apologize to reframe the conversation around their screen.

PROVIDER: I'm sorry. I didn't mean to imply anything there. Could we maybe just talk a bit more about the questionnaire you filled out?
TEEN: Okay.

Commenting on substance use in a judgmental manner
PROVIDER: More than once a week is a lot for someone your age to be smoking.
TEEN: (sad) I know.

COACH: You can build a stronger relationship with an adolescent by taking this time to explore how and why she uses, rather than imposing your own judgments about her use. Later on, you can elicit the consequences marijuana is having on her life.

Eliciting ideas for change too early in the brief intervention
PROVIDER: So, what are some other things you and your friends could do together? Besides smoking.
TEEN: Um I dunno? I mean, I'm not their boss, I don't decide what we do.

COACH: This question discusses ideas for changing behavior, and it's too early in the brief intervention to do so. It's important to first build an adolescent's motivation to change through exploring consequences, sharing feedback, and assessing her readiness for change.