Step 2: Pros and Cons

Responding to a teen’s pros about substance use in a judgmental manner
PROVIDER: I hear what you’re saying about pot helping you with your stress, but it can’t be helping your grades.
TEEN: (resistant) My grades are fine.
PROVIDER: Mr. Silva was telling me --
TEEN: -- Look, it’s just a hard time in my life right now. I think if my parents are splitting up, I’m allowed to get a B.

COACH: Imposing your opinion about the cons of use made her defensive. An affirmation now could help her see that you do understand how hard things are for her.

PROVIDER: You are going through a very difficult time, and you’re doing your best to manage that and keep up your grades here at school.
TEEN: Well… trying!

Suggesting vs. eliciting consequences

PROVIDER: Underage drinking is incredibly risky for your health.

TEEN: (sighs)

PROVIDER: I know it’s fun now, but it can have a lot of long-term consequences. It can affect your brain development, cause serious medical problems… you could get arrested or get hurt, which could affect your chances of making the varsity team.

TEEN: Like, this ankle thing is the worst that’s happened so far, and I’m not gonna jump off any more buildings.

COACH: Try to elicit cons from teens, instead of providing them yourself. If an adolescent can’t think of any cons on his own, it can be useful to offer suggestions in a neutral way, like “Some teens tell me that when they drink they black out or forget stretches of time. Does that happen to you?”

Criticizing friends
PROVIDER: (gently) I hate to say this, but these friends don’t sound like the best influences.
TEEN: Listen, they’re really cool people, okay? And when stuff got hard… they were there for me. You don’t know them.

COACH: Any plan you make with a teen has to build on her existing values. Since she cares about her friends a lot, criticizing them makes her less interested in working with you.

Asking about change too early in the brief intervention

Do you have any ideas about how to make sure this doesn’t happen again?

PROVIDER: So, do you have any ideas about how to make sure this doesn’t happen again?

TEEN: (rolls eyes, sarcastically) I’ll avoid hot tubs.

COACH: It’s premature to talk about a change plan this early in the brief intervention.