Step 5: Negotiate an Action Plan

Suggesting vs. eliciting a plan

PROVIDER: Do you think you could cut back to just two drinks?

TEEN: Um I could try

PROVIDER: How many can you drink and not have a hangover the next day?

TEEN: Maybe two or three.

PROVIDER: Okay, so what is a limit you'd be willing to set for yourself at this point?

TEEN: Um, well I guess I could stick to two drinks.
PROVIDER: Okay, two drinks. So that would be two 12-oz cans of beer, and you mentioned sometimes you do shots, so one 1-oz shot and one 12-oz can of beer might work for you.
TEEN: Yeah I could do that.

COACH: Notice how the adolescent resisted the plan when you suggested it ("Do you think you could cut back to just two drinks?"), but he was willing to try it once you asked him to come up with his own plan. Remember never to push a person towards change; the change must come from them. Instead ask, "What's a limit you could stick to?"

Accepting a vague plan

PROVIDER: Let's make a plan that you will drink less at parties.

TEEN: (shrugs) Okay.

PROVIDER: Okay. And what would that plan look like?
TEEN: Well, when I go to a party I'll watch how much I drink and make sure I don't have too much.

COACH: This plan is too vague. It will be difficult for an adolescent to implement a plan that does not have a specific maximum number of beers he will drink.

Giving up too soon on involving parents
PROVIDER: That's fine. If you're not comfortable telling your mom, then we won't tell her.
TEEN: Thank god (sigh) Well, I guess it'll just be one more thing I'm hiding from her. (nervous laugh)

COACH: Although you don't want to pressure adolescents to involve their parents if they're adamantly opposed to it, it's still a topic worth exploring before you give up. Research supports better outcomes when parents are involved.

Not offering a referral for high-risk marijuana use
PROVIDER: Okay, so you have a plan to quit smoking marijuana. I'll check in with you in two weeks to see how you're doing.

COACH: If an adolescent's frequency of use puts her in the high-risk category, and she's using marijuana to deal with stress, it's advisable to refer her to a counselor. Be sure to make a referral before you let her go.