Step 2: Pros and Cons

• Elicit pros (what she likes about drug use)
• Elicit cons (what she likes less about drug use)
• Summarize pros and cons

Discuss Pros
PROVIDER: So things are really stressful at home right now, and smoking makes it easier to handle that.
EMILY: I just feel like my brain is always going and going, and I want to just turn it off Well -- that sounds bad, but it's just nice to not think about everything all the time.
PROVIDER: Smoking is how you manage those difficult feelings.
EMILY: Yeah, I mean plus hanging out it's like my one hour a day where everything's fine.

COACH: Establishing with Emily that she uses pot to manage her feelings is an important step. This will help you discuss healthier coping strategies later in the conversation.

Discuss Cons
PROVIDER: What are some things you like less about smoking?
EMILY: (sigh) I don't know I'm having all this drama now with my mom (trying to joke) I'm, like, talking to you No offense.
PROVIDER: (understandingly) Hm
EMILY: (appealing to Player) But, like, I'm not a bad kid!

Discuss Cons
PROVIDER: Are there people in your life who've expressed concern about your pot use?
EMILY: (trying to joke) Well, you, apparently (looks away) and I'm having all this drama with my mom
PROVIDER: Mm
EMILY: (appealing to Player) But, like, I'm not a bad kid!

EMILY THOUGHT: I want my old life back

Discuss Cons
PROVIDER: From what you said, it sounds like you think smoking is putting pressure on your relationship with your mom.
EMILY: (sigh) Yeah Like, she found some in my jacket last week? And you know (sad laugh) "she wasn't mad, she was just disappointed..."
PROVIDER: How did you feel?
EMILY: Well, awful, you know? Like... "Great, now I'm another thing she has to worry about." (sigh) I felt so bad I tried to quit, but (ironic laugh, eye roll) that worked.

Discuss Cons

PROVIDER: A lot of teens I talk to tell me that smoking pot regularly makes it hard for them to keep up in school. What kind of connection do you think there might be, if any, between your smoking and your grades dropping?
EMILY: (nervous) I don't know I mean, my dad says kids who smoke pot do bad at school, but some of my friends are really good students, and they smoke, so I dunno, I guess I'd just feel really stupid, if it was (sigh)
PROVIDER: So you're not sure if smoking is affecting your grades, but you're concerned it might be.
EMILY: (sad) I guess

COACH: If an adolescent is having trouble putting a thought into words, you can rephrase that thought in a reflection, which she can then agree or disagree with. In this exchange, the reflection "So you're not if smoking is affecting your grades, but you're concerned it might be." collected Emily's thoughts and helped her consider them head-on.

Reflect
PROVIDER: You feel guilty about giving your mom more to worry about.
EMILY:
PROVIDER: That might even be another reason it's not fun to be at home.
EMILY: (quietly) I just don't want to hurt her.

COACH: Reflections not only rephrase what an adolescent said; they can also move the conversation forward by suggesting the thoughts or feelings the adolescent might express next. "That might even be another reason it's not fun to be at home." is a great example of this technique.

Follow Up
PROVIDER: What happened when you tried to quit?
EMILY: Well I promised my mom I was going to stop, and I tried but then, like two days later, she and my dad had a big fight again, and I got really stressed, so So I'm lying to her, (sarcastically) which is great... (sigh) and every day when I get home, I feel like you know, this is the day she's gonna bust me again
PROVIDER: That sounds really stressful.
EMILY: (sad laugh) Yeah.

COACH: Investigating adolescents' previous attempt(s) to quit is important in understanding their use, exploring their ambivalence, and figuring out barriers that may make it challenging to attempt quitting again. If adolescents have tried to quit and failed, as Emily has, that suggests they may need a referral to a specialist.

Summarize
PROVIDER: Okay, let me just summarize what I've heard from you, and see if I have this right. On one hand, you like hanging out with your friends, especially now that being at home is so stressful, and smoking is part of what you guys do together. Smoking itself also helps you relax and takes your mind off the hard stuff at home. And on the other hand, smoking is making things harder at home and at school. You think it might be affecting your grades. Your mom is unhappy that you're smoking. And hiding your smoking from your mom and lying to her about it is actually causing you more stress.
PROVIDER: Did I get that right?
EMILY: (bitter laugh) Yyyyup. (pause. sigh.) Well, at least I'm not smoking crack. If I have to be a screw-up, (ironically) at least I'm doing it "the natural way."

COACH: You've learned what Emily gets out of smoking pot and the concerns she has about its effects on her life at home and at school. Next, in the Feedback step, you can build on her concerns by sharing your own information about marijuana's negative effects and clearing up any misconceptions she may have.