Tips for Discussing Substance Use

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Do's and Don'ts

DO:

  • Use open-ended questions
  • Be aware of your biases & try to keep them out of the conversation
  • Explore your client’s readiness to change (see the Readiness Ruler under "Tools")
  • Target your intervention to their stage of change (See Assessing readiness to change under "Substance Abuse")
  • Use Elicit Provide Elicit to provide information, especially during low readiness stages
  • Balance sustain talk (arguments against change) with attention to change talk (arguments for change)
  • Use affirmations to support past successes & positive steps
Affirmations video example
  • Use reflections to show empathy and understanding
  • Make a plan to have a follow up discussion
Admitting mistakes video example
Managing conflict video example

DON’T

  • Use stereotypes & stigmatizing language
Overcoming stigma video

Tell the caregiver what to do

  • Make suggestions or give advice without permission
  • Stay focused only on sustain talk
  • Push change before the caregiver is ready

Judgmental unwanted advice video

Elicit-provide-elicit

OARS: Open-Ended Questions, Affirmations, Reflections, and Summarizing

OARS are communication skills that can help home visitors have a productive and open conversation with caregivers about substance use.

See more information about the OARS on the communication page

Open-ended questions: Questions that do not invite yes/no or other short answers.

  • Examples: "Tell me about your smoking since our last visit”

Affirmations: Statements supporting the person and their change behaviors

  • Examples: ”You are trying your hardest to stay off drugs and you're doing a great job”

 Reflections: Simple statements that convey "I heard what you just said," "I understand what you are saying," or "I'm trying to understand"

  • Simple: Demonstrate listening by repeating or slightly rephrasing caregiver
    • Example:
      • Caregiver: “I just don’t know what more I can do”
      • Home visitor: “You are not sure what else you can try”
  • Emotion-focused: Acknowledging the person’s emotions
    • Example:
      • Caregiver: “I just don’t know what more I can do, I am so tired of it”
      • Home visitor: “You feel frustrated with how things are going”
  • Double-sided: Capturing both sides of a speaker’s ambivalence
    • Example:
      • Caregiver: “Even if I want to, I just don’t know what more I can do”
      • Home visitor: “You have tried a lot already that has not worked, but you want to feel better"

Summaries: Linking together and reinforcing caregiver statements

  • Example: "Let me see if I understand, you still want to socialize with your friends, and part of that may involve drinking alcohol. But you are also thinking about drinking smaller amounts or less often so that you are better able to take care of all your responsibilities."

Do's and Don'ts

Elicit provide elicit image
  • Example: "You seem concerned about your child's asthma attacks, and you seem to be wondering if there is more you can do to prevent them..."

Provide

  • Example: "Children who are around cigarette smoke are more likely to have an asthma attack. The smoke acts as an irritant and trigger for asthma attacks."

Elicit

  • Example: "What do you think about this information?"

See video example using Elicit, Provide, Elicit