The chart below contains examples of how patients might resist talking with you about their drug use and going into formal treatment and provides appropriate responses to help improve patient outcomes. Please note: these responses may not be applicable in every case.
NOTE: Click box below to view clinician response.
Patient Resistance Scenario 1
Patient answers “no” to any drug use, seemingly without considering it thoughtfully or is reluctant to give details.
Clinician Response
- Gently probe with a question like: “Not even when you were in school?”
- Encourage discussion by saying “go on” or “tell me more.”
Patient Resistance Scenario 2
Patient is uncomfortable disclosing personal substance use on a form.
Clinician Response
- Let the patient know you will follow up in person about the screening.
- Reinforce that all information provided will be kept confidential when possible.
- If patient is still uncomfortable, skip screening but provide information about harms associated with drug use.
Patient Resistance Scenario 3
Patient appears ashamed or embarrassed about recommendations to change substance use behaviors.
Clinician Response
- State that this is a health-related medical recommendation and is not meant as a judgment.
- Remind the patient of your role—that clinicians have a duty to share test results with their patients.
Patient Resistance Scenario 4
At-risk patient appears ambivalent to the idea of changing his/her substance use behavior.
Clinician Response
- Acknowledge the patient’s ambivalence and the fact that ambivalence is common.
- State your concern about specific ways that drugs may negatively affect your patient’s health or personal life.
Patient Resistance Scenario 5
Patient becomes upset, argumentative.
Clinician Response
- Do not argue with the patient. Give the patient time to make a decision (unless the condition is life-threatening).
- Discuss the patient’s concerns and reflect them back (e.g., convey that you understand the claim that drugs make the patient feel better).
Patient Resistance Scenario 6
Patient resists referral for additional assessment.
Clinician Response
- Explore concerns about the assessment.
- Emphasize that referral for an assessment may not mean entering substance abuse treatment—and that treatment, if recommended, likely will include different options.
Patient Resistance Scenario 7
Patient cites barriers to attending the referral appointment.
Clinician Response
- Problem-solve about barriers and offer support, such as reminder calls, assistance arranging transportation, and child care.
Patient Resistance Scenario 8
Patient resists the idea of going into formal substance abuse treatment.
Clinician Response
- Clearly state that you are not insisting on formal treatment.
- Explain that treatment is often easier than quitting “cold turkey” and that stopping the use of certain drugs (e.g., alcohol, benzodiazepines) without medical supervision can be dangerous.
Patient Resistance Scenario 9
In follow-up visits, patient shows no progress with change efforts.
Clinician Response
- Acknowledge that change is difficult.
- Repeat the brief intervention and discuss other ways to support the patient’s efforts.
- Make additional referrals for patients who did not attend an appointment.
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