Synopsis
Use a collaborative motivational conversation to explore ambivalence, strengthen personally meaningful reasons for change and agree a feasible next step without losing clinical safety priorities.
- Ambivalence means having competing reasons to change and to continue; explore both without treating uncertainty as dishonesty.
- Ask open questions, listen reflectively, affirm specific strengths and summarise the person's own reasons and concerns.
- Seek permission before offering information, then ask what the information means for the person's goals and choices.
- NICE CG115 recommends a motivational intervention as part of the initial assessment of all people who misuse alcohol.
- Alcohol interventions require trained competent staff, an appropriate evidence-based manual, supervision, outcome monitoring and review of practice competence.
- Agree an achievable next step and review date; readiness to change can differ between behaviours and change over time.
- Smoking cessation support should include discussion of evidence-based treatment options and the effects of smoking changes on relevant medicines.
Key red flags
A dependent drinker planning immediate unsupported cessation, especially with previous withdrawal seizures or delirium, needs a clinical withdrawal plan rather than encouragement to stop abruptly.
Investigation priorities
Understand the pattern, consequences and level of clinical risk.
Management branches
The person expresses uncertainty or competing views about a health-related behaviour change.
- Agree what to discuss, ask an open question and listen for both benefits and costs as experienced by the person.
- Reflect the main tension accurately, affirm relevant efforts and invite correction before offering an interpretation of their priorities.
- Explore how the behaviour relates to valued goals and what might make a small change worth considering at this point.