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Teens Only Listen to One Person…Themselves: How a Child’s Own Reasons for Change Lead to the Most Success

Monday, August 22nd, 2011

Beautiful Teen Girl In Hospital Gown Crying

This guest post is by Dr. Michael Pantalon, author of “Instant Influence: How to Get Anyone to Do Anything–Fast” (Little, Brown and Company).

Imagine you are in the Emergency Department (ED) with your 16-year-old daughter who was brought in for her second episode of alcohol poisoning in six months.  The doctor is about to discharge her because, medically, she’s fine, but you know she’s going to go right back to heavy drinking, if you don’t do something.  You and your husband feel you’ve tried everything to help your daughter, but you also believe that there has to be some way to take advantage of this dire emergency to motivate her to get into treatment and to stop drinking.

I’ve seen hundreds of families in this very situation and their dilemma is always the same: they all want to influence their child to get on a better path, but they don’t know that there is a quick, easy and scientifically-proven way of getting the job done.  The approach I’m referring to is called “Instant Influence.”  It’s based on Motivational Interviewing, which in its briefest form, has been shown to reduce substance use among adolescents and young adults seen in the ED, as well as, my 20 years of experience motivating some of the most resistant to change substance abusing children and adults in a wide variety of settings.

People tend to only listen to one person — themselves.  And, as a result, they’re only influenced by one person …again — themselves.  So, as frustrating as this may be for a parent who would like to sternly say, “You have to stop!” and to have that be enough, the real trick to motivating someone is to get them to convince themselves to make a change for their own good reasons.

But how do you do this?  How might the mom in the example above motivate her daughter to finally accept treatment for her drinking problem?

The two most important things to do are:

1)    STOP trying to motivate your child by telling her about your feelings, thoughts or reasons for change, such as, “You’re worrying me to death!” “I think you HAVE to go to rehab right from the hospital” or “The best reason for you to stop drinking is for your health.”

2)    START asking your child questions that are specially-designed to evoke her own good reasons for change.

To help you remember what things you should vs. should NOT say, I’ve devised two simple lists for parents to follow:

DON’T…

Express your anger. Of course, as a parent, you are feeling angry, but expressing it doesn’t motivate your daughter.  Your anger is very likely legitimate, but if we stick to the idea that kids change when they hear themselves argue in favor of the change, yelling will NOT evoke such reasons – it may even make it harder for her to come up with good reasons to change.

Blame. It’s not a time to figure out who’s responsible for allowing the situation to get so bad, but instead, to garner some motivation to move forward with a better plan.

Confront her with admonitions to stop. Of course she knows you want her to stop drinking!  She doesn’t need to hear that, nor will it be motivating.  I know it feels almost irresponsible NOT to say that she HAS to stop drinking, but because of “reverse psychology,” it could be demotivating.

Tell her your reasons for why she needs to stop drinking by nagging. You may have some excellent reasons (her health, grades, family, etc.), but since only her reasons will ultimately influence her to take actual steps toward stopping or enrolling in treatment, your reasons will prevent you from getting at hers and they may backfire and create more resistance because they sound more like admonitions than reasons that motivate. You can express your concerns but focus on the behavior and why it worries you.  Don’t make it sound like you think your teen is a bad person because he/she has tried drugs and alcohol.

Assume the ER will somehow scare her away from drinking in the long-term. Even if the doc has given her a “this-is-your-brain-on-drugs” speech and she seemed scared, the fear won’t last, nor will any temporary reduction in her drinking.  And again, the fear invoked by the physician is based on HIS, not your child’s, reasons – they didn’t come from her.  No personal reasons, no change.  Additionally, our brains work very hard to suppress scary thoughts and images, so even if they seem to scare some kids straight at the moment, that effect will likely be forgotten very soon.  Finally, remember that it is developmentally right on track for teenagers to feel invulnerable, so it’s pretty hard to truly scare them, anyway.

Use a “tough love” approach, such as threatening harsh punishments. Yes, consequences can be helpful, but when doled out in a tough, blaming and angry way, the likely side-effect is one of interpersonal conflict, which often leads the teen to focus on her anger at the mom (retaliatory toughness), which in turn leads back to alcohol or drug use, given that this sort of stress is a big trigger of relapse.  Also, in order to help overcome an addiction, the teen needs a consistent and loving relationship with her parent, but such a relationship is hard to maintain when using the “tough love” approach.  The bottom line here is that tough love makes love tough. A balanced approach with fair but firm boundaries and consequences is more effective than harsh discipline in motivating people.

DO…

Start by saying, “While I am very concerned about your drinking, I know that it’s ultimately your decision whether you choose to accept help. I can’t watch you 24-7 or force you not to drink, so you’re in the driver’s seat here.  But can I ask you a few questions?”  By frankly acknowledging your daughter’s autonomy, her defensiveness will go down, which makes her more open to answering the questions that follow, which will evoke her own more motivating reasons to change.  And the fact of the matter is that she IS the only one who can make a change possible.

Ask , “Why might you decide to get help for your drinking?” This question basically corners her into saying something positive about getting help.  If she says, “I don’t want to get help,” you say, “I didn’t ask IF you’re going to get help, but why you might ever decide to get help?  In other words, if you were to ever get help, what would make you do that?”  Because the question is hypothetical and very surprising (the typical question is “Why haven’t you gotten help for your drinking?”), the person’s defensiveness is further lowered.  Because the question also focuses on the POSITIVE side of the issue (getting help vs. not getting help), the daughter is much more likely to say something positive about treatment (e.g., “Because it’s the only way I’ll be able to get back on the lacrosse team”).

Ask, “Have you ever done something you regretted while drinking? What was it?” This is helpful if your child has a hard time coming up with her own good reason for seeking help.  Recounting such a story (e.g., the child might have gotten into a big fight with her best friend while intoxicated) helps her come up with a motive for getting help, such as, “Well, I might get help so that I don’t do that again.”   By the way, this works even when they don’t tell you what the regretful behavior was.

Ask, “How ready are you to take a next step on getting help (e.g., looking up local specialists with you), on a scale from 1-10, where 1 means not at all and 10 means totally ready?” Get her to pick a number.  This technique helps you get away from the all-too-common, but ineffective, Yes/No question of, “Are you going to go treatment or what?” which makes it too easy for the child to say no.  She’ll say no even if she has a little motivation to go.  The scale question allows her to reveal that little bit of motivation – it may only be at a 2 or 3, but it shows you that there is hope.

Ask her why she did not pick a LOWER (yes, lower) number? This forces her to defend why she has even a small amount of motivation.  Again, we’re focusing on the positive.  DO NOT ask why she didn’t pick a higher number because that will make her defend the negative – her resistance.

(If she said “1″ to the scale question), Ask, “What would turn that “1″ into a “2″? Usually, the child says something like, “If I thought I would have to keep coming to the hospital.”

Reiterate the good answers AND ignore the bad. Based on the above, this would sound like, “It looks like you might want to look into treatment so that you can get back on the lacrosse team and so that you don’t keep getting into big fights with your best friend.”  They may not be the reasons the parents think are most important, but they’re going to be the most motivating, because they’ve come from the child.

Follow-up with an addiction specialist with expertise in motivational enhancement strategies.

Finally, you might also ask the ED doc why he/she might do what is called Screening & Brief Intervention and Referral to Treatment, or SBIRT, with your daughter.  An SBIRT includes many of the above “DO’s” and could be the tipping point in terms of getting your daughter to get into treatment and stop drinking.  In fact, more than any time in the past, ED docs are strongly encouraged to go beyond simply addressing the medical consequences of problem drinking and to try to motivate patients to address their substance problems.  For more information on SBIRT, check out our Yale team’s website on the subject at www.yale.edu/sbirt.

Related Links:
Addiction is a Chronic Medical Disease
Challenging the Stoner’s Classic “Chill Defense”

Posted by  |  Filed under Addiction, Alcohol, getting help, Motivational Interviewing, tough love, Treatment



9 Comments on “Teens Only Listen to One Person…Themselves: How a Child’s Own Reasons for Change Lead to the Most Success”

susan lea says:
August 23rd, 2011 at 1:10 am

I’m feeling a little angry right now so hopefully this won’t sound too grumpy. But I need to relate my own experience with emergency room visits. In a perfect world, there would be lots of doctors in hospitals that have resources at their disposal to actually help young people who have alcohol and drug problems. Needless to say, this isn’t a perfect world.

1st visit with my 21 year old daughter, 2 years ago: She has pneumonia from smoking heroin. She’s in pain and experiencing withdrawals. The doctors were very kind, gave her a prescription for antibiotics and a fentanyl patch. Sent her home. Not much help.

2nd visit 6 months later: Infections, withdrawals, bad drug interaction. She gets a lecture from the emergency room nurse that she should stop using drugs. They can’t get a blood draw since her arms are in bad shape. They give her a prescription for antibiotics and send her home. Not much help.

3rd visit: She’s suffering from severe stomach pain. She’s having withdrawals, running a fever and crying. The doctor asks her if she’s been using drugs. (I’m thinking, what medical school did he go to?) She says she’s an IV drug user addicted to heroin. The doctor leaves the room and doesn’t come back for an hour. Later, when she says she’s in too much pain to stand, he tells her she’s being dramatic. He tells her to make an appointment with her doctor and sends her home. No help at all.

4th visit, this time to the psych ward about 3 months ago: Suffering from a drug induced psychosis. Hallucinating and scared. The nurse looks bored and gives my daughter a lecture. Then she accuses her of lying because she’s afraid of having blood drawn. Meanwhile my daughter thinks there are snakes in the room. The ER doctor comes in and asks, “Do you feel you are a danger to yourself.” Duh!!! And when my daughter says “no” she’s released to go home. A friend and I stay with her for the next 24 hours since she doesn’t know where she is and thinks there are tarantula’s crawling on her.

When it comes to addiction, overdoses & alcohol poisoning, most emergency rooms are ill equipped to help or treat or refer anyone to where they need to go for real help, especially if they have no money or insurance.

The suggestions in this article are wonderful and helpful. But without an educated and caring medical community that can help, it’s tough for parents to find somewhere to turn.



Cathy | Treatment Talk says:
August 24th, 2011 at 4:43 am

Wonderful suggestions and certainly something all parents should read. It feels that this is something parents almost need to be coached in before the trip to the hospital, jail or where ever their child happens to be because their emotions so easily get in the way of having a calm discussion.

In the best scenario it would be helpful if the hospital personnel could hand the parents your list of Do’s and Don’t's, and/or do the SBIRT. I know many parents are excited about the new medical addiction specialty and this may lead to more awareness for all when parents enter ER in this type of a situation. Thanks for sharing!



teen help says:
August 30th, 2011 at 9:35 pm

My dad used to yell at me all the time, even when I hadn’t done anything that would cause me to get into trouble. I agree that yelling at a teen doesn’t help. My mom was the only sane person in the family and I am still amazed that she didn’t go insane with all of the stuff that was going on in our family.



liz says:
September 3rd, 2011 at 11:10 am

HMO is to be blamed for a lot these issues. Mental and substance abuse coverage offered by the insurance company is a joke. I wish that would change. Very few issues can be cured under 10 – 20 visits to the shrink. Health at least sometimes can be prevented but mental is more challenging. It need to be more affordable.



Patti Herndon says:
January 13th, 2012 at 12:28 am

Thank you for this extremely helpful insight to Motivational Interviewing, Dr. Pantalone. Encouraging parents to direct the focus on the learning opportunity presented in this article regarding MI.

As the parent of a dually-diagnosed son and a counseling student trained in MI; I credit a great deal of the momentum that my son and family experience in the recovery journey as directly attributable to the learning and application of the principles associated with Motivational Interviewing. In addition, we were helped tremendously as we engaged learning regarding the “Stages of Change Model”.

MI is one, evidence-based option to research/understand/consider…and perhaps even ‘add-on’ to your current approach in supporting your substance use disordered family member.

MI encourages the substance-using individual to make their own argument for change. This is much more effective than their arguing with parents/family members/friends about the reasons they should change.

This approach has helped us as family -minimizing anxiety and stress in the family system. We understand now, more than ever, how much of our dedicated efforts to help were actually creating a great deal of tension and stress we all experienced. We understand, now, how that relational dynamic triggered/perpetuated our sons use of substances in coping.

It’s very common pattern in families impacted by addiction… Loved ones can inadvertently, unintentionally add anxiety to the mix as they interact in “stress mode”. Understanding and applying the principles of MI helps family members minimize stress and maximize self-efficacy, thus recovery-for everyone in the family.

Recognizing and expanding our options in the journey helps give us a sense of empowerment. This builds hope reserves. Hope is a clinical component in recovery. And being better equipped to sustain hope, we cope better with the challenges we face. We are increasingly proactive as we make our way. And equally as critical… we are better ‘reactive’ when met with the challenges that come with the substance use disorder of our family member.

Thanks for this GREAT article. Keep up the great work!

Addiction is the journey. Recovery is the destination.



Motherofanaddict says:
May 7th, 2012 at 3:40 pm

With a Son that is 25 and has relapsed 5 times, and I am an enabler #1, I would like to hear what others would do. Should I kick him out, I can’t emagine him on the streets he is living with my Mom. I am very broken he has also been in the best facilities three different times. Please any feedback would be very appreciated. Thank you,



sharyna says:
April 23rd, 2013 at 4:50 am

To Motherofanaddict, My husband would end up beating his own mother to get money for drugs/alcohol. She did nothing. Kept giving him money, did not ask him to leave her house, protected him by not telling. She was not the only one in the family he terrorized. He ended up dying of the disease of addiction when he was 57 yrs old. Your son is 25, don’t lose him at 57. Kick him out, I would. Don’t make his life Disneyland. My husband was spoiled. Took his mother’s master bedroom for himself and (before he married me) any trollip he chose to drag home from the bar. His mother set no rules or boundries for him. NO, as long as you live under my roof, you will do such and such. You all probably think I’m an idiot for marrying the guy and I probably am. But maybe I went thru all that so I can teach you. Set rules and boundries, even with adult children. Follow your morals and values. If religion is important to you then say so. Make a rule that your adult child goes to church every Sunday with you. If they don’t, let there be consecquinces!! I think living on the streets awhile without inexhaustable funds, might have helped my late husband. Definitely rules would have helped if anybody would have enforced them. Don’t pay for rehab yourself. If the adult child is forced to take on the financial commitment, they are more likely to succeed. You spending the money is “no skin off their teeth”. Well, you said, “Any feedback would be very appreciated”….



Patti Herndon says:
April 29th, 2013 at 6:53 pm

Sharyna,

Addiction is beyond difficult. Clearly, you have been through so much challenge. It’s time for some peace for you..You deserve peace and forward momentum. Sometimes we don’t know that our own anger is holding us captive.

Please read the blog by Dr. Pantalon again, Sharyna. Take a deep breath, center your thoughts…read it with an open mind and heart. When you’ve read it again, ask yourself if your anger, resentments, sense of loss is holding you captive and keeping you from the kind of life/the peace you deserve.

Godspeed in your journey to peace Sharyna.



kendra says:
April 29th, 2013 at 7:16 pm

I am a Mom of 8. I have a Grandma who was an alcoholic, Mother was and my sister who has been since she was 13. She is 32 now and still addicted to anything and everything- we helped her for years, threw her out and she became homeless. THe minute she found security again, she started using Meth. All of this started with POT. I now have 2 sons who are pot heads. The eldest was given up but now lives with me and came with the use. My other started with friends. I am needing advice on how to make it all stop. We have done everything in the book. Only thing left is kicking them out. WE did this with my sister and it did not work. I believe it has to come from within. How do you make them understand that they have addictive personalities and they are addicted? How do you stop it? What if they run away? I need answers so please understand- I am very familiar with it- I picked my sister off the ground unconscious many times- have seen her on a respirator, have seen her whacked out from too many drugs and have said good bye many times. I do not want this future for my kids so please give me some solid – lock down advice pollard.kendra@gmail.com and I am not shy to talk about it.




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