BIDMED Intervention Script

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BIDMED Intervention Script

Introduction

Thank you for answering all of those questions, I know there were a lot. We are now going to have a change of pace. We will be having a brief conversation about your use of drugs and alcohol and the role that these might play in your life. Remember, my role as a counselor is not to change you use of alcohol or drugs or tell you that you should change. The only person who can make that decision is you. We have about 30 minutes.

Use of Drugs

C: Tell me about the drugs you have been using in the past three-months.

C: How often do you use ______?

C: What would a typical week of use of ____ and _____ be like?

C: Do you ever have heavy days of use?

C: What is that like?

C: What about alcohol?

C: When did you last use ____ or _____ or alcohol?

If used today

C: How soon before you came to the ED did you use ______?

Transition Statement.

C: You use ____ and _____. You use _____ most often, and typically you use/don’t use alcohol when you are using ______

Elicit Pros and Cons

Pros

C: (Starting with the most often used). What do you find good/beneficial/like/helpful about using______

C: Anything else

C: What about _____?

C: Anything else you get from using ______?

Repeat as necessary

Cons

C: What concerns do you have about using ______?

C: Anything else?

C: What about ______do you have the same concerns using that?

Additional ideas for eliciting Cons:

C: Do you family or friends have any concern about what you use?

C: Tell me about their concerns.

C: Does how you get ______cause you any concerns?

If patient asks for clarification give this. e.g.

C: Well, some people are worried because to keep using _____ they may have to spend money they need for other things.

C: What worries about your health do you have because of your use of ______or ______?

C: Anything else about your health?

If patient said they had been using anything just before they came into the ED

C: You said that you had been drinking and using cocaine before you were brought to the ED. Do you think this had anything to do with why you had to come to the ED?

If patient says their current use had anything to do with coming to the ED explore this.

C: Tell me about other time where your use of _____ or _____ has caused you to get inured/ become ill.

C: How did you feel when that happened to you?

If previously mention job/ school/family life

C: How does your use of ______affect this?

If not mention many cons counselor could ask about the survey the patient just completed

C: You just filled in a lot of questions about your use of drugs and about consequences and risks that may have happened because of your use. Was there any question that you answered that made you think about your use?

If appropriate

C: Has your use of any of these drugs or alcohol led to you having unprotected sex?

If yes

C: Can you tell me about that?

C: What’s your fear about the unprotected sex you had?

C: You mentioned that you are frightened that you may have an STD, are there any other infections that you are concerned that you may have been exposed to?

May need to provide information about HIV and Hep B/C.

If this is the flow of the conversation discuss testing here

Summarize Pros and Cons

C: Let me see if I can bring together what we have been talking about. You use alcohol because you like the taste and you have always been used to drinking. Marijuana helps you control your anger and brings you down, especially after you have been using cocaine. You find using cocaine exciting although you do worry about the legal consequences of getting caught buying or using cocaine. Is there anything I missed out?

Elicit Future Goals

C: Currently you are in college; where would you like to see yourself in 5 years time?

C: How could your use of ______interfere with that plan?

Or

C: You said that your relationship with your daughter is important to you.

C: How could your use of ______affect that?

If change talk:

C: You said that you are concerned that with your kids becoming teens that your use of marijuana and vicodin would be a bad role model.

C: What would you like to do about that?

C: Have you ever tried to cut down or stop your use of marijuana or vicodin before?

C: Tell me about that

Affirmation

C: You did really well to stop your marijuana use while you were pregnant. What helped you to do that?

C: When was it that you started using again?

Importance and Confidence

C: Currently on a scale of 1 to 10, with 1 being not important and 10 being really important, how important is it for you to make a change in your use of______?

C: What makes it a ______?

C: On a scale of 1 to 10, with 1 being not confident and 10 being really confident, how confident are you that you could make a change in your use of ______?

C: What makes it a ______?

Summary for change plan

Write this out from the patient’s responses.

C: You have said that you would like to change you use of ______and ______to help you in school/ with your family relationships/ to stop getting into risky sexual situations. We have about 10 minutes left, I would like to talk with you about what that change would be like.

C: I mentioned some of the reasons you had said for changing, are there any other reasons?

C: Going forward from today what would you like your use of ______and _____ to be like?

C: What would help you to make that change?

Here you may discuss the use of other resources depending on what patient has said or level of severity of use.

Pros of Changing / Cons of Changing

C: What concerns do you have about changing your use of ______and ______?

C: What do you want to get out of changing ______and ______?

C: You mentioned that using ______helps you to relax and socialize. How do you think you would do this if you were not using or using less of ______?

C: You said you had concerns about the unprotected sex you have been having; what do you want to do about that?

Write formal Change Plan(with permission from participant)

If testing had not previously been mentioned:

I would like to talk to you about another important health issue. I wonder if you have ever been concerned about your risk from infections like HIV, or hepatitis B and C. What do you know about these infections?”

“Even though you feel you are at low risk from these infections because you do not use injections drugs and you have not had unprotected sex, the Centers for Disease Control, the government agency that’s responsible for advising the public about health risks recommends that everyone should know if they have these infections or not. The best way to do that is to get tested. We can do that now. I can organize a free rapid HIV test, and you would now the result in 20 minutes. I can also organize tests for hepatitis B and C that requires some blood being drawn and sent to the lab. You would get those results in about a week. We would also do those tests for free. Would you like me to organize those tests for you?”

Ending session:

If made change plan

C: Thank you for spending the time talking to me. I will be calling you on ______when we will have our last conversation. In the change plan you made you are going to try out your new plan for using ______and ______. You have decided to let your friends know that you are making this change and ask them to help you by not using ______when you are around. If you find this does not work for you, you want to contact the drug treatment program that we talked about. Anything I have missed?

If no change plan

C: Thank you for spending the time talking to me. I will be calling you again on ______to have our last conversation. At that time we can have a discussion about any of the topics we discussed to day, or any other issue that concerns you.
Change Plan

C: You said you wanted to make changes in your use of ______. Do you mind if we take a few moments to write down your plan for making these changes?

Your Change Plan