Reducing Stigma Education Tools (ReSET) > 04. Putting Treatment into Practice

04. Putting Treatment into Practice

MODULE 2 | SECTION 4 OF 5

Putting Treatment into Practice

Imagine that you are caring for one of your patients, Mr. Smith. What would your interaction with Mr. Smith sound like if you approached the interaction from a motivational interviewing perspective and were careful to keep your possible implicit biases in mind?

Please choose the most appropriate response via the drop-down menus provided.

You

Hi Mr. Smith, tell me a little bit about what brings you in here today.

Mr.Smith:

I am feeling horrible – I feel like I have the flu it hurts so much. My body hurts, I have been vomiting and I have diarrhea. I can’t do this. The only thing that helps are percocets. Please help me.

You

  • A. Are you really in pain? You seem fine. I can’t just prescribe you Percocet.
  • B. It sounds like you are really in a lot of distress. What else are you experiencing?
  • C. I see that you are in pain, however, there is nothing I can do about it at this time

 

The correct answer is B. Here, you are validating what your patient is saying, and spending more time to understand his current situation. A is dismissive and non-productive. C does provide some validation to the patient, however is incorrect because there are treatments available to assist with the extreme discomfort of opioid withdrawal.

Mr.Smith:

It hurts so much. I’m shaky. I am withdrawing, I know how it feels every time and I can’t take it.

You

  • A. You just have to stop using. You won’t die from withdrawal. I’m going to discharge you with some outpatient resources.
  • B. I know it is uncomfortable, but this is an outpatient issue
  • C. Let me go and order some comfort medications at this time so that you can get some relief. I can tell how uncomfortable this is for you

 

The correct answer is C. You are acknowledging his extreme discomfort, and offering immediate solutions for it. A is invalidating and includes the stigmatizing statement that all a person has to do is “stop.” B does show that you understand their discomfort, but offers no immediate relief or solutions.
Mr. Smith is now feeling slightly better after receiving multiple medications for his withdrawal symptoms.

Mr.Smith:

Thank you. I am feeling a little better.

You

  • A. Tell me how you feel about using heroin.
  • B. Why can’t you just decide to quit heroin?
  • C. Let’s talk about why quitting heroin is a good idea.

 

The correct answer is A. You are not making assumptions about Mr. Smith’s feelings or beliefs and creating an open space for Mr. Smith to voice his own thoughts. B contains a stigmatizing belief that substance use disorder is a choice rather than an illness. C does not allow space for the patient’s ambivalence.

Mr.Smith:

Well, it’s not like I’m proud that I use it.

You

  • A. All you have to do is go cold turkey, decide you want to quit, and avoid hanging around all of your friends who are drug addicts.
  • B. It sounds like you might have mixed feelings about using heroin. Can you tell me some good things about your use? Can you tell me some not-so-good things?
  • C. Well then shouldn’t you stop using it?

 

The correct answer is B. You are allowing Mr. Smith the space to think through his ambivalence, allowing the provider the ability to point out discrepancies between the patient’s goals/values and current behavior. A contains a stigmatizing phrasing suggesting that people who use heroin are “bad.” C again contains the stigmatizing belief that substance use disorder is a choice that people can just “stop” on their own.

Mr.Smith:

It just takes away all of my anxiety. I’m finally in a place in my life where I can relax and forget about all the bullshit that I’ve been through. I’ve been hurt so much in my life it feels better to numb all of the feelings. Heroin does that for me. I finally get momentary relief from all of the bullshit I’ve had to put up with. It’s literally the only time I feel slightly happy in my life. But the more I have, the more that I need it. And when I can’t get heroin, I have to deal with getting horribly sick like this. I haven’t been able to see my children and I was just fired from my job for calling in sick. I don’t like what it is doing to my life.

You

I really appreciate your honesty and sharing these thoughts with me. It sounds like you are able to get momentary relief with heroin, but now you are finding that it is causing issues in areas of your life that are very important to you. Right now, on a scale of 1 to 10, how interested are you in stopping use of opiates? With zero being not interested at all, and 10 being extremely interested.

Mr.Smith:

Well, I guess I am about a 7 on a scale of 1 to 10. I want to stop using because it is affecting so much of my life, but I don’t know how to stop using and I’m afraid I won’t be successful.

You

I understand this is a big step, but it sounds like you are wanting to hear about ways to treat this. We are happy to discuss this with you in further detail.

Mr.Smith:

Yes, thank you. I am interested.

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