Effective practitioners create an environment where a young person feels most able to give an honest and realistic account of their own motivations and concerns.  Practitioners need to be intentional in confirming with the young person, and others involved in their care, that their work is being driven by the goals of the young person.  Practitioners can work with a young person to formulate a range of strategies that will enable their substance use related goals (ceasing, reducing or controlling use) to be achieved. This can best be achieved when practitioners understand the function of substance use unique to each young person, and their reasons for wanting to change their substance using behaviour. 

It is essential that practitioners continually consider the young person’s motivation for pursuing modifications to their substance using behaviour as it has a major influence on whether interventions are successful and desired outcomes achieved.  A young person’s motivation to develop and change is sustained when their sense of self-efficacy is fostered. Practitioners can draw on a young person’s existing strengths as well as facilitate the development of new competencies that can be applied by the young person to make change sustainable (YSAS 2002).

Important risk management advice
Practitioners should enlist the help of a G.P. or other health professional with AOD expertise whenever a young person makes dramatic reductions in their substance use, and be alert to after-hours mental health services and other supports should they be needed. Young people moderating or ceasing alcohol or benzodiazepine use after long term or dependent use in particular should be considered for a carefully monitored home based or residential withdrawal referral prior to commencing a controlled use plan, due to the danger of seizures.

All young people, regardless of the substance type, who choose to cut down or cease using substances should be carefully monitored for withdrawal symptoms as they pursue their goals. The practitioner should take care to keep the issue of lowered tolerance and increased risk of overdose on the agenda. 

Specific strategies are required for young people with low literacy levels
Many of the ideas in this module are based on utilising written materials such as worksheets, a drug diary, a pros and cons table and so on. Not all young people respond to text based resources, so assess for cognitive capacity and literacy levels prior to using these materials. Many practitioners opt to use sketch pads and other art materials, document verbal discussions of goals in an accessible style, or source supporting information specifically designed for low literacy levels. Where there may be a cognitive impairment, practitioners find it helpful to use concrete language, repetition, incorporating sensory learning tools such as ball games and movement, and of course, lots of positive reinforcement from other professionals and caregivers.