Use this when time is limited and you want to agree useful interim care or explore uncertainty without making readiness a condition of help.
Choose the task that matters today
First distinguish the obstacle. Is the person waiting for an appointment, facing a cost or transport problem, uncertain about changing use, or struggling to carry out an existing plan? These difficulties can overlap. A delay in access does not tell you how motivated someone is. Ask: 'While that appointment is pending, what would help most this week?'
Clinical needs continue during a wait. Review symptoms and risk, offer appropriate interim care and clarify who is providing follow-up. If there is already a clear goal, move to practical planning. There is no need to manufacture a discussion of ambivalence.
Ask permission, then listen for what matters
'Would it be useful to spend a few minutes on how this is affecting you?' can open the discussion without taking over the consultation. Ask what the person hopes for, worries about or would like to understand. Give them room to disagree or decline.
Reflect their meaning before adding another question. If they have expressed both points: 'Using gives you some relief, and you are worried about your sleep. Have I understood?' You do not need to resolve every tension. Avoid assigning motives or a stage of change.
Offer a clear clinical view
Listening does not mean withholding advice. Ask what the person already knows, offer a small amount of relevant information and check their response: 'What do you make of that?' Clear safety advice can sit alongside respect for autonomy. Urgent assessment must not wait for a motivational conversation.
Brief alcohol interventions can have modest average benefits for hazardous or harmful drinking. Evidence is less consistent for other drugs and for motivational interviewing compared with other active care. A short conversation complements assessment and treatment; it is not a prerequisite or a substitute for either.
Agree something the person can use
Ask: 'What is one step that feels realistic before we next meet?' It might involve attending existing care, discussing a symptom, arranging transport or choosing a relevant harm-reduction measure. If changing use is not their goal today, ask what could make the coming week safer.
Make the step concrete enough to revisit. Explore likely obstacles and available help. Difficulty controlling use does not make participation in care pointless: agree achievable responsibilities, including communicating barriers and following safety advice. Do not infer indifference from a missed appointment or an unsuccessful attempt.
Keep responsibility shared and review possible
Agree who will do what and when to review, including what should prompt earlier help. 'We can review this even if things have not gone to plan' keeps the conversation usable. Support can include family with appropriate consent, but relatives should not become the sole treatment monitors.
Keep the plan manageable for both patient and practice. Clear contact arrangements, shared care and professional support matter. Use the next-step sheet only if it helps; a brief conversation or clinical note may be enough.
For health professionals
A place in the clinical conversation
An original optional discussion aid, not a validated treatment. Distinguish access barriers, ambivalence, cognition, mental health and acute risk. Use alongside your usual clinical judgement. Keep online notes de-identified and record patient information in the appropriate clinical system.
Use the sheet alongside your clinical assessment. It does not produce a diagnosis, measure risk or determine treatment. The clinical referral information is available if specialist input would be useful.