SBIRT Toolkit
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# Step 4: Negotiate and Advise

# Key Objectives:

  • Shift the focus of conversation from reasons to change to negotiating a personalized plan for change.
  • Help the client identify a goal for how to stay within safe limits or abstain from gambling.
  • Summarize conversation.
  • Suggest follow-up appointment and/or referrals to treatment services (if appropriate).
Objectives Actions / Examples

Provide Advice

  • Discuss abstinence or decrease in use
  • Provide personalized advice/education

Signal shift of conversation
“After everything we’ve discussed, I wonder what you make of gambling at this point.”

Provide menu of options (see 'Menu of Options' below)
“It sounds like you are quite motivated to make a change. Now I would like to discuss some specific steps you can take. Here are some options that I think would be most useful for you.”

Negotiate a Goal

  • Bolster confidence/
    self-efficacy

Assist client in identifying a goal from a menu of options(see 'Menu of Options' below)
“What steps do you think make most sense for you to take next?”

Acknowledge client’s autonomy
“It’s completely up to you what you do with this information. Only you can decide to change.”

Summarize conversation
“So let’s summarize what we’ve been discussing today [summary]. Does that sound about right to you? Is there anything that I missed?”

Next Steps

Suggest scheduling a follow-up appointment to discuss progress

Provide referrals to treatment, if needed

TIP

A menu of options can vary depending on the services available in your local region, but some options for preventing problem gambling include:

  • abstinence
  • setting time limits
  • setting money limits
  • reducing high-risk gambling situations (e.g., not drinking while gambling)
  • increasing time spent on other leisure activities.

Setting monetary limits is the most common suggestion for limiting problem gambling. When discussing any option, it is important to have a collaborative conversation with the client about how to best move forward with that step.

# Example

Clinician: “One of the best ways to reduce the risk of engaging in problem gambling is to set a limit on how much you will spend before gambling.”

Client: “I agree, I think setting a budget for gambling would be important to me. My wife gets very upset when I lose a lot of money at the casino.”

Clinician: “What do you think would be the best way for you to limit how much money you spend at the casino?”

Client: “I could withdraw cash before going out with my friends and not bring my ATM card with me.”

Clinician: “That sounds like a good option.You could also create a separate bank account that’s only for leisure activities. Or you could bring someone with you, maybe your wife, who could support you and make sure you only spend what you planned at the casino.”

Client: “I think that not taking my ATM card with me and maybe asking my wife to come to the casino and making it more of a date night would be a good idea.”

# Close: Thank Client

Acknowledge the client’s willingness to discuss their gambling behaviours with you and thank them for their time.

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