How to approach patients who don’t want help

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How to approach patients who don’t want help

Access AOD training  Download PDF of this page  AOD resource list 
Alcohol and other drugs > My patient doesn’t want my help

Most people who use alcohol and other drugs don’t develop a substance use disorder (SUD).

If you suspect that your patient is experiencing harms from their substance use, or may have a SUD, your course of action will depend on how willing the patient is to discuss their substance use and whether they are willing to make changes. Changing a pattern of substance use is most likely to succeed when a patient is open to the idea of making some changes, ie “ready, willing and able” to change.

Not the nail

Motivational interviewing in practice requires clinicians to suppress the initial righting reflex so that they can explore the patient's motivations for change.” 1 2

Support patient autonomy

Dr Shani Macaulay explores how patient autonomy and being hopeful can support patients to make lasting behavioural change. 1 2

Download video transcript
Motivational interviewing techniques Facilitating behaviour change in the general practice setting, AFP

Focus on harm minimisation

[1] Australian Family Physician, RACGP 2012. Motivational interviewing techniques Facilitating behaviour change in the general practice setting. Viewed 19 January 2022.
[2] Jason Headley 2013. It’s Not About the Nail. Viewed 19 January 2022.

Frequently asked questions

Roll with the patient’s resistance. Accept that your patient’s use will continue and discuss ways to make this as safe as possible and minimise harms.

You can use motivational interviewing techniques to elicit the patient’s own motivations in their life. What are their values and goals? Highlight to them (if appropriate) where reducing or stopping their substance use may align them closer with these values and goals. You can explore these further in subsequent consultations.

Treat the whole person and continue to offer support on management of all their health issues and review preventative health measures. Keep an open-door policy and people will return when ready for change or help.


If the patient is willing to talk about their substance use, be curious. If you do not know what a patient is referring to, ask them. The patient is their own expert and might want to tell you about their life and the context of their substance use.

Explore harm minimisation options and use motivational interviewing techniques to optimise the potential for behaviour change.

Motivational interviewing can help patients examine their own situation, without becoming confrontational, and can be helpful when:

  • ambivalence is high and people are stuck in mixed feelings about change
  • confidence is low and people doubt their abilities to change
  • desire is low and people are uncertain about whether they want to make a change
Raise a patient’s awareness through helping them to make the link between their presenting problem or long-term health issue and their substance use. Provide a brief intervention using the FRAMES acronym.


There are many counselling styles which can be used depending on the patient and their presentation. Reflect on your medical training and what you have witnessed within hospital and community-based medical settings. How much of what you’ve seen is directive counselling or authoritative? How much was more empathic and patient centred? 

Patients who experience harms associated with their substance use may have experienced stigma and judgement. Quality care often means access to a non-judgemental GP, who will listen and empathise, treat their presenting health problem(s), and keep the door open until they are ‘ready, willing and able’ to change.


When providing advice on lifestyle management that will require behavioural change, it can be useful to do a ‘brief intervention’ after you have screened for substance use.
Brief interventions are five-to-fifteen minute conversations that enable GPs to provide non-judgemental feedback about a patient’s substance use. Feedback includes acknowledging that use may continue, discuss the impact AOD use has on their health, and discussing options that are available to the patient to manage their use and minimise harm.


Case studies

Case Study - Dan

Dan drinks most nights and uses alcohol to relax. He doesn’t see this as a problem and does not want to change. He sees his alcohol use as normal. Listen as his GP talks to him about his drinking and uses motivational interviewing to help him examine how his drinking may be impacting his life.

GP          And then, I just wonder what the alcohol is costing you? is that a stress, a financial stress for the family, given your wife is parenting and children, lovely as they are, are expensive?

Dan        Yeah it is expensive and it comes up because I guess it does add up when you think about it in terms of what I might have spent on it, my wife said that, she said, "o you know we can't afford to be spending all of this money", and I try to get good deals on it and all that sort of stuff and sometimes the guys buy the drinks, but yeah it does, it does add up a bit, but it's hard, it's just what we do and just what we do after work, and I wouldn't say I'm drinking any more than any of the other guys and if they buy a round, then I need to buy a round, you know what I mean

GP          Yes, so I'd be concerned about them too. Um so in terms of the physical health matters we do need to measure your blood pressure and examine your stomach and I think probably do some blood tests to check how your liver's doing

Dan        Really? Just having that much can affect my liver?

GP          Yes, yeah it could. It often may not give any symptoms

Dan        it's not as though I'm drinking a bottle of whiskey a day or something like that

GP          No, no, no, I want to absolutely stress that I have no moral view of your drinking, alcohol in moderation can be very pleasant and very safe

Dan        Yep

GP          It's when you're drinking to what we'd call in medical terms, excessive, the effects on your health can be quite significant. We also know it can affect your mental health, um so people sometimes drink when they have depression, to feel better, but the problem is that the alcohol actually compounds the depression

Dan        For me it kind of helps, I kind of see it in the other way, in that, just stress you know, it's full on, the long days at work and then the income and my dad's sick and my wife's not working, and for me it’s like well, it kind of helps to relax you and calm you down a little bit and all of that you know

GP          Yeah, and I guess you have to be out of bed fairly early

Dan        Yeah, yeah, yeah, yeah, really early

GP          To get to work

Dan        Yeah, yeah, yeah

GP          And then a lot of tradies have to do overtime on building sites

Dan        Yeah, we do

GP          Yeah, so I imagine when you get home, the children, you know, they often ark up in the evening and they're a bit tired and cranky and the house often quite a tense place

Dan        Yeah, it is, well sometimes I don't get home in time and they've kind of gone to bed and I miss them a little bit and my wife gets a bit annoyed because I'm not there and that, but they wake up and stuff too, which is hard because I've got to get up early, and I wake up and it's noisy and yeah it's a bit stressful, yeah there's no doubt about that, and I'm trying to get ready in the mornings and I'm trying to go out and it's full on, it's really full on sometimes and I don't think people understand that, I don't think my wife understands that and it's a lot of responsibility and you're trying to juggle everything but you can't, you can’t kind of do it all, you know?

GP          Yes, yes

Dan        So a couple of drinks, I thought that's something just to relax me a little bit

GP          So you've alluded to at times some tensions with your wife. Do you mind if I ask how the relationship's going?

Dan        Yeah, um, I mean yeah just tension I guess, because she just goes on about the fact that I'm coming in late, I’m going out for a drink after work and she's at home and then, "why don't you see the kids?" and but you know it's that whole kind of, it's a tough situation, because I do have to work and as you say I've got to do long hours sometimes and I have to be up early and I have to be onsite and you know, so I can kind of see where she's coming from but yeah no we argue about it and there's money and all that kind of stuff and money strains and then she says you're spending too much money and you shouldn't be drinking. So we have those arguments but I guess that's normal relationships isn't it, I mean, I guess that's what happens?

GP          Are there any plans for her to return to work, because you said your younger child's one?

Dan        yeah

GP          Is she on maternity leave or your plan is for her to stay home? And parent full time

Dan        oh probably parent full time, at least maybe, until school kind of age you know

GP          Ok

Dan        So then maybe she can go back part-time then or something like that

GP          Yes, yes

Dan        So it's just so much like childcare and all that's expensive and yeah it doesn't make sense that you know she might as well just stay at home

GP          Yeah so I can see you're in quite a challenging situation

Dan        Yeah, yeah, yeah, it’s full on, but you know, you’ve just got to get through it

GP          I'd like to talk to you further about some of these matters and I think also we need to do a better job improving your back               

Case Study - Carl

Carl is a farmer who consumes 4-8 beers most nights. Listen as his GP uses motivational interviewing to talk to him about his drinking and draw attention to how his alcohol use may be impacting his life negatively.

GP          And you mentioned you get together with the guys at the pub and stuff. Are you going every night down to the pub?

Carl        Either the pub or we'll just hang around one of the sheds, you know. Yeah, just sort of kill the rest of the day, you know. Once we've done everything we can do, sometimes there’s not much to do you know, so once we've done everything we'll just get together and sort of chew the fat.

GP          ok, that can be a pretty boozy affair sometimes these, these things so how much how much uh alcohol we end up drinking?

Carl        we all have a bit you know that's yeah just sort of depending how long we got you know

GP          ok

Carl        just sort of it's a good way to sort of for everyone to sort of get together and sort of talk about stuff

GP          yeah and what are we talking about?

Carl        everybody having it everyone's you know everyone's got that different points in what they've got to do on their properties and and then you start talking about your kids, sport and whatever else you know

GP          ok

Carl        so it takes your mind off everything, it's good

GP          yeah ok um and so how much would you end up drinking on these nights?

Carl        Oh you know, three, four, six

GP          yeah ok, you ever go higher than that? you never you know sometimes people are

Carl        Oh not usually, no you know you might get up to about eight or something like that you know

GP          yeah and your drinking beer?

Carl        yeah, yeah stubbies, yeah

GP          yeah um and do you have any days off drinking? Do you try and go a couple of couple of days a week without it or...

Carl        no no no, it's just part of the day yeah sort of become part of the day yeah

GP          Do you reckon you could manage a day off? What do you reckon would happen?

Carl        Yeah, sometimes in the morning I think, you know and you wake up and you're a bit worse for wear sometimes think I won't have any today you know and uh but then time comes around and you're feeling a bit better and you know you're sort of just as normal

GP          yeah ok, it can sort of leads into...

Carl        yeah well you know it's all of us there and everyone's going through the same stuff so it's good to sort of share

GP          yeah and does it ever, you know that alcohol can be uh, can be a friend and a foe. Does it ever cause any troubles for you?

Carl        oh, not that I've noticed

GP          yeah has Cheryl ever make any comments about it, does it affect the way you interact with the kids or anything

Carl        She sort of reckons I'll get a bit you know if I've had a few I'll come home and get a bit cranky with the kids and even her you know so she's, she's you know often comments you know "how long have you been in it today?" you know

GP          Yeah

Carl        That sort of thing

GP          And has it ever affected your work?

Carl        My work?

GP          yeah

Carl        oh you know, sometimes you're a bit away with the fairies sometimes and you know you stick your arm into a barbed wire fence

GP          Yeah right, and Cheryl mentioned about that there's a few sheep getting loose and stuff

Carl        Oh yeah, it was only once

GP          yeah, a couple of weeks ago

Carl        yeah I just forgot to shut one of the gates and you know a few got out and we you know spent the next day searching them down and uh they’re all back that's just once you know it was but it's not something I normally do obviously it's very rare

GP          yeah ok

Carl        You know it's normally like clockwork

GP          yeah sort of routine

Carl        yeah absolutely

GP          yeah ok um but have you ever when you went after you've had a few drinks do you end up, how do you get home?

Carl        Or if we're down the pub, I'll usually just drive home. It's not far you know

GP          ok has it caused, ever been picked up or?

Carl        no 

GP          yeah and I guess the main concern made is obviously you know we all know, we all know people who've had accidents or uh you know run off the road after a few drinks

Carl        yeah, with people around the place but, I don't know, I think that the truck knows its way, you know. Sometimes you know you arrive at home and you oh, I’m home

GP          yeah, I guess from my point of view mate, I've just got you know it's a bit risky isn't it you know. The last thing anybody needs you know would be for you to have an accident and injure yourself

Carl        yeah

GP          or like injure somebody else you know

Carl        I don't think Cheryl's talked about yeah, you know you shouldn't be driving home but you know what choice have I got?

GP          yeah

Carl        you know

GP          yeah

Carl        Once you're there then you're there and you've got to get home and

GP          Do you ever do a designated driver type of thing with the guys?

Carl        Oh, no not really

GP          Might be something to think about if you know if you're all there just to keep each other safe

Carl        yeah

GP          yeah

Carl        draw straws I suppose

GP          that's right, that's right or take it in turns, have a roster, that's something yeah. Yeah, so definitely something to think about mate. It would be, it would be more of a disaster if something was to happen on that front

All case studies are based on factual scenarios and are illustrative and general in nature. The patients in these case studies are played by actors and individuals should always seek personalised professional advice from their GP.

Further Training

RACGP AOD Program training modules related to this topic are available on gplearning and include:

  • Alcohol and Other Drugs - Essential Skills
  • Alcohol and Other Drugs: Facilitating behaviour change

Access AOD training  Download PDF of this page  AOD resource list 

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