I like to start off by asking a youth what the substance is helping them with? Come at the substance use as not a negative but a positive…and explore from there. What does the substance do for them? How does it help them? Are there any perceived negative impacts from it? So often the substance is in fact meeting a short term need and so if we know what that is then we can possibly offer a safer alternative. This also validates a youth and again puts them at the center of plan.
I also really appreciate the comments around building up the therapeutic relationship to the point where you can have open conversation around this.