Table II.

Top Ten Clinical Tools

Black Bag Tool [MI Core Principle]	Case Example	MD Questions/ Statements [Patient Responses]
1. Drinking Likes and Dislikes [Express Empathy and Roll with Resistance]	“Michael”, a 20 year old college junior, often drinks >15 drinks per night on weekends, recent break up with girlfriend	“What do you like about drinking?” [“It’s fun, social, relaxing…takes my mind off the stress of school.”]
		“What don’t you like about drinking?” [“Hangovers, and I get a little nasty when I’m drunk…I don’t think that helped things with my girlfriend.”]
		“On the one hand you enjoy the social aspects of drinking, but on the downside, it often causes troubles for you in relationships and in what you say to people.” [“Yeah, exactly.”]
2. Life Goals and Alcohol Use [Develop Discrepancy]	“Melinda”, 18 year old freshman, with fatigue and history of 15–20 drinks per week.	“What are your goals for the next few months?” [“Feel better, improve grades, save money for travel]
		“…and the next few years?” [ …”graduate with a 3.5, get a good marketing job.”]
		“If you kept drinking at these current amounts, do you think those goals would be ‘easier, harder, or no effect’?” [“Harder…”]
3. Reducing Risk Agreement [Support Self- Efficacy]	“Justin”, 24 year old MBA student with a DUI and a car accident last year.	“So what do you think you can do to prevent this in the future?” [“I should really cut down…And I will never drink and drive, or drive with anyone else who’s been drinking (my friend Ben thought he was fine to drive, but totaled my car).”]
		“I agree completely. What’s a realistic amount you can cut down to when you drink?” [“Maybe 5 or 6 drinks max, over several hours, no more than twice a week.”]
		“That sounds good. Who will support you in these healthier goals?” [“My girlfriend, Sarah, and George…I’m afraid Ben is a bit of a lost cause.”]
		“When will you talk with them about this?” [“Tonight.”]
4. Feedback on Alcohol Use, Binges per Month [Express Empathy]	“Tina”, a 21 year old sorority junior, return visit for routine annual exam.	“From your health history it looks like you’re staying fit and eating well, but you seem to drink quite a bit, and I wonder if this might be a risk for you…what do you think about this?” [“Yeah, I sometimes think I should cut down a little…”]
		“Why?” [“Well, I’ve been trying to work out more, but it’s hard when I’ve been drinking the night before.”]
5. Tracking Numbers of Drinks [Roll with Resistance and Support Self- Efficacy]	“Brianna”, a 19 year old, recent ankle sprain, enjoys her sorority and her partying, resistant to change.	“Sounds like you’re not really interested in changing your drinking at the moment. Would you be willing to keep track of your alcohol drinks using these pocket-sized cards over the next month?” [“Sure…that’s fine.”]
		(follow-up visit 1 month later) “How’d it go?” [“When I wrote it down, I was really surprised at how much I was actually drinking. I still like going out, but I’ve cut way down from before.”]
6. Readiness to Change 1–10 Scale [Roll with Resistance]	“Kevin”, a 22 year old senior, with recent treatment for a wound infection; has 30 drinks weekly, hangovers, occasional blackouts.	“So, given what we’ve talked about, how willing, on a scale of 1–10, would you be to make a change in your drinking?” [“About a 5 or a 6, I guess.”]
		“Good. Well, how come you’re not at a 1 or 2?” [“Well, I really don’t like the hangovers or blackouts, and I need to improve my grades this semester…”]
7. Drinking Consequences: Overall Compared With College Students Nationally [Roll with Resistance and Develop Discrepancy]	“Steven”, 25 year old biology grad student, with allergies and recurrent sinusitis, occasional cigarette smoker (when drinking), 20 drinks weekly.	“Have you regretted something you did or has anything bad happened to you as a result of your drinking?” [“Yeah, I have a set of twins in Texas…”]
		“What do you think about these infections with your current drinking and smoking?” [“Well, I can tell they’re not good for me…my throat and lungs feel sore afterwards, and it’s probably pretty bad for my immune system.”]
		“What do you think you could do about that?” [“I should really stop smoking, then I would drink a lot less, too…”]
8. Drinking Consequences: Calories [Roll with Resistance and Develop Discrepancy]	“Rosalie”, 20 year old junior, moderately overweight, rarely exercises, 18 drinks a week.	“In a month, if you have 72 drinks, you are consuming about 10,000 calories, just from alcohol; that’s the equivalent of about 30 cheeseburgers, or one a day. What are your thoughts about that?” [“Ugh. That’s gross. I knew some of my weight was from drinking, but not that much…I think I better cut down.”]
9. Drinking Consequences: BAC [Roll with Resistance and Develop Discrepancy]	“Clayton”, a 23 year old senior, drinking 10–12 drinks twice a week, admits to hangovers, but denies needing to change anything.	“You know, you told me you really like that ‘relaxed buzz’ you get from a few drinks, but then it seems you continue to drink until you not only lose that pleasant feeling, but pass out and “feel like crap” the next day. What do you make of that?” [“Well, I don’t know…guess I’d rather not blow off the next day…”]
		“What could you do differently?” [“I could stop at 8 beers and leave out the shots and I’d feel better the next day…”]
10. Alcohol Norms: Personal Use Compared with Peers’ Use [Roll with Resistance, Develop Discrepancy, and Support Self- Efficacy]	“Victoria”, an 18 year old sophomore, drinking about 7–8 shots on weekend nights, relationship problems, mild depression.	“As you can see from these charts, compared with other young adults (age 18–25), your 15 drinks a week is in the 8th percentile; that means you drink more than 92% of your peers…What do you think about that?” [“Whoa. That’s hard to believe.”]
		“What do you notice about your moods or energy level after you’ve been drinking?” [“Well, it starts out fun and all, but after partying I kind of feel down and wiped out.”]
		“What do you think about that?” [“You know, it seems kinda fake, the good feeling you get when you’re drunk…I think I’d feel better about myself if I didn’t get to that point”]