ubstance and alcohol use has increased during the Covid-19 pandemic. Unfortunately, our culture often discourages vulnerability and help-seeking behaviors, especially for health care professionals. Our colleagues worry what their coworkers will think. Or worse, they worry they will be prevented from practicing medicine. 

We can help our colleagues and change the culture of medicine by having conversations, even when they are uncomfortable, about substance and alcohol use. 

Before you have the conversation 

While these conversations are hard—for you, and the person you are talking to—they are a skill you can learn. I’ve provided a template below that you can follow to make it easier. But first, it’s important to get into the right frame of mind. 

Before you talk to a colleague about their struggles, you need to understand your own discomfort. Some people's personal discomfort with these difficult conversations comes from a need to be liked. Your discomfort might come from worry about your job or upsetting the team balance. These conversations can be lifesaving, so you must seek to understand your reticence and put aside whatever is holding you back. 

You should also consider your goals for the conversation. Goals provide clarity. Come to the conversation with the intent to express concern and give information, not with the intent to punish or extract an admission of guilt.  

The more you practice and have these conversations, the easier they become. 

Starting the conversation  

After you have confronted your discomfort, recognized your goal, and prepared for the conversation, you can use this template to have the conversation. 

1. Find the right time and place. It’s not a good time to talk to someone in the hallway or on their way to rounds. Choose a quiet moment in a private room. For example, alone in the lounge or next to each other while charting. Plan for a 15-minute conversation. 

2. Give your colleague choices to help fend off the possibility that they may react with defensiveness. You might start the conversation by saying: 

• “You can do what you want with this, but I wanted to share some of my concerns with you.” 

• “I’ve noticed you’ve changed lately. Would it be okay if we talked about it?” 

• “I’m worried about you. Can we talk?” 

3. Use objective observations and language. Avoid being accusatory. You might say things like: 

• “I noticed you’ve come in late a lot.” 

• “I thought I smelled alcohol on your breath.” 

• “You haven’t looked well recently.” 

4. Use expressions of concern for your colleague. Ask them if they have felt an increase in stress in their lives. Tell them you care about them or are concerned about them. 

5. Ask if they have any thoughts about your observations. Give them the chance to respond and just listen.

6. Be prepared to hear excuses or rationalizations about what they are doing. They could also be angry. These are all normal reactions. You are providing an opportunity for them to share and it is not your role to refute their responses.

7. Give contact information for support services. You can tell them that while they may not want to seek support at this time, you hope they will keep the number just in case. You can encourage them to put it in their wallet or purse or save the number in their phone. You never know when someone is going to decide they need help, so give them the information so they have it when they are ready.

8. Ask permission to follow up or check in with your colleague in the future. Follow-up is important to see if they are getting the help they need. Consider phrases like: 

• “Can I follow up on this conversation?” 

• “Can I check in on you later?” 

Talking about substance use is uncomfortable for most of us. But by following these steps you can turn an uncomfortable conversation into an opportunity to help a colleague heal.