Written by Elizabeth Cairns, Mobilize Recovery Special Projects, and reviewed by Code Recover Peer Advisors, August 2026

Peer recovery support specialist Kara Trainor talks about what the peer brings to the table, and how to approach patients in different stages of change.

Helping someone with a substance use disorder (SUD) is not about telling them what they should do. Often, the patient is aware of problems their use may be causing, and also aware that they need help to manage it. Many times, the help that is offered to people with SUD can feel to them like punishment, or like something that is forced on them without their consent or participation. They might feel scared, vulnerable, or trapped.

Motivational Interviewing (MI) was developed as a method of drawing out a person's own reasons for wanting to change, rather than forcing change on them. (source) It utilizes a collaborative conversation style that strengthens a person's motivation and commitment to change. We aren't the experts on the patient's life, they are. Our job is to help them find their own reasons for wanting something different.

The Spirit of MI: PACE

MI practitioners adopt a specific mindset, often called the "Spirit of MI." You can remember it with the acronym PACE:

• Partnership: You are a team. You work with the patient, not on them.
• Acceptance: You respect the patient's autonomy and their right to choose, even if they choose not to seek treatment today.
• Compassion: You act in the patient's best interest to promote their welfare and healing.
• Evocation: You "evoke" (draw out) the patient's own ideas and strengths rather than "installing" your own.

Communication Skills: OARS

When working with a patient, use these four communication skills to move the conversation forward:

1. Open-Ended Questions: These cannot be answered with a simple "yes" or "no."
   • Instead of: "Are you ready to quit?"
   • Try: "What has your experience with recovery been like in the past?"
2. Affirmations: Recognize the patient's strengths or efforts.
   • Example: "It took a lot of courage to come into the hospital today while you were feeling this way."
3. Reflective Listening: Mirror back what the patient is saying to show you understand.
   • Example: "It sounds like you're feeling exhausted by the cycle of withdrawal and just want some stability."
4. Summarizing: Periodically recap what you've discussed to ensure you're on the same page and to transition to the next step.

Listening for Change Talk

One of the biggest hurdles for new peers is the urge to "fix" the patient's problems. If you push, the patient will naturally pull back. If you hear yourself saying "Yes, but...", you're on the wrong track. Instead, listen for Change Talk. These are statements the patient makes that hint at a desire for change (e.g., "I'm tired of being sick," or "I want to see my kids again"). When you hear Change Talk, use a reflection to highlight it.

Change talk can also help you assess where the patient is in the "stages of change" model. (source) The six stages are:

• Precontemplation (not ready)
• Contemplation (maybe, exploring the idea)
• Preparation (getting ready, planning)
• Action (concrete steps toward change)
• Maintenance (continuing and sustaining the change)
• Termination (completing the change, or reversing course to one of the earlier stages)

Remember, your goal isn't always to elicit a "yes" to treatment. Any positive change is a win, and sometimes the goal is just to make the patient feel respected enough that they reach out again the next time they are in trouble.