Hard conversations

MAT Conversation Opener Library

A browsable library of original, alliance-preserving phrasings for raising medication-assisted treatment with a patient — filter by the patient's readiness, the patient's concern, and what you want the opener to do.

Original phrasings. Adapt to the patient and your clinical voice. Educational only; runs entirely in your browser and collects nothing.

Filter the library

Showing 8 starter openers

Leave filters blank for the starter set; add only the details that matter.

Patient readiness any

What's in the room any

Opener move any

I want to flag something. I'm not a prescriber, so I can't put you on a medication or take you off one. What I can do is help you figure out whether it's worth a conversation with someone who can. Is that a conversation you'd be open to me helping you set up — at some point, not necessarily now?

contemplationpreparationtrust deficitcost / accessseparate idea from decisionoffer informationaffirm autonomy

Can I bring something up that I've been sitting with? I remember you've said in the past that medication isn't really the route you want to go. I don't want to push past that. I just wanted to ask if we could revisit it — not today, just at some point — because some things have changed in the field and I'd want you to have the latest if you ever wanted it.

contemplationactionmaintenanceidentity-protectivestigma-internalizedask permissionname prior positionseparate idea from decisionaffirm autonomy

I want to bring up something that's a bigger deal in pregnancy than people sometimes realize. Medication treatment such as buprenorphine or methadone is guideline-supported during pregnancy; stopping suddenly can be risky and should be managed with an OB or addiction prescriber. I'm not your OB and I'm not going to make this call. I do want to make sure the option is on the table and that you're talking to a prescriber who knows this. Can I help you find that conversation?

contemplationpreparationfear of side effectsidentity-protectiveoffer informationseparate idea from decision

Pregnancy / postpartum context only — the specific guideline framing is what makes this opener honest.

What happened last week scared me, and I think it scared you too. I don't want to make the visit today about pushing anything on you. I do want to ask one thing — would you be willing to have one conversation with a prescriber about whether medication might lower the chance of this happening again? Just one conversation. We can decide everything else later.

contemplationpreparationidentity-protectivefear of side effectsseparate idea from decisionask permissionoffer information

I know we mostly talk about other things, and I don't want drinking to take over the hour. I do want to say once that there is a medication — naltrexone — that some people find genuinely helps with the wanting-a-drink part of this, without having to make any big decision about quitting first. I can tell you more if you ever want. No pressure to take me up on it.

precontemplationcontemplationidentity-protectivecurious but cautiousoffer informationleave door openseparate idea from decision

That's a real concern and you're not the only one I hear it from. I'm not going to tell you it's wrong. What I can say is that the way I've come to understand it is a little different — and I'd rather earn the right to share that than just dump it on you. Would it be okay if we came back to this next time?

contemplationstigma-internalizednormalizeask permissionseparate idea from decision

Can we put medication on the list of things we talk about?

precontemplationcontemplationpreparationidentity-protectivecurious but cautiousask permissionseparate idea from decision

Sometimes the right move is the smallest one.

You asked me last week about Suboxone, and I've been thinking about how to answer you honestly. I'm not the prescriber, so I can't tell you what would be right for your body. What I can do is tell you what I generally know and connect you with someone who can actually answer the medical questions. Want me to start there?

contemplationpreparationcurious but cautiousoffer informationseparate idea from decision

About this library

How to use it

A fluency aid for non-prescribing clinicians — therapists, counselors, social workers, case managers — who need to raise the topic of medication-assisted treatment (MAT, also called MOUD or pharmacotherapy for alcohol use disorder) without rupturing the relationship. Pick filters that match the situation, read the openers that come back, lift one into your own voice. Use the phrasing as a starting point. Your clinical judgment comes first.

Patterns to avoid

“Have you ever considered…” — sounds like a lecture is coming.
“I really think you should…” — collapses autonomy.
“Everyone I work with is on something — why not you?” — peer pressure.
“If you don't try this you're going to die.” — sometimes true, rarely useful as an opener.
“Your insurance covers it so we should do it.” — administrative, not relational.
“Let me tell you about Suboxone…” without first asking permission.

What this library is not

Not a script — every opener needs adaptation to the specific patient and relationship.
Not clinical content about the medications themselves. For that, see SAMHSA TIP 63 on medications for opioid use disorder.
Not MAT training. For real training (including for non-prescribers), see PCSS-MOUD.
Not motivational-interviewing training. For that, see MINT (Motivational Interviewing Network of Trainers).
Does not recommend specific medications, route to specific providers, or score what you said.

This tool is a fluency aid, not a script and not medical or legal advice. The phrasings are original starting points; adapt them to the patient, the relationship, and the moment. Use your clinical judgment, follow your licensing board, and defer to the prescribing clinician on anything to do with the medications themselves. Runs entirely in your browser. Nothing is saved or sent.