How Do You Start a Conversation About Your Patient’s Drug Use?
Follow the steps below to learn about engaging your patients in a discussion about their drug use.
Step 1. Ask the patient about past drug use.
Use this Quick Screen question to determine whether additional screening is necessary: In the past year, how many times have you used the following:
Alcohol—For men 5 or more in a day; For women 4 or more drinks in a day?
Prescription drugs for nonmedical reasons?
Note: Any current tobacco use places a patient at risk — advise all tobacco users to quit. Encourage patients who drink to stay within acceptable drinking limits. If your patient is an at-risk drinker, please see the National Institute on Alcohol Abuse and Alcoholism’s publication “Helping Patients Who Drink Too Much: A Clinician’s Guide” for information to help assess, advise, and assist at-risk drinkers or patients with alcohol use disorders.
Source: Smith, P. C., Schmidt, S. M., Allensworth-Davies, D., & Saitz, R. (2010). A single-question screening test for drug use in primary care. Arch Intern Med, 170(13):1155–1160. doi:10.1001/archinternmed.2010.140
Step 2. Determine risk level.
If the Quick Screen indicates the patient is at risk for illicit or prescription drug abuse, continue with the NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test (NMASSIST) online. This Web-based interactive tool presents a short series of screening questions. Enter patient responses and the tool will generate a substance involvement (SI) score, which determines the risk level and suggests the degree of intervention needed.
Step 3. Depending on risk level, do the following:
Advise: Provide medical advice about the patient’s drug use.
Explain that it is your role as his/her medical provider to convey health recommendations.
Recommend quitting before problems (or more problems) develop. Give specific medical reasons.
Refer patients with suspected co-occurring conditions (e.g., depression, pain) to a relevant specialist.
Assess: Determine the patient’s readiness to quit.
Say something like, “Given what we’ve talked about, do you want to change your drug use?”
If the patient is ready to quit, assist his/her in efforts to stop using drugs.
If the patient is unwilling to quit, raise awareness about drugs as a health problem. Let the patient know that you will revisit the issue at future visits.
Assist: Offer help based on the patient’s readiness level.
Jointly complete a progress note form with the patient to document the screening results and create a follow-up plan. (Sample Progress Notes are available on the NIDAMED Web site.)
Help set concrete and reasonable goals for making a change (see the Change Plan Worksheet available on the NIDAMED Web site for more information).
Arrange: Refer the patient for specialty assessment and/or drug treatment, if necessary.