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Resource Guide: Screening for Drug Use in General Medical Settings

Recommendations to Address Patient Resistance

May not be applicable in every case.

Patient Resistance Scenario	Physician Response
Patient answers "no," seemingly without considering it thoughtfully or is reluctant to give details.	Gently probe with a question like: "Not even when you were in school?" Encourage discussion by saying "go on" or "tell me more."
Patient is uncomfortable disclosing personal substance use on a form.	Let the patient know you will follow up in person about the screening. Reinforce that all information provided will be kept confidential when possible. If patient is still uncomfortable, skip screening but provide information about harms associated with drug use.
Patient appears ashamed or embarrassed about recommendations to change substance use behaviors.	State that this is a health-related medical recommendation and is not meant to judge or stigmatize them. Remind the patient of your role - that physicians have a duty to share test results with their patients.
At-risk patient appears ambivalent to the idea of changing his/her substance use behavior.	Acknowledge the patient's ambivalence and the fact that ambivalence is common. State your concern about specific ways that drugs may negatively affect your patient's health or personal life.
Patient becomes upset, argumentative.	Do not argue with the patient. Give the patient time to make a decision (unless the condition is life-threatening). Discuss his/her concerns and reflect them back (e.g., convey that you understand the patient's claim that drugs make them feel better or that their peers use them).
Patient resists referral for additional assessment	Explore concerns about the assessment. Emphasize that referral for an assessmentmay not mean entering substance abuse treatment - and that treatment, if recommended, likely will include different options.
Patient cites barriers to attending the referral appointment.	Problem solve about barriers and offer support, such as reminder calls, assistance arranging transportation, and child care.
Patient resists the idea of going into formal substance abuse treatment.	Clearly state that you are not insisting on formal treatment. Explain that treatment is often easier than quitting "cold turkey" and that stopping the use of certain drugs (e.g., alcohol, benzodiazepines) without medical supervision can be dangerous.
In followup visits, patient shows no progress with change efforts.	Acknowledge that change is difficult. Repeat the brief intervention and discuss other ways to support the patient's efforts. Make additional referrals for patients who did not attend the referral.