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.

Physician asking a patient about past 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?
  • Tobacco products?
  • Prescription drugs for nonmedical reasons?
  • Illegal drugs?

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

Physician speaking with a patient

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.

Physician speaking with a patient

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.

Find a treatment program with the Substance Abuse Treatment Facility Locator:

Next Page: How Do You Address Patient Resistance?