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