RELEVANT BEHAVIORS
 

ASK:

  1. Screen all patients for past and present substance use.
  2. If any use, ask "CAGE" questions for alcohol/drugs, or use NIDA modified "ASSIST" questionnaire.
  3. Ask about frequency of use.
  4. Ask about method of administration.
  5. Ask patients for their perspective on the current and potential consequences of drug use.
  6. Ask patients how they acquire their substances, including how they can afford them.
  7. Ask about past quit attempts, or attempts to cut down; including withdrawal symptoms, how long abstinent, etc.
  8. Ask about current mood and any past mental health problems.
  9. Ask patients if they are open to hearing that they might have a substance abuse problem and might need specific help for this.
  10. Assess patients' conviction and confidence about their willingness to quit using.
  11. Conduct interviews in a non-judgmental way. (ie: Do not say, "This is really a will-power problem and you need to just quit!" or make other statements that might induce judgment or shame.)

TELL (Brief Intervention):

  1. Tell patients that you are concerned that they have a substance abuse problem, and need help to manage it. Talk about the potential negative impact of substance use on patients’ health, family, employment, mental health and well-being.
  2. Recommend assistance / treatment, and speak succinctly about options: stop on their own, join a 12 step program, go to an addiction specialist, be referred to a treatment center.
  3. If patients are on prescription narcotics, negotiate a treatment contract with them.
  4. Inform patients about the role of drug and alcohol testing in treatment monitoring.
  5. Communicate that individual needs vary, and that treatment usually includes psychological, social, vocational, and biological interventions.
  6. Make a supportive statement like, "Recovery is usually a long-term process and it may take years to return to full functioning."
  7. Offer to communicate with patients' families.
  8. State your willingness to provide continuing care to patients who abuse substances.

ASK:

  1. Ask patients if they are ready to accept a referral to treatment.
  2. Ask patients about their reactions to the discussion.
  3. Ask patients about their questions and concerns.