It can be really difficult to get an accurate history from someone who abuses substances if they don’t want you to know the details. Here are some tips for getting a history on addiction from a couple of substance abuse counselors I talked to:
- Assessment requires:
- Knowing context of addiction
- Network of support the patient has
- Problem-solving with the patient, figuring out level of insight, drawing them to see the conclusions you’ve come to by asking them rhetorical questions. Try to figure out the discrepancy with what the patient believes vs reality is where progress takes place.
- Tell a patient that their information stays with you, “it goes nowhere,” and you are just there to help them with their course in the hospital. Point out that substance abuse can affect them if they go into withdrawal, or if they need a higher dose of pain meds.
- Be supportive by acknowledging disclosures and encouraging details. Ask how they feel or what happened in their lives. “I’m going to be as transparent with you as you are with me.” Understand that deception may be part of the course; lying may be a mechanism to get what they want, or they may be scared or mistrustful of the healthcare system.
- One interesting question that can be asked is, “Where do you see yourself in 1 year? 5 years? Ten years?”