# 46 December 2003

"God is like a mirror. The mirror never changes, but everybody who looks at it sees something different."

Rabbi Harold Kushner

(continues below)

mental health professional trainings
primary care professional trainings
psychological assessment supervision and consultations
Shawn Christopher Shea
links and recommended readings


# 46 December 2003

Tips for Uncovering Drug and Alcohol Histories

TISA Description of the Problem: As we all know, it is frequently challenging to uncover valid information when first working with a person coping with alcoholism or street drug abuse. Unconscious defense mechanisms such as denial and intellectualization, as well as conscious distortions and deceit can all play a role in hindering the elicitation of valid data. Bruce Berger, M.D. provides some nice questions that can help with this common problem.

Tip: I find the following questions useful, particularly in helping to get a feel for the client's understanding of the extent of his or her substance abuse problem as well as the defenses the client uses to avoid facing the impact of the abuse (for the sake of simplicity, the following questions are phrased for use with alcoholism but they are equally useful with drug abuse):

"When you do have periods when you stop drinking, what actually stops you? Do any of the following ever stop you: lack of money, your own sense of self control, passing out, physical problems like a seizure or a coma?"

"When you are drinking what do others say about you? Do they ever say you are funny, mean, stupid, or anything else?"

"In your opinion what are the advantages of your drinking to you personally? What are the disadvantages?"

TISA Follow-up: With such questions it is interesting to see what the client comes up with during the open-ended phase of the inquiry. At such points one gets a vivid chance to see defenses such as denial and rationalization as well as positive characteristics such as insight and motivation. The more closed-ended inquiries may help to stir up some data that would not otherwise be made spontaneously available by the client and may also help the client to look at the consequences in a new light.

Tip provided by:

Bruce Berger, M.D.