Asking About Substance Abuse

Mar 06, 2017

“Slow down, our sages advise,
slow all the way down to the pace
of stone and shadow.”

Diane Ackerman

Asking About Substance Abuse

TISA Description of the Problem: One of the classic dilemmas in clinical interviewing is the problem of minimization and denial when clients describe their substance abuse histories.The first task is to help the client to admit to the use of the substance in the first place. The second task is to uncover the amount of use. Kevin Rice, LCSW addresses the first task in the following simple, but effective tip.

Tip: When asking about substance abuse I almost always get a more accurate response when I use the word “experiment” in place of “use”. Thus my question about a specific drug might look like this:

“Have you ever experimented with marijuana?”

TISA Follow-up: Here is a nice example of how changing just one word can have a surprising effect on the power of a question. Language counts. I sometimes add a small phrase that I think can even further increase the likelihood of uncovering use as follows: “Have you ever experimented with marijuana, even once?”

Tip provided by:

Kevin Rice, LCSW
Tri-city Mental Health Center
Pomona, California

TISA is a site dedicated to advancing the science and art
Of preventing suicide and teaching clinical interviewing