Several Strategies for Uncovering Drug and Alcohol Histories (excerpted from the Psychiatric Clinics of North America)

“The voice of intellect is soft, but it does not rest until it has gained attention. In the end, after being dismissed countless times, it finds an audience after all. This is one of the few points upon which we can be optimistic.”

Sigmund Freud

Several Strategies for Uncovering Drug and Alcohol Histories (excerpted from the Psychiatric Clinics of North America)

TISA Description of the Problem: As we continue moving through the year 2008, we have a very special series of “Tips of the Month.” In 2007 our TISA website was honored by having an article published in the Psychiatric Clinics of North America based upon the Interviewing Tip of the Month feature. The article was entitled, “My Favorite Tips from the Interviewing Tip of the Month Archive.” (Shea, SC: Psychiatric Clinics of North America, June 2007,Vol 30:#2, 219-225). These tips all appeared on this website and will now be re-printed with some additional comments – exactly as they appeared in the Psychiatric Clinics of North America – during the first eight months of 2008. Congratulations to all of the contributors whose tips were chosen as the very best!

Let us take a look at our second tip from the article: 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, minimizations, 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):

1) “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?
2) “When you are drinking what do others say about you? Do they ever say you are funny, mean, stupid, or anything else?”
3) “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.

Notice how Dr. Berger deftly uses the techniques of motivational interviewing as delineated by Miller and Rollnick (1) in his two questions appearing in #3. By first asking the client how drinking helps him – and accepting these benefits as real – it opens the door for the client to be more open to subsequently sharing the problems attached with drinking – perhaps more readily accepting that they, too, are real.

(1) Miller WR, Rollnick S.: Motivational Interviewing, 2nd Edition. New York: Guilford Press, 2002.

Tip provided by:

Bruce Berger, M.D.