The “One-Word Difference” When Asking About Substance Abuse

Mar 07, 2017

“Sometimes in order to understand the complexity of the principles lying at the base of big phenomena it is necessary to realize the complexity of phenomena which look small and insignificant.”

P. D. Ouspensky
Russian philosopher
from A New Model of the Universe

The “One-Word Difference” When Asking About Substance Abuse

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 the following article, “My Favorite Tips from the Interviewing Tip of the Month Archive” published in the Psychiatric Clinics of North America (Shea,SC: Psychiatric Clinics of North America,June 2007,Vol 30:#2,219-225). These tips all appeared on this website. During the first eight months of 2008 they will now be re-posted with some additional comments – exactly as they appeared in the article. Congratulations to all the contributors whose tips were chosen as the very best. Let us look at our third tip from the article.

As we saw in the February Tip of the Month, 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, to begin my inquiry into the possible use or abuse of marijuana, I would begin:

“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

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Of preventing suicide and teaching clinical interviewing