History Taking - Substance Use Disorders

History Taking

·         Attitude of interviewer important: non-judgemental, empathic, detached, normalising behaviour, start estimates of use at a high level, person can then say „no, not that much‟ – feels less judgemental

·        Often illegal: won‟t tell unless good rapport

·        Signs of Substance Abuse

o  Changed behaviour

o  Skipping work/school

o  Drug seeking behaviour

o  Money problems

o  Relationship problems

·        Questions:

o  Reason for presentation

o  Which drugs

o  Ever intravenous

o  What are the useful effects – why do you continue to use

o  Quantity and frequency, pattern of use (regular or binge)

o  Cost per week

o  Duration of use, age at first use, reason for first use

o  Heaviest use

o  Have you or others ever been concerned about your use

o  Attempts at cutting down and duration of abstinence, what made you start again

o  Problems associated with use, including relationships, job, legal considerations, etc

o  Any withdrawal effects

o  Past treatment and outcome, what was and wasn‟t helpful 

o  Relationship to psychiatric symptoms. Do they drink when they‟re anxious? Have panic attacks followed ­ drug use, etc

o  If alcohol, ever been in an accident, had a head injury or fracture

·        Medical history, psychological history, social situation

·        Family History: check psych, suicide and A&D history

·        Corroborative interview

·        Drug users have high mortality: health consequences, accidents, suicide, high-risk neighbourhoods, etc 

·        Physical examination: yellow fingers/teeth, injection marks, liver, cardiac murmurs, pregnancy/STD, mental status, signs of intoxification/withdrawal