Get a Clue: pearls for success
The first step in managing substance abuse
Clue: "If you don't know what you're treating . . ."
What is identifying substance misuse?
(including severity and history of use)
The reason listing "occasional cocaine use" is less than ideal
What is incomplete Hx?
Hx should include last use, how much (last day/week), route of use (PO, IV, smoking, snorting) frequency of use, when was first use, how long been using, how long using at current frequency, periods of sobriety and pattern of use
The vice to avoid at all costs when talking with a patient about their drug use.
What is judgmentalness?
Method of talking with a patient about their behavior which yields the best results (Sydney gave a presentation on it last week)
What is motivational interviewing (MI)?
When attempting to talk with a patient about their drug use, this is a crucial part of developing a strong physician-patient relationship.
Clue - "No means no"
What is consent?
Asking, "can I talk to you about your drug use" respects patient autonomy and helps fosters a good relationship.
Term for when someone stops doing drugs
What is sobriety?
In the history, sobriety from all substances should be listed
The mutual feeling between physician and patient when each allows the other to speak and takes the time to listen and understand.
What is respectfulness?
Used to assess how ready the patient is to change behavior. (We use this when assessing pain)
What is a scale (1-10)?
The manual used to define and classify substance abuse.
Clue - Freud could've contributed
What is DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition from the American Psychiatric Association)?
Term for when someone stops doing drugs and then starts again.
What is relapse?
If relapsed recently can examine relapse risk factors in Hx
What the physician should feel when helping the patient lead the discussion.
What is humility?
The patient may do this (think back) when thinking about why they want to change their behavior.
What is reflect? Could also be about looking at the impact of their behavior in the future.
That is needed to have a constructive conversation with the patient.
Clue: But not in a creepy way like Kaa from The Jungle Book sssssssssss
What is trust (or report or a good relationship, etc.)?
Should be included in medication history and social history for drugs users who have previously seen their physician about their drug problem.
What is treatment history?
For example, AA/NA/detox/rehab/outpatient and prescriptions
Key emotion the physician should display toward the patient.
What is empathy? (not a real virtue but it should be) other answers: compassion/caring
The physician's lead-in to a discussion about behavior which shows empathy and compassion (in biochem, positive or negative)
What is feedback? For example, you might say, “I’m concerned about the impact of drug use on your health”.
The key word when trying to understand a patient's perspective.
Clue: Also a scientist's favorite word
Why (why do you use drugs, why do you think that, etc.)?
Similar to allergic reactions, this should be included in the history with each substance misused, especially if the patient has attempted cessation.
What is withdrawal and seriousness of withdrawal?
Physician's response when a patient is not ready to quit.
What is patience? (and maybe some perseverance)
One of the most important aspects of talking about drug use. Touchdown
What is goal setting? Allowing the patient to make a concrete plan they can follow.