Detecting If a Patient Is Struggling with Substance Abuse

Use these tips to properly screen and assist patents who may have a drug or alcohol problem.

As a healthcare provider, ensuring the physical and emotional health of your patients is your main priority. Diagnosing diseases, conditions, and syndromes is usually pretty straight forward; however, navigating and identifying substance abuse is a more challenging topic.

The National Institute on Drug Abuse (NIDA) estimates over 25 million Americans over the age of 12 have used an illicit drug within the past month. With this number slightly rising year after year, properly screening and detecting a patient’s potential drug or alcohol problem is becoming more important than ever. Utilize the following tips for detecting, taking action, and steering a substance-abusing patient to the proper healthcare specialist.

Understand the Statistics

Knowing your statistics may be key to your approach. According to the Substance Abuse and Mental Health Services Administration’s most recent (2013) National Survey on Drug Use and Health (NSDUH), the NIDA found marijuana to be the highest rising illicit drug, with 19.8 million Americans over 12 having used it within the past month. Alcohol, tobacco, prescription drug, cocaine, and hallucinogen usage stabilized or slightly declined since 2002, while methamphetamine use was slightly higher than the 2010 survey. Aside from alcohol, more than half of new drug users begin with marijuana, and over half of the new users are under the age of 18.

Other key statistics include:

  • Alcohol and marijuana have the highest rate of dependence or abuse among all drugs.
  • Illicit drug abuse peaks in the late teens and twenties.
  • Drug use is increasing among those 50-65 years of age.
  • Binge drinking is more prominent among men than women (30.2 percent vs. 16 percent).
  • Alcohol and tobacco usage is significantly declining in teenagers, and not rising in adults.
  • The “treatment gap” still exists: an estimated 22.7 million Americans needed treatment in 2013, while only 2.5 million received it.

Detecting the Problem

It’s typical for healthcare providers to ask patients about their drug or alcohol habits, and it may become routine for patients to answer the question without careful consideration. It’s your job as a provider to strategically structure conversation with empathy that leads to affirmative, honest responses. Although it’s not certain you will uncover a substance addiction, the correct questions can be enough information to detect, briefly consult, and provide assistance properly.

The NIDA suggests the following steps while conversing with patients about their use of substances:

Inquire about past drug abuse.

Ask the NIDA Quick Screen questions: “In the past year, how many times have you used alcohol (more than 5 drinks in a day)? Tobacco products? Prescription drugs? Illegal drugs?” Regardless of their answer, ensure you provide proper guidance to stay within proper drinking limits and avoid all tobacco products. Further screening questions you may ask include:

  • In the past year, have you felt or wanted to cut back on your alcohol or drug use?
  • In the past year, have you ever drunk or used drugs more than you intended to?

Access the risk and take action.

If the patient expresses past abuse or is hesitant to answer the questions, the NIDA suggests you offer an online Alcohol, Smoking and Substance Involvement Screening Test (NMASSIST) to determine a substance involvement (SI) score. This score will help you determine the severity of their abuse. Approach the conversation by first explaining your role as a medical provider, and communicate that abstaining from any substance abuse is the best solution to preventing future problems.

Providing Assistance

After calculating if the patient’s SI score is low, moderate, or high risk, use your interpersonal skills and natural instincts to assess the patient’s state. Ask further questions to determine if the patient is willing to discuss, admit, and change their substance problem. If they are responsive, refer them to a specialist and thank them for the open communication. If they are not ready to discuss the problem, restate that substance abuse is a treatable health problem and that you’re willing to discuss any concerns that may arise at any time.

Treatment and rehabilitation are valuable options that can give patients guidance and hope at their own pace. Ensure you refer abusing patients to the proper specialist and continue to provide follow-up care during primary office visits. Your alertness and strategic approach to screening patients for substance abuse will help build a healthier, safer community.


Frequently Asked Flu Questions 2017-2018 Influenza Season (2017, September 14). Centers for Disease Control and Prevention. Retrieved from

Talking to Patients about their Drug Use. (2015, June). National Institute on Drug Abuse. Retrieved from