Taking an accurate substance use history is of great importance in the management of addiction. There are a number of strategies that one could use but the most important part of history taking is that of demeanour and empathy. The best results and most accurate information are often obtained when one treats one's patients with human empathy and in a non-judgemental manner. There is a quote by Walt Whitman 'be curious and not judgemental' which I try and use as my guiding principle when I am taking a substance use history. A good tool for taking a comprehensive substance use history is the DUDIT . Dr Ferghal Armstrong usually utilises his own mnemonic 'TARCD' when taking a substance use history:
Timing • First use • Last use • Frequency of use • Time within the day • Periods of abstinence
Amounts (and overdoses)
Routes • Oral nasal intravenous etc
Risk • Drug specific risks e.g. seizures with alcohol withdrawal • Access to Needle syringe programs • Transmission of BBV
Costs • Financial • Relationships • Loss of activities and hobbies
Dependency Factors • DSM 5 criteria - CHEW THAT COP
A question that is not frequently asked but is of great importance is a simple one: 'What do the drugs do for you?'. This question asks not about dependence or withdrawal but rather what reason is the person taking drugs and from personal experience can cause some quite profound revelations or open up some deep emotions or profound hurts that have caused the individual to start using drugs.
In summary it is very important to be empathetic, non-judgemental when conducting a substance use history regardless of the actual technique used to elicit the history-the non-verbal cues the patient perceives will be vital in the accuracy of the history obtained.
Author: Dr Thileepan Naren MBBS FACRRM FRACGP
Thileepan is an Addiction Medicine Advanced Trainee and experienced general practitioner with a demonstrated history of working with disadvantaged and marginalized groups.