A good clinical interview includes questions about substance use and sequelae of use across medical, psychiatric, personal, legal and social domains. Pay close attention to high risk or under recognized patients including pregnant women, young and older adolescents, older adults, Native Americans, health care providers, noncompliant patients, those with major psychiatric disorders and individuals in the criminal justice system.

With adult patients, start with a question about use: “Do you use, or have you ever experimented with alcohol or other substances?

If “yes”, or if the answer is equivocal, follow with:

  • Have you ever felt a need to Cut Down on or Control your use of alcohol or other drugs?
  • Have friends/family made comments to you about your use of alcohol or other drugs … have those comments ever Annoyed you?
  • Have you ever felt bashful, embarrassed or Guilty about things you have said/done when using alcohol or other drugs that you would not have said/done otherwise?
  • Do you ever use Eye-openers (drinking or using in the morning to “get going” or settle your nerves)?

One helpful strategy is to ask the patient about his/her perspectives and observations about their use and consequences. Helpful questions include the following:

  • Do you ever think you use too much?
  • Have you ever tried to cut down on your use?
  • Have you needed to use more to get the same effect?
  • Has use created any problems, e.g. medical, educational, job?