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Mastering Substance Use History

November 18, 20212 min read

On Cracking Addiction this week

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.

Substance use historyAddiction managementEmpathy in healthcareDUDIT toolTARCD mnemonic
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Dr Thileepan Naren

Dr. Thileepan Naren, an esteemed medical professional, holds prestigious qualifications including MBBS, FACRRM, FRACGP, and FAChAM, showcasing his extensive expertise in the field. Renowned as an Addiction Medicine Specialist, he brings a wealth of experience to the forefront, particularly in catering to the needs of disadvantaged and marginalised communities. With a proven track record, Dr. Naren exemplifies dedication and compassion in providing comprehensive healthcare solutions to those in need.

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