Alcoholics

[Aesculapius]

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Hi all,
Do you have any suggestions on how to get alcoholics (and drug users) to actually tell the truth when asked about their substance use habits (i.e., accurately describe what and how much they use)? I try to do the whole non-judgmental thing, but I find constantly that patients lie and minimize what they do (sometimes even to the point of denying + laboratory tests). I recognize that this is probably part of their overall pathology, but was wondering if anyone had any tricks or suggestions.

 

[GeneralVeers]

Hi all,
Do you have any suggestions on how to get alcoholics (and drug users) to actually tell the truth when asked about their substance use habits (i.e., accurately describe what and how much they use)? I try to do the whole non-judgmental thing, but I find constantly that patients lie and minimize what they do (sometimes even to the point of denying + laboratory tests). I recognize that this is probably part of their overall pathology, but was wondering if anyone had any tricks or suggestions.

I don't really care. I ask them, and if they deny it I just assume they are lying. Most of the time it makes no difference to my treatment and management

 

[thegenius]

Hi all,
Do you have any suggestions on how to get alcoholics (and drug users) to actually tell the truth when asked about their substance use habits (i.e., accurately describe what and how much they use)? I try to do the whole non-judgmental thing, but I find constantly that patients lie and minimize what they do (sometimes even to the point of denying + laboratory tests). I recognize that this is probably part of their overall pathology, but was wondering if anyone had any tricks or suggestions.

It's tough - the most luck I have is when I ask about Etoh and drugs as part of the overall history. I have a standard blurb for most patients I see with any symptom...
- do you have any chronic medical problems?
- what meds do you take?
- any major surgeries?
- any chance your pregnant? (if female)
- do you smoke?
- drink alcohol?
- use any illicit drugs?
- any major allergies?


So for a patient who I need to have an accurate drug history...before I blurb out the above i say "I ask these questions of all patients, so I can best help them." then I blurb out the above. when I come upon the EtOH and drug history...if your cadence is right it's just another question like the others.

Then, when they do say "I drink every day" or "I use meth and weed", I respond by saying "thank you for your honesty, I appreciate it." Patients seem to appreciate it when I appreciate them. Doh!!!!


Works about 20% of the time. :-(

 

[thegenius]

I don't really care. I ask them, and if they deny it I just assume they are lying. Most of the time it makes no difference to my treatment and management

And that is the issue is I agree...most of the time it doesn't really matter. But occasionally it does, and when it does matter it's helpful.

 

[frosted2]

Likely not applicable since I am pre-hospital, but I always tell them that I am not the police and I won't get them into trouble, I just need them to be honest with me so we can work as a team to get them feeling better.

 

[WilcoWorld]

Hi all,
Do you have any suggestions on how to get alcoholics (and drug users) to actually tell the truth when asked about their substance use habits (i.e., accurately describe what and how much they use)? I try to do the whole non-judgmental thing, but I find constantly that patients lie and minimize what they do (sometimes even to the point of denying + laboratory tests). I recognize that this is probably part of their overall pathology, but was wondering if anyone had any tricks or suggestions.

Don't ask your coworkers about their drinking habits until after shift change.

😎

 

[Apollyon]

Don't ask your coworkers about their drinking habits until after shift change.

😎

As I sit here drinking my second beer (but not the last) of the night!

 

[Apollyon]

When people say "occasionally", I say, "if you are Catholic, you can drink to the saints every day, and every day is an occasion". If I have a REALLY good rapport, I will go as far as saying, "Hey, I have a beer. I'm not a teetotaler."

However, our client base is mainly locals in a tiny village, and visitors that come camping in the woods. In other words, the two most common names are Miller and Labatt, with Coors and Molson also present.

 

[Apollyon]

As I sit here drinking my second beer (but not the last) of the night!

On to #4, and keepin' on!!

 

[Gastrapathy]

With a real alcoholic, I just normalize a lot of booze. Ask their drink of choice, then suggest they drink a lot. “So, like a case a day?” “About a fifth a day?” Etc. They give you back a shocked look “no not a fifth, only 10x the cirrhotic dose” and you know all you need to know.

 

[RoyBasch]

I don't really care. I ask them, and if they deny it I just assume they are lying. Most of the time it makes no difference to my treatment and management

This is all that needs to be said.

 

[Birdstrike]

Hi all,
Do you have any suggestions on how to get alcoholics (and drug users) to actually tell the truth when asked about their substance use habits (i.e., accurately describe what and how much they use)? I try to do the whole non-judgmental thing, but I find constantly that patients lie and minimize what they do (sometimes even to the point of denying + laboratory tests). I recognize that this is probably part of their overall pathology, but was wondering if anyone had any tricks or suggestions.

Why do you need a trick to get an obvious alcoholic to tell you the truth about their drinking, when you already know the truth about their drinking?

 

[Vandalia]

Why do you need a trick to get an obvious alcoholic to tell you the truth about their drinking, when you already know the truth about their drinking?

Yep. Apart from the possibility of toxic alcohols I really don't (didn't) care.

In the same way I really don't care (medically at least) about how the GSW got the projectile in their body. That is why God invented psychologists, social workers, and chaplains, as appropriate.