Gathering Information About Substance Use

Understanding the Role of Substance Use

All substance use or history should be documented, regardless of whether the applicant has a formal diagnosis of substance use disorder. As a case manager it is important for you to try to understand the role(s) that alcohol and other drugs play in a person's life. Questions about why a person uses and how the use helps (or doesn't) are crucial to this understanding.

What You Need to Know

It is important to understand the role of alcohol and other drugs in the person’s life and its meaning to that individual’s unique life experience.

• Why does the person use?
• How does it help?
• How does it interact with symptoms?
• How does it impact the person’s impairments?
• How is it relevant to disability?

Common Challenges

Case managers must go beyond asking “do you use?” or “have you ever used?”

• This type of question often yields only a “yes” or “no” answer
• Simply asking what, when, and how much may not be helpful
• It is not your role to make a diagnosis of substance use disorder

Denial

Phrasing questions in a judgmental way can put you at odds with the person.

• The individual may not consider the alcohol or drug use as “abuse” – and perhaps it is not
• Denial is a common element of substance abuse and addiction
• The individual may fear that admitting to substance use will lead to denial or loss of benefits
• Possession of drugs or paraphernalia is often illegal, so the person may fear arrest
• The person may fear that sobriety is required to receive benefits; however, they may not be able to stop using right now (this is an issue for treatment)

Phrasing Questions About Alcohol and Drug Use

Questions should lead to developing a comprehensive sense of what substance use means to the person. Rather than ask “do you use,” ask questions around “when you use.”

• What was going on in your life when you started using/drinking?
• When you use (or drink), how do you feel?
• When you use, how does it affect your (mental illness symptoms)? Does it make them better or worse?
• Have you ever stopped or tried to limit your use? Why? What happened?
• See Section IV of the SOAR Medical Summary Report Interview Guide for additional suggestions

Documentation or Further Evaluation

Gather documentation of treatment for substance use disorders or documentation indicating periods of sobriety when symptoms of mental illness were present.

• Look for records of hospital emergency room visits, stays in detox units, and participation in substance abuse or alcoholism treatment programs or co-occurring disorders treatment in mental health settings
• Inquire about involvement in self-help programs such as Alcoholics Anonymous, Narcotics Anonymous, or other programs that do not keep records; document in case notes
• If the person has been involved with the criminal justice system, they may have received treatment in jail or while on probation
• If there are few or no medical records, it may be useful to have the person evaluated for co-occurring substance use disorders, preferably by a current or past treatment provider