Substance use disorders: approaching the patient traditional history and physical, or screening?

Physicians are encouraged either to assess patients via the traditional history and physical examination for substance abuse issues, or to screen them to determine who is at risk for developing problems related to drug or alcohol use. The former approach is more time consuming and requires some training for the physician to become adept, yet it is ultimately more rewarding both for the patient and physician. Screening and referral is quicker, but also requires some training and an awareness of resources to which the patient at high risk can be referred. This chapter offers basic guidance for both approaches: how to take a productive history, what to look for in a physical examination, which laboratory tests are most helpful; plus standard screening questions and referral indices.