Many of the skills required for dealing with drug-related issues are those used in general counselling. However, this site provides steps, techniques, resources and discussion of some key issues (eg confidentiality and statutory considerations) to enable staff to successfully initiate drug-related interventions.

Screening Questions What to say and do to allow you to raise drug issues.

Index of Suspicion Indicators of drug use and consideration of how to manage signs and indicators of drug use.

Setting, Confidentiality and Involuntary Clients Clarifies context & options.

Intoxication A note on intoxication

A Short Screening Instrument to Detect Alcohol or Other Drug Dependency & Problems

Having some standard, rehearsed assessment questions as well as standardised screening tools, may help make this routine procedure.

Routine screening. This can be as simple as adding a couple of questions to assessment forms such as "Does the client use alcohol or other drugs?"

A general and simple screening tool, adapted from the Severity of Dependence Scale (SDS) can be used for most people.

Where alcohol may be an issue possibly use the AUDIT screening instrument. A range of alcohol screening tools is available at standardised screening questions.

Ask routine questions such as, "Do you smoke? What about alcohol? Any other substances?".

Ask direct consumption questions: In some circumstances where you are quite certain the client is using substances, opening questions could be, "How many 'tinnies' would you have on an average day?" or "How many cones do have each day?" Then follow up with, "what about other substances?"

Use bridging statements such as, "many people use alcohol or other drugs to cope with stress - do you find this helps?"

This refers to signs and symptoms which may make you consider further assessment for drug use. Identification of drug use issues should be ongoing throughout treatment contact. Signs may provide a positive opportunity to raise and deal with drug use issues. (See: Symptoms of Intoxication and Withdrawal Chart)

Similar signs: Signs of drug use can be similar to other conditions (e.g. anxiety, tired, in love, flu, etc.)

Reflect observations: If you are suspicious about a particular sign, reflect the sign or symptom back to the client in an inquiring manner, "I notice that you're slurring your words and that your eyes are red."

Gently persist: If they do not volunteer drug use as the reason and you are still suspicious, you can still gently persist if you feel it is appropriate, "I understand that you may be tired. However, I want to offer my assistance and it would help us both if you could let me know if you've also been using some substances."

Before raising drug use issues, staff not only need to be clear on their role, but also on the purpose of their asking about drug use and have an appreciation of how the client would deal with these questions.

Societal values and statutory roles: Drug use in our society is generally frowned upon. Social workers, particularly in their statutory role, represent societal values. For clients to disclose their drug use, they would have to believe that there was a good reason and that it was safe to do so.

Positive relationship: Before asking questions about drug use, a positive relationship based on mutual trust is desirable (but not always possible).

Investigation vs inquiry: Sensitivity and a skillful approach will be required for truthful responses where there may be negative consequences for disclosing drug use.  Some examples include; child maltreatment investigation, child concern reports, family support assessments and youth being assessed regarding their accommodation needs.

Purpose and confidentiality: The purpose of any information gathering, along with an explanation of confidentiality including its limitations, should be given early in any assessment procedure.

Client loss: Clients may have a lot to lose by disclosing their drug use.  If there is a sense of hesitancy about disclosure, staff should inquire about the client's perceptions about what they may have to loose.  Accurate perceptions should be acknowledged.

Advantages for client: The worker will need to think, in advance, of any advantage for the client to disclose any drug use information and keep this up her/his sleeve in case of hesitancy. For example, "I am here to work with both you and your family to improve your quality of life and reduce any problems you may be having."

Conflict resolution: Should this approach be unsuccessful, particularly if you sense a degree of conflict between yourself and the client, you might follow the steps recommended by James Barber (1991) in managing the involuntary client.

Refer: Alternatively, you might consider referring the client to a drug treatment agency for assessment.

Urine testing: As a last resort, if you consider that the client has an alcohol or other drug related problem, you could offer a choice of urinalysis or discussion. Urinalysis should not be presented as punishment, but rather as an opportunity for all to get a clear picture and possibly as some added motivation if drug use is present and there is a decision to change.

This short note provides some key points on dealing with intoxication in the context of raising the issue. However, you are advised to go to the site on intoxication for more comprehensive management tips.

Reflect signs: As previously stated signs of intoxication need to be checked out as being a result of drug use.

Avoid further issues: Raising any further issues about drug use while the client is intoxicated should be avoided.

Listen respectfully: The worker should simply listen respectfully to what the client has to say and arrange for another appointment when the client is not intoxicated.

Duty of care: Identify any duty of care issues such as safety of child/ren, domestic violence, driving when intoxicated or possibility of accident or overdose.

AUDIT   |    CAGE  |    On-Line Alcohol Dependency Screening
Alcohol Screening & Assessment Instruments

The Severity of Dependence Scale (SDS - Gossop, M. Griffiths, P., Powis, B. & Strang, J. 1992) has been used successfully to identify degree of dependence by users of different drugs. The adaptation below allows for general screening of dependence without necessarily knowing which substances are being used. The lower section referring to specific problems does not come from the SDS.  It is ordered around the notion of Lover (relationships) Liver (health) Livelihood and Law.  While the SDS has been validated, this adaption has not been tested for validity or reliability.

During the past year...

Never (0)

Sometimes (1)

Often (2)

Always (3)

Never (0)

Sometimes (1)

Often (2)

Always (3)

Never (0)

Sometimes (1)

Often (2)

Always (3)

Never (0)

Sometimes (1)

Often (2)

Always (3)

Not at all (0)

A little
(1)

Quite difficult
(2)

Impossible
(3)

Higher scores, especially over 4, indicate that you might be dependent and that you should consider cutting down or at least having a break to prevent or reduce problems.

ALCOHOL AND OTHER DRUG-RELATED PROBLEMS

Alcohol and other drugs can cause short-term problems and longer-term problems.   Circle those areas which may be causing you problems.

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