TABLE 1.
Challenges and potential approaches to discussing alcohol and substance use with patients
| Challenges in discussing alcohol and substance use | Potential approaches |
|---|---|
| Inaccurate or imprecise patient estimates of alcohol use | Use a visual chart (Figure 2) to help patients understand how much alcohol is in a single drink Ask what patients drink and how long it takes them to get through the unit of alcohol the commonly purchase [eg, “how long it takes to get through a “fifth” (750 mL) of liquor,” or “how often would you purchase another “pint” (375 mL) because you ran out?”] |
| Stigma and shame | Use first-person plural pronouns to discuss substance matters to reduce confrontational undertones (eg, we, us) Normalize asking about alcohol use (eg, “Doctors commonly ask all their patients about we are doing with alcohol use,” “It is common for all of us to find it difficult to talk about our drinking with our doctor”) Use destigmatizing language to reduce defensiveness and encourage psychological openness (eg, instead of “addict” “substance abuse,” or “alcohol-associated,” say “person with alcohol use disorder” or “patients with alcohol challenges”; use substance use disorder or alcohol use disorder in general)a Normalize AUD care and treatment as an expected part of medical and liver care and of equal importance and relevance. Project reasonable, proportional, and authentic optimism about patients’ potential for improvement |
| Ambivalence about changing alcohol use behaviors | Use a patient-centered, motivational interviewing 34 approach based on the following interview principles (use your OARS): Open-ended questions: for example, “What brings you here today? How do you hope I might be able to help you today?” Affirming: Center on the patient and their successes no matter how small (“you” not “I” language). For example, “You did a really good job of keeping track of your drinking this week!” “Thanks for coming in today. It’s good to see you!” Reflections: Nonjudgmentally reflecting back something that your patient has said (with an emphasis on reflecting back language “change language”). For example, “You increased your alcohol use after your mother died last year, and now you realize it may be time to cut back.” Summarizing: Pull together several things someone told you. Often, reflections and affirmations are in summaries. |
a
For further suggestions regarding destigmatizing language in alcohol use care, please see.