December 5, 2023

How to Talk With Patients about Substance Use Disorder

Discussing substance use disorder (SUD) with patients is a complex and sensitive task that requires a healthcare professional to approach the subject with empathy, understanding, and a non-judgmental attitude. Given the depth of this topic, a detailed discussion is warranted. Let’s explore this in several key areas.

1. Understanding Substance Use Disorder

Definition and Nature: SUD is a medical condition characterized by an uncontrollable use of substances despite harmful consequences. It’s crucial to understand that SUD is not a moral failing but a health issue that affects brain function and behavior.

Prevalence and Impact: Awareness of the prevalence and impact of SUD helps in recognizing its significance. SUD affects millions worldwide, impacting not just the individuals but also their families and communities.

2. Preparing for the Conversation

Gathering Information: Before initiating a conversation about SUD, it’s important to gather relevant patient history and information. This includes understanding their substance use patterns, previous treatment history, and any co-occurring mental health disorders.

Setting the Environment: The setting for such discussions should be private and comfortable, ensuring confidentiality and reducing the risk of stigma or judgment.

3. Initiating the Conversation

Approach with Empathy: Start the conversation with empathy and understanding. Acknowledge the patient’s experiences and feelings, and express your concern for their well-being.

Use Open-Ended Questions: Employ open-ended questions to encourage patients to express themselves more freely. This approach helps in understanding their perspective without making them defensive.

4. Building Trust and Rapport

Non-Judgmental Attitude: Maintaining a non-judgmental attitude is crucial. Avoid language that might be perceived as blaming or shaming.

Active Listening: Demonstrate active listening by paying full attention, nodding, and paraphrasing what the patient says. This shows that you are engaged and value their input.

5. Addressing Denial and Resistance

Understand Denial: Denial is a common defense mechanism in individuals with SUD. Recognize and gently address it without confrontation.

Motivational Interviewing: Utilize motivational interviewing techniques. This involves guiding rather than directing the conversation, helping patients explore and resolve their ambivalence about substance use and change.

6. Providing Information and Education

Educate About SUD: Offer information about the nature of SUD, its effects on health, and the benefits of treatment. Use language that is clear and understandable.

Discuss Treatment Options: Inform patients about the various treatment options available, including medical treatments, counseling, and support groups.

7. Creating a Collaborative Treatment Plan

Involve the Patient: Involve patients in creating their treatment plan. This gives them a sense of control and responsibility for their recovery.

Setting Realistic Goals: Help patients set achievable and measurable goals. This could involve reducing substance use, attending therapy sessions, or engaging in supportive activities.

8. Addressing Co-Occurring Disorders

Integrated Treatment Approach: If the patient has co-occurring mental health disorders, discuss the importance of an integrated treatment approach that addresses both SUD and mental health.

9. Providing Support and Resources

Offering Resources: Provide resources for additional support, such as contact information for local support groups or treatment centers.

Continued Support: Emphasize your availability for ongoing support and follow-up appointments.

10. Handling Setbacks

Discussing Relapse: Discuss the possibility of relapse as a normal part of the recovery process. Focus on strategies for coping with setbacks and continuing treatment.

11. Professional and Ethical Considerations

Confidentiality: Maintain patient confidentiality as mandated by law and professional ethics.

Referral to Specialists: If the situation is beyond your scope, don’t hesitate to refer the patient to a specialist in addiction medicine.

12. Self-Care for the Healthcare Professional

Recognizing the Emotional Toll: Understand that dealing with SUD can be emotionally taxing for healthcare professionals. Engage in self-care practices and seek professional support if needed.


Talking with patients about SUD is a delicate process that requires a balanced approach of empathy, factual information, and encouragement. The goal is to establish a trusting relationship where patients feel supported in their journey towards recovery. It’s about guiding, not pushing, and recognizing the unique challenges each patient faces in overcoming substance use disorder.

Leave a comment