Such a person, when weaned from the physical dependence, is unlikely to return to opiate use unless they are medically prescribed. The patient with the disease of addiction is highly likely to return to drug use despite a lack of medical need for the drug. This patient has become psychologically dependent on the drug. The routine history is unlikely to identify patients who are at risk. This is due to a powerful psychological trait present in addictive individuals - denial.
Denial causes the individual to minimize a problem when it is present or to deny it completely.
Routine history taking using face valid questions is a very inaccurate way to screen for substance abuse. Patients who have an active substance abuse problem are going to answer no to this question. They may do this because they have poor insight into their problem or they may fear the consequences of their honesty. Such consequences include having prescription refills denied and perhaps being required to seek additional help for their addiction. There are several reasons why addiction should be a concern in pain management practices.