Patients who present with exacerbation of their hypertension, diabetes, or other medical conditions may be responding to the stress they are experiencing at home. If you suspect a substance abuse problem, it is recommended that you begin by asking your patient what he or she thinks may be causing the problem. In the case of very young children, the parent should be asked this question. Even if the answer is no, it is wise to make a note to ask again at your next meeting. This is because of the tremendous influence denial has on family members' ability to deal with these issues.
Denial becomes an integral part of the family's difficulties and a major obstacle to recovery.
When the patient tells you about a family member that is abusing or possibly addicted to a drug, you may want to consider a referral to a specialized program for further assessment and treatment. If this is not possible, a more in-depth medical and psychiatric assessment should be done. It is important to include an assessment of mental health problems with a focus on depression and suicide risk. Also, once a reasonable rapport has been established with the patient, you may want to take a history of any abuse the patient may have suffered from a substance abusing relative. Finally, testing for sexually transmitted diseases should be offered when appropriate.