Some physicians prefer to inquire about drug use after taking the social history.
Questions about drug use should be asked respectfully but without apology. Apologies or excessive preambles before asking drug-related questions will suggest to the patient that an admission of substance use or dependence will not be heard or will be met with disapproval. If the patient's illness or laboratory tests are highly suggestive of a substance use disorder but the patient denies substance use, the physician should discuss his or her concerns frankly toward the end of the consultation, after the history and physical examination. The physician should directly relate information from the history, physical examination, and laboratory tests to the possibility of drug use. Follow-up questions about drug use are more likely to engender a useful dialogue if they are asked in a concerned manner in the context of a differential diagnosis.