Substance abuse management: Guidelines for assessing options

• Ask the client:
  • What are the good things about doing drug or drinking?
  • What are some of the not-so-good things about doing drugs or drinking?
  • How does doing drugs/drinking affect other aspects of your life?
    
    
• Examine the client-identified motivations for drug/alcohol use:
  • Pleasure
  • Escape
  • Energy
  • Sexual activity
  • Relief from emotional or physical pain
  • Helps being more social
• Ask whether there are any other pleasurable activities that do not relate to using drugs.

• Intake method:
  • Is your method of intake causing you harm?
  • Should you alternate with other methods of intake?
  • How do injecting, snorting, smoking, oral, keistering affect you?
  • What would you think about using the drug orally opposed to intravenously?
  • What if you alternated between injecting and snorting?
• Frequency:
  • How many times do you use/drink in a given day?
  • How would it work for you if you reduced the number of times you shoot up each day from 6 to 3 times?
  • How would it be for you to drink 3 drinks after dinner instead
    of 5?
• Dosage:
  • How much do your use/drink each time?
  • What amount do you like to use (1/4 gram, 1 shot)?
  • How much does it take to give you the pleasurable effects you like?
  • How would it work for you if you injected an eight rather than a quarter?
  • How would it be for you if you drank 2 shots in your drink instead of 3?
• Purity:
  • How safe do you feel about "the cut" in the drugs you use?
  • How would you feel about maintaining one or two regular, reputable dealers who do not cut the product with a lot of "bunk"
• Drug combinations:
  • Do you experience any negative effects that might be caused through interaction with other drugs you are taking? (i.e. Methamphetamines and antidepressants or antiretroviral drugs; alcohol and antidepressants etc.)
  • How does using effect the daily dosing regimen of protease inhibitors, other HIV medications or any other medications you need to take on a regular, consistent basis?
  • What would you think about setting an alarm of some kind that could help you manage some of these issues?
• Environment:
  • Are you in a safe physical environment when you use?
  • Are you alone or with others?
  • Do you feel safe one way more than another?
• Outside responsibilities:
  • Have you reduced outside responsibilities?
  • Have you coordinated responsibilities around your high?
• Adverse reactions:
  • Have you prepared for adverse physical reactions?
  • Have you prepared for adverse psychological reactions? (i.e. What if you get really paranoid? Do you have a plan for dealing with it?)
• Legal risk:
  • What level of legal risk do you face in using?
  • Do you have a relatively safe copping plan?
  • Are you on probation, do you have warrants?
  • Are you going to be in public?
• Financial risk:
  • What effect does using have on your finances?
  • Are you able to maintain basic survival needs such as food, housing, clothing and transportation?
  • What effect does using have on your ability to maintain comfort needs such as health care, message, counseling, recreation?
• HIV and STD risks:
  • Do you have all the drug injecting equipment you'll need for your drug using period? (Sterile syringes, cookers, cottons, bleach, water)
  • Do you have all the right equipment for your sexual play? (Condoms, lubrication.)

• Before getting high:
  • Have you had a nutritious meal?
  • Have you had plenty of water or juice to drink?
  • Have you taken multivitamins?
  • How would it be for you to plan for these things before you use?
  • What would you think about always having a healthy meal before you drink?
    
    
• During the night:
  • Can you drink water, suck popsicles, ice cubes, or find some way to rehydrate your body?
  • What do you think about planning to have these things available to you before you use?
    
    
• After the high:
  • Have you stocked the refrigerator with appealing foods for when you come down?
  • What is your plan to have these things ready?
    
    
• General eating plan:
  • Do you know the foods that will contribute most to restoring depleted levels of dopamine and serotonin or to stabilize post-withdrawal mood swings?

• Your use and affects on relationships:
  • How does use affect your family (parents, brothers, sisters and others)?
  • How does it affect you lover, sexual partners?
  • How does it affect your drug using friend?
  • How does it affect your non-drug using friends?
  • How does it affect your relationships with your employer, doctor, case manager?

• Your use and your work:
  • How does getting high or drinking positively and negatively affect your job?
  • How does your job effect getting high or drinking?
  • Do you like or dislike your work?
  • How are your job and using related?

• Your use and community involvement:
  • How does getting high positively or negatively affect being involved in the community?
  • Are there activities that bring you satisfaction that you would like to do more?

• Your use and enhancing pleasure:
  • What are pleasurable things about getting high or drunk?
  • What are the not-so-good things about getting high or drunk?
  • Are there other sources of pleasure that are affected by getting high or drunk? If so, what are they?