48 Substance Abuse Questions You Can Ask Your Clients in Therapy

Substance abuse is a complex and pervasive issue that extends its reach into various facets of individuals’ lives, communities, and societies at large. It encompasses the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs, leading to a spectrum of physical, psychological, and social consequences. The impact of substance abuse is far-reaching, affecting not only the individuals directly involved but also their families, friends, workplaces, and the broader community. Understanding the intricacies of substance abuse is crucial for addressing the challenges it poses and fostering effective prevention, intervention, and recovery strategies. In this exploration, we delve into the multifaceted aspects of substance abuse, examining its causes, consequences, and the vital role of support systems and professional intervention in the journey toward recovery. Keep reading to learn 48 substance abuse questions you can ask your clients in therapy.

When we look at recent studies, an estimated 46.3 million people, 12 and older, in the United States were living with a substance use disorder in 2021. The National Survey on Drug Use and Health found that the most commonly abused substances were alcohol, marijuana, pain relievers, methamphetamine, stimulants, cocaine, and heroin, respectively in 2021.

Individuals who are living with a substance use disorder can experience a range of symptoms including health concerns and mental health distress. Additionally, they may find themselves struggling to meet their responsibilities at school, work, and within their home. Addiction is known as a chronic and progressive disease, meaning that the symptoms and consequences experienced will continue to worsen until the individual stops using substances.

If you work in a substance abuse treatment program, you are likely more than comfortable with substance abuse questions. However, there is a large number of individuals who misuse and abuse substances without meeting the criteria for a substance use disorder. These individuals may find themselves in other counseling settings with initial concerns other than their substance use.

In these situations, you may realize that your client’s use does not require formal substance abuse treatment and that they may benefit from psychoeducation and an exploration of healthy lifestyle changes that can help them cope with their distress. Questions to ask during a substance abuse evaluation can help you determine the severity of your client’s use and determine how you can best support them.

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There is no cookie-cutter approach for individuals who are living with a substance use disorder. Treatment providers tend to provide a holistic treatment approach that addresses different areas of an individual’s life that have been impacted by their substance abuse. As an example, research has shown that concurrent treatment of dual diagnoses is more impactful than treating one or the other. Common mental health concerns you may see among clients living with a substance use disorder include anxiety, depression, bipolar disorder, borderline personality disorder, ADHD, PTSD, and other trauma-related concerns.

A noticeable difference found among clients enrolled in substance abuse treatment programs is the presence of external sources of motivation. Clients may begin to see you because their partner, parents, or other family members have pressured them to do so. Or, they may be coming in after choosing to go through a drug court instead of a criminal court for legal concerns, or under the recommendation of their employer.  Being mindful of where your client falls into the stages of change can help you determine which therapeutic approach would be the best fit.

Getting Ready for Your First Therapy Session with a New Client with Substance Abuse

The way that you prepare for your first session with your client will be dependent on whether you are the first treatment provider that they are meeting with. As an example, you may be responsible for completing intake assessments or that may fall into the responsibilities of one of your colleagues, such as a medical provider.

If you work in a setting where you are conducting the intake, it can be helpful to prepare and organize the documents and assessments that you need to complete. This can include a biopsychosocial assessment, screeners, informed consent, and HIPPA forms. Questions to ask during a substance abuse evaluation should explore different areas of your client’s life, including their:

  • History of use
  • Experienced symptoms
  • Consequences of their use
  • Family, friends, and other relationships in their life
  • Current home environment
  • Health history
  • Mental health history
  • Risk assessment
  • Education and career

If you are meeting with your client after one of your colleagues has completed their intake, you should take time to review their assessment paperwork. This can provide you with valuable insight into your client’s substance use, symptoms, level of functioning, and other mental health concerns. The focus of your session will likely revolve around developing your therapeutic rapport and identifying the goals your client would like to work towards.

Open-ended substance use questions can be helpful with clients who have hesitations or reservations about engaging in treatment. Motivational Interviewing is a commonly used approach within substance abuse treatment programs because it promotes client participation in a way that the client feels in control. For those who have strong external motivators or do not see their use as a problem, this can be an impactful approach to use

Substance Abuse Questions to Ask Clients in Therapy

Substance abuse questions can be used in every interaction you have with your clients. Open-ended questions for substance abuse can be used when you want to give your client space to share what they are thinking, feeling, and experiencing. Open-ended questions can provide you with valuable information about your client’s substance use, mental health, and motivation for change.

Examples of substance abuse questions include:

  1. How are you feeling today?
  2. Have you encountered any challenges since our last meeting?
  3. Can you recall something positive that happened since our last session?
  4. Was there a particular aspect from our last meeting that resonated with you?
  5. How may I assist you today?
  6. What are your current feelings about your substance use?
  7. Have you experienced any feelings of guilt related to your use?
  8. Are there any feelings of shame associated with your substance use or actions under the influence?
  9. How do you envision your life changing if you were able to abstain from using substances?
  10. Have there been periods of sobriety in your past?
  11. What factors contributed to your success during those periods?
  12. Can you discuss the factors leading to your relapse?
  13. Is there a shift in your motivation for recovery compared to previous experiences? If so, where is this motivation coming from, such as personal desire, relationships, family, or work?
  14. When did you initiate substance use?
  15. How has your upbringing influenced your substance use?
  16. Is there a family history of substance abuse or mental health issues?
  17. Have you noticed an increase in the amount of substance needed to achieve the desired effect, indicating tolerance?
  18. Can you share your experience with withdrawal symptoms?
  19. What is your perception of substance abuse counseling?
  20. What benefits do you believe you could gain from substance abuse counseling?
  21. Are there specific emotions that you find challenging to cope with?
  22. Do you recognize some of your triggers?
  23. How can we address external triggers you encounter?
  24. What do you value in your life?
  25. Can you identify what is important to you?
  26. In what ways has addiction impacted your values?
  27. Are there adjustments you can make to align your behaviors with your values?
  28. Whom in your life do you care for?
  29. How has addiction affected your relationships?
  30. What changes would you like to see in your relationships?
  31. What qualities come to mind when you think of someone you can trust?
  32. If you were struggling, is there someone you could reach out to?
  33. What helps you stay grounded?
  34. Can you share any feelings of shame or guilt you may be carrying?
  35. Have you found attending meetings to be beneficial?
  36. How would you assess your financial situation, considering any impact of addiction?
  37. Do you have concerns about meeting financial obligations or providing for basic needs?
  38. Is your sleeping arrangement secure?
  39. What self-care practices are you currently employing?
  40. What has been effective for you lately?
  41. What activities can you incorporate into your day to support your recovery?
  42. How would you describe your self-care routine?
  43. Can you outline your goals?
  44. Do you have any upcoming events or situations causing concern?
  45. How would you describe your current mood?
  46. Have you ever contemplated self-harm? If so, have there been instances when you acted on these thoughts, and could you share the details?
  47. Do you engage in high-risk behaviors, such as reckless driving, excessive spending, gambling, or unsafe sex?
  48. What has been your experience with binge drinking?

Final Thoughts on Choosing the Right Substance Abuse Questions in Therapy

Thank you for taking the time to read our article about 48 substance abuse questions you can ask your clients in therapy! The effects of substance abuse and misuse can be widespread, emphasizing the significance of gaining insight into how you can support clients within your clinical environment who might be grappling with drug and alcohol issues. Employing substance abuse-related questions enables you to assess whether it is suitable for the client to proceed with your services or if they would benefit from a more intensive level of care.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

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Kayla VanGuilder, MA, LCMHC
Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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