Informing the Patient of the Diagnosis of Abuse and Motivating Him or Her to Treatment

This chapter discusses a very difficult process in the management of substance abuse. Physicians must guide presentation so that it is clearly perceived even in the face of militant patient denial while at the same time avoid so alienating or discouraging the patient that he or she abandons all treatment on the basis of perceived insult. Our training as physicians does not give us the extraordinary sensitivity required in this endeavor, and our early experiences are often ineffective and bad ones. We can all recall instances when we were successfully intimidated in one way or another so that we avoided the issue of abuse, only later to acknowledge that we had missed a splendid opportunity for intervention.