For substance use patient what are the questions need to ask

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I now have solid information from multiple authoritative sources. Here is the complete, organized answer:

Questions to Ask a Substance Use Patient

A thorough substance use assessment covers 8 core domains. The goal is to gather diagnostic information while building rapport - use open-ended, non-judgmental questions.

1. Screening Questions (Initial)

Start broad. Simple validated tools used in clinical practice:

CAGE Questionnaire (for alcohol; 2+ positive = likely disorder):

Have you ever felt the need to Cut down on your drinking?
Have you ever felt Annoyed by criticism of your drinking?
Have you ever felt Guilty about your drinking?
Have you ever had a morning Eye-opener (drink first thing in the morning)?

AUDIT-C (3-item, best for risky/hazardous drinkers):

How often do you have a drink containing alcohol?
How many drinks do you have on a typical drinking day?
How often do you have 6 or more drinks on one occasion?

Single Alcohol Screening Question (SASQ): "How many times in the past year have you had 5 or more drinks in a day (men) / 4 or more (women)?"

2. Type and Pattern of Use

What substances do you currently use? (Ask specifically: alcohol, tobacco, cannabis, opioids, stimulants, benzodiazepines, hallucinogens, inhalants)
When did you first start using [substance]?
How much do you use per day / per week?
How often do you use it?
What route do you use? (oral, smoking, snorting, injecting)
Do you use more than one substance at a time?

Start with socially accepted substances (tobacco, alcohol) before asking about illicit drugs - this reduces defensiveness. (Swanson's Family Medicine Review)

3. DSM-5 Diagnostic Criteria Questions

These 11 criteria (2+ in 12 months = substance use disorder) should each be explored:

#	Question to ask
1	Do you often end up using more than you planned, or for longer than you intended?
2	Have you tried to cut down or stop but been unable to?
3	Do you spend a lot of time getting, using, or recovering from the substance?
4	Do you have strong cravings or urges to use?
5	Has your use caused you to fail in responsibilities at work, school, or home?
6	Do you continue using even when it causes problems in relationships?
7	Have you given up important activities (hobbies, social, work) because of your use?
8	Have you used in situations where it was physically dangerous (driving, machinery)?
9	Do you continue using even though you know it causes physical or mental health problems?
10	Do you need more of the substance to get the same effect? (Tolerance)
11	Do you get physical or emotional symptoms when you stop? (Withdrawal)

Mild = 2-3 criteria; Moderate = 4-5; Severe = 6+ (Harrison's Principles of Internal Medicine, 22e)

4. Withdrawal and Tolerance

What happens when you stop using or run out?
Have you ever had tremors, sweating, seizures, or hallucinations when stopping alcohol?
Have you ever used the substance just to prevent withdrawal symptoms?
Has your usual dose stopped having the same effect?

5. Past Psychiatric and Medical History

Do you have any diagnosed mental health conditions (depression, anxiety, PTSD, psychosis)?
Have you ever been hospitalized for psychiatric reasons?
Are you taking any prescribed medications?
Do you have any chronic medical conditions (liver disease, HIV, hepatitis, heart problems)?
Have you had any overdoses?

6. Prior Treatment History

Have you ever been in treatment for substance use before?
What type of treatment (detox, rehab, outpatient, AA/NA, medications)?
What worked? What didn't?
Have you ever had a period of sobriety? How long? What helped?
Have you ever received medications like methadone, buprenorphine, naltrexone, or disulfiram?

7. Social, Occupational, and Legal History

Has your use affected your job or school performance?
Have you had any legal problems related to your use (DUI, arrests)?
Has your use caused problems with family or relationships?
Who do you live with? Is anyone else in your household using substances?
Do most of your friends or social group also use?
How do you pay for the substance? (assesses financial and safety risk)

8. Safety and Risk Assessment

Have you ever shared needles or injection equipment? (infection risk)
Have you been tested for HIV, hepatitis B, hepatitis C?
Have you ever been in an unsafe situation (violence, sex work) related to your use?
Have you had any thoughts of harming yourself or others?
Have you ever experienced an overdose, or witnessed one?

Interview Tips (from Kaplan & Sadock's Comprehensive Textbook of Psychiatry and Swanson's Family Medicine)

Begin with non-intrusive, open-ended questions and work toward specifics
Avoid judgmental language or pejorative statements
Focus on negative consequences and loss of control - these are the most revealing
Provide empathy to build trust - most patients initially deny use
Get collateral history from family/significant others when possible
Confront the patient only if you have solid objective evidence (lab results, physical findings)
If several questions seem too sensitive, return to them later in the interview

Sources:

Swanson's Family Medicine Review, Substance Abuse chapter
Harrison's Principles of Internal Medicine 22e, Alcohol Use Disorder Criteria
Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Initial Evaluation / SUD chapters
Miller's Anesthesia 10e, Patients with a History of Substance Use Disorder

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