The VHA/DOD Substance Use Disorder Guidelines, the National Quality Forum consensus standards (2007) and the RAND evidence based practice metrics consistently call for primary care practices to routinely screen for substance use and to monitor patients who have previously screened positive or who have a prior substance use disorder. It is reasonable to expect that behavioral health programs with a high prevalence of co-occurring mental illness and substance use among their patients, would routinely monitor substance use and actively promote reduction or abstinence.

Behavioral health programs and behavioral health clinicians should maintain a vigilant review of alcohol and other drug use by multiple modes of assessment, ranging from careful observation by provider during medical appointments to the use of biological measures. Promote abstinence or reduction, as indicated, and offer supportive verbal encouragements.

1. Look for spontaneous signs of use and ask the patient about their specific use and frequency of that use.
2. When possible, discuss other areas of concern in the patient’s life since these constitute collateral assessment and prognostic indicators.
3. Use biological assessments concurrently with the ongoing dialogue including the breathalyzer, urine toxicology, and BAL.
4. Encourage abstinence or reduced use, consistent with the patient’s motivation and agreement

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