The Assessment of Suspected Substance Use Disorders 1 [The] successful treatment of substance use disorders depends on a careful, accurate assessment and diagnosis. (Greenfield & Hennessy, 2008, p. 55) Introduction Almost two generations ago, Samuel Shem (1978) wrote a novel about a man’s internship year at a fictional hospital in the Boston area titled The House of God. In this novel a wiser, more advanced resident set down various“laws”to help the interns survive, not the least of which was the rule that“If you don’t take a temperature, you can’t find a fever”(p. 420). This dictum applies to substance use disorders as well: Many health care professionals avoid discussing the patient’s substance use or abuse to avoid having to deal with this uncomfortable issue. This might be why the majority of referrals to substance abuse rehabilitation programs do not come from a health care provider (Madras, 2010). Unfortunately, there is a consequence of this therapeutic myopia: The substance use disorders (SUDs) are all too often an unacknowledged causal factor in various disease states, as well as its contribution to the problems experienced by dual diagnosis clients, 2 not to mention the various legal, financial, interpersonal, vocational and personal problems either caused or at least exacerbated by SUDs. These problems make it imperative that the health care professional obtain an accurate history of the patient’s substance use patterns (Johnson, 2003). Further, in this era of major changes in the health care insurance system in …….

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