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55 Questions for Substance Abuse Clients in Therapy

Substance use is something that can be traced back in human history, including the time of the Greeks. Drugs and alcohol have been associated with religious practices, celebrations, and are  included in other areas of our lives. Keep reading to learn 55 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 experienced any challenges since we last saw each other?
  3. Can you think of something that went well since our last session?
  4. Was there anything from our last session that resonated with you?
  5. How can I help you today?
  6. How do you feel about your substance use?
  7. Have you found yourself feeling guilty about your use?
  8. Are you carrying any shame related to your substance use or things you have done under the influence?
  9. How do you feel your life would be different if you were able to not use substances?
  10. Have you had any periods of sobriety in the past?
  11. What helped you during that time in your journey?
  12. Can you share your thoughts about what contributed to your relapse?
  13. Is anything different for you regarding your motivation for your recovery today than it has been in the past?
  14. Where do you feel your motivation for your recovery is coming from? This could include your own desire, your partner, your family, and your employer.
  15. Can you tell me about when you began using substances?
  16. Can you tell me about your perception of drugs and alcohol growing up?
  17. How do you feel your environment growing up has impacted your substance use?
  18. Do you have a family history of substance abuse or mental health concerns?
  19. Have you found that you need more of a substance to reach the same desired effect, also known as tolerance?
  20. Can you tell me about your experience with withdrawal symptoms?
  21. What is your perception of substance abuse counseling?
  22. What do you think you could gain from substance abuse counseling?
  23. Are there any emotions that you have a hard time sitting with or coping with?
  24. Do you know what some of your triggers are?
  25. What are some of your external triggers?
  26. What can we do to cope with some of the external triggers you experience?
  27. What do you value in your life?
  28. Can you tell me what is important to you?
  29. How has your addiction impacted what is important to you?
  30. Are there any changes you can make that would align your behaviors with your values?
  31. Whom in your life do you care for?
  32. Can you tell me about how your addiction has impacted the relationships in your life?
  33. What changes would you like to see in your relationships?
  34. What are some of the characteristics that come to mind when you think of someone you can trust?
  35. If you were having a hard time, is there someone in your life you could call?
  36. How likely are you to reach out when you are struggling?
  37. What helps you stay grounded?
  38. Can you tell me about any shame or guilt that you are carrying?
  39. Have you found going to meetings to be helpful?
  40. Do you feel as though you would benefit from additional social support?
  41. How do you feel you are doing financially? Did your addiction have an impact on your finances?
  42. Have you been concerned about being able to pay your bills or buy food?
  43. Do you have a safe place to sleep at night?
  44. Can you tell me what you have been doing for yourself lately?
  45. How would you describe your mood today?
  46. What has been helping you?
  47. What are some of the things you can do during your day to support your recovery?
  48. How would you describe your self-care practices?
  49. Can you tell me about your goals?
  50. Is there anything coming up in the near future that you have concerns about? This could be a family gathering, holidays, work event, or other planned activity.
  51. How would you describe your mood?
  52. Have you ever thought about taking your own life?
  53. Was there a time when you acted on these thoughts? Can you share what happened?
  54. Do you find yourself engaging in high-risk behaviors, like reckless driving, excessive spending, gambling, or unsafe sex?
  55. What has your experience been with binge drinking?

Final Thoughts on Therapy Questions to Ask Clients with Substance Abuse

Thank you for taking the time to read our article about 55 substance abuse questions you can ask your clients in therapy! Substance abuse and misuse can impact anyone, which speaks to the importance of having an understanding of how you can help clients in your clinical setting who may be struggling with their use of drugs and alcohol. Your use of substance abuse questions can help you determine if it would be appropriate for your client to continue working with you, or if they qualify for a higher level of care.

If you are looking to learn more about substance use disorders and substance abuse treatment options, we encourage you to look for related continuing education and training opportunities. 

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

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Kayla Loibl, MA, LMHC
Author: Kayla Loibl, MA, LMHC

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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