Psychosocial History

Establishing Rapport

Establishing initial rapport with a patient during an evaluation is essential in gaining a valid, consistent, and thorough psychosocial history. Strategies consistent with motivational interviewing, an approach developed by William Miller and Stephen Rollnick, may be helpful in facilitating a positive relationship between the interviewer and patient. For example, the interviewer should strive to promote a positive relationship throughout the assessment using empathie listening, providing support and encouragement, displaying genuine concern for the patient, responding to patient concerns, and providing needed clarifications and explanations. Interviewers should avoid statements that are likely to elicit resistance, such as confrontation of denial of a substance abuse or dependence problem, excessive questioning, interrupting the participant, and arguing with the participant.

Obtaining an accurate psychosocial history can also be problematic because of the social stigma of alcohol and other drug use. However, there are ongoing efforts by federal agencies, researchers, and advocacy groups for recovering alcoholics and addicts to characterize addiction as a chronic medical condition. As a result, the public perception of addiction may be changing. This change may make it easier to establish rapport and build trust. It may also increase the importance of family history and mental health comorbidi-ties in the psychosocial history.

Demographic Characteristics and Related Issues

Follow-up questions to the patient can target information about specific demographic variables, such as the patient's family constellation, marital status, current employment, educational history, and cultural background. This information will help the interviewer appreciate the patient's background and provide a foundation to understand the effect of substances on the patient's life. For example, some cultures may prohibit the use of alcohol, whereas other cultures embrace it as part of tradition and practice. As a result, patients' attitudes and beliefs about substances may be shaped by their culture and, in turn, can affect their behavior. In addition, age is an important factor that may affect substance use. Experimentation with substances typically occurs during adolescence, so young adults may have different triggers for alcohol and drug use (e.g., peer pressure from friends) than older adults.

In addition to demographic characteristics, patients typically present with issues that may be caused by or related to substance use. These areas include family, social, legal, educational, occupational, and medical issues and are critical to address during the psychosocial history. Assessment of the patient's family history of substance use and other problems (e.g., financial, partner violence) helps to increase understanding of the family of origin and its impact on the patient's substance use. Similarly, the patient's social history can provide information about how the patient may have changed relationships and social activities. For example, a patient may be spending less time with a spouse and more time with friends who use substances more frequently. The assessment of family and social history may also be useful in identifying any codependent relationships.

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