• Dr Simon Moore MD CCFP

HOW TO: Get bonus points on your addictions history (2 of 3)

What does the above picture of a businessperson have to do with the substance use history? Check out our Pearls For Practice at the end of this blog post to find out

This is part 2 of a 3-part series to help you prepare for exam questions on addictive disorders (see our archives at www.thereviewcourse.com/studytips for the previous post on this topic), since we know not every resident gets comprehensive training on addictions medicine.

To get bonus points on your substance use history exam, or to identify further problem areas in patients of your practice, there are 3 things you can do for a more comprehensive addictions history:

1) Quantify their substance use

2) Find out if there is another addictive disorder

3) Find out how severely their use impacts their life

Today we’ll cover Topic #2; here's how.

2) Find out if there is another addictive disorder

There are 8 domains of addictive disorders beyond just substances (drugs and alcohol). These are crucial to ask about because they often coexist: if a patient is overusing one thing, they're often overusing something else. Be sure to ask!

It shouldn't be hard to memorize these domains because you already know all of them, but if you need a mnemonic to organize them you can use WISE STEP$:

W - Work

I - Internet

S - Spending

E - Exercise

S - Sex

T - Theft

E - Eating

P - Pornography

$ - (Gambling)


Remember that addictive disorders come in all shapes and sizes, so when you screen for addictive disorders, you should screen broadly.

Patrons of Insite, Vancouver’s supervised injection site, aren’t all street-involved or homeless; they sometimes come in wearing a business suit and set down their briefcase before injecting heroin.

Just because somebody doesn’t fit our stereotype of a patient with addictive disorder doesn’t mean they shouldn’t be screened. To reinforce something you learned in medical school: screen broadly, and ask every patient.


Many, many thanks to Dr. Paul Sobey MD CCFP ABAM, the President-Elect of the Canadian Society of Addictions Medicine, for his inspiration on this topic. I attended his excellent lecture on addictions last month and he kindly granted permission for me to use many of his tips in this series. If this was helpful, let me know – even just a simple “thank-you” - and I’ll pass on your thanks to him!