Capsule Commentary on Callon et al., Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?
J Gen Intern Med
Capsule Commentary on Callon et al., Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?
Jeffrey L. Jackson 0
0 Zablocki VAMC , Milwaukee, WI , USA
Corresponding Author: Jeffrey L. Jackson, MD MPH; Zablocki VAMC, Milwaukee, WI, USA (e-mail: ). Compliance with Ethical Standards: Conflict of interest: The author has no conflicts of interest with this article.
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A for many chronic medical illnesses. Patients who are
dherence is an important factor in disease management
nonadherent to antiretroviral therapy risk increased viral
resistance, opportunistic infections and disease acceleration.1
Substance abuse is commonly comorbid among patients with
chronic disease and is a predictor for nonadherence in HIV
treatment.2 Callon and colleagues found that how providers
ask questions about substance abuse impacted the accuracy of
patient answers.3 In their cohort, 162 patients actively abusing
substances (as identified in a post-encounter interview) were
audiotaped during visits with 56 providers. While substance
use questions were asked less than half the time, open-ended
(How’s the drinking going?^) and normalizing questions
(BWhen was the last time you used?^) were 100% accurate
in uncovering substance abuse, while closed-ended (BHave
you used any cocaine?^) or biased questions (BHave you been
clean?^) provided accurate answers less than half the time.
The authors suggest that future research should focus on why
providers fail to ask about substance use and whether universal
screening of high-risk patients would be effective.
An important limitation is that the group was identified as
actively using based on a post-encounter interview that used
open-ended and normalizing questions. It may not be
surprising that similar questions during the interview would appear
very accurate. However, these findings are plausible and
mirror general beliefs. There are a number of topics that patients
and providers have difficulty discussing including sexual
trauma, intimate partner violence, substance abuse, sexual
orientation, sexual functioning and mental health. General dogma is
that providers should approach these topics with open-ended,
normalizing questions. For example, the CDC recommends
that a sexual history begin with the normalizing statement,
BJust so you know, I ask these questions to all of my adult
patients, regardless of age, gender, or marital status.^4
Callon’s contribution to the literature is to quantify just how
inaccurate patient responses will be when close-ended or
leading questions are used. BYou don’t drink, do you?^ elicits
a markedly different response than BTell me about your
alcohol consumption.^
1. Lucas GM , Griswold M , Gebo KA , Keruly J , Chaisson RE , Moore RD . Illicit drug use and HIV-1 disease progression: a longitudinal study in the era of highly active antiretroviral therapy . Am J Epidemiol . 2006 ; 163 ( 5 ): 412 - 20 .
2. Chander G , Himelhoch S , Moore RD . Substance abuse and psychiatric disorders in HIV-positive patients: epidemiology and impact on antiretroviral therapy . Drugs . 2006 ; 66 ( 6 ): 769 - 89 .
3. Callon W , Beach MC , Saha S , Chander G , Wilson IB , Laws MB , Sharp V , Cohn J , Moore R , Korthuis PT . Assessing problematic substance use in HIV care: which questions elicit accurate patient disclosures ? J Gen Intern Med . 2016 . doi:10.1007/s11606- 016 - 3733 -z.
4. US Department of Health and Human Services . Centers for Disease Control. A Guide to Taking a Sexual History . CDC Publication: 99 - 8445 . https://www.cdc.gov/std/treatment/sexualhistory.pdf. Accessed 8 June 2016 . (...truncated)