Information 1-3

  • Asking about alcohol, tobacco and other drugs (ATODs) provides clinicians with an opportunity to promote healthy lifestyle behaviours and prevent or improve chronic conditions

Child safety notification

  • See Child safety reporting for suspicion of harm or neglect

Health check recommendations

  • All people > 15 years of age annually

1. Procedure

  • Ask the patient the ATODs questions. See Table 1.
  • Provide brief intervention
  • Determine if the patient requires a referral and place on a follow-up and recall register

Table 1. ATODs questions

Tobacco 2,3

Does the person smoke?

  • If yes then continue with questions

Minutes after waking to having first cigarette?

Number of cigarettes per day?

Any cravings or withdrawal symptoms in previous quit attempts?

Alcohol and drug use 1–3

Does the person drink alcohol or use drugs?

  • If yes then continue with questions. Consider inhalants, injected drugs, prescription medicines, etc

Has the person ever felt they ought to cut down on their drinking or drug use?

Have others been concerned or commented on their drinking or drug use?

Have they felt worried about the level of drinking or drug use?

Have they ever had a drink or used drugs first thing in the morning to steady their nerves or to get rid of a hangover?

2. Results

  • Provide brief intervention if the patient answers yes to using ATODs
  • Praise successes if patient doesn’t use ATODs
  1. Tobacco questions 2,3
    • The tobacco questions can indicate dependence if a patient answers they:
      • smoke within 30 minutes of waking or
      • smoke more than 10 cigarettes per day or
      • have a history of withdrawal symptoms in previous quit attempts
  2. Alcohol and drug use questions 2,3
    • Answering yes to any question identifies a patient who may have a substance abuse disorder
    • Answering yes to 2 or more questions is considered clinically significant and requires referral

3. Brief intervention

  • ATODs use is responsible for high global morbidity and mortality rates, specifically alcohol and tobacco
  • Avoid minimising harmful behaviour or negative health effects
  • Use a matrix of questions for patients to critically think about their ATODs use. See Table 2.
  • Encourage the patient to:
    • talk to someone they feel comfortable with
    • seek help from the health service if they wish to quit or change their ATODs use
  • Offer self-help and cessation support programs resources. See Resources
  • See Alcohol reduction and Smoking cessation

Table 2. Motivational questions

What are the good things about taking drugs, smoking and drinking alcohol?

What are the bad things about smoking, drinking alcohol or taking drugs?

  • All my friends do it
  • Makes me look cool
  • Helps me unwind /relax
  • Gets me started
  • Tastes good
  • Keeps me awake
  • Gives me a boost
  • Costs a lot of money
  • Makes my chest feel tight, short of breath when running, playing sport or climbing stairs
  • Becoming overweight
  • Hangovers
  • Makes me lazy, cough, gives me bad breath
  • Everyone bludges a smoke off me
  • Hate craving for a smoke
  • Causes cancer and damages the body
  • Trouble with police

What are the good things about NOT smoking, drinking alcohol or taking drugs?

What are the bad things about NOT smoking, drinking alcohol or taking drugs?

  • Won’t be breathless any more
  • Will have more money
  • Can save up for something special
  • Will feel stronger, healthier and live longer
  • Friends may not want to spend time with me
  • Not looking cool
  • Weight gain

4. Referral

  • If harmful drug taking behaviours are identified, with consent, refer to an appropriate source. See Table 3.

Table 3. Referral options

Queensland Health

Other services

5. Follow-up

  • Place the patient on a recall register to monitor and support ATODs reduction
  • Ensure all referrals are actioned
  • Provide the patient with the next scheduled follow-up appointment

6. References

7. Resources

  1. Queensland Government alcohol, tobacco and other drugs resources
  2. Alcohol and Drug Information Service on 1800 177 833 all hours
  3. Turning Point online counselling service
  4. Quit HQ and Quit
  5. National Alcohol Strategy 2019–2028
  6. Smoking, nutrition, alcohol, physical activity (SNAP) A population health guide to behavioural risk factors in general practice 2nd edition
  7. Quit phone apps available for download from Apple iTunes and Google Play stores
  8. RACGP: Smoking cessation: a guide for health professionals
  9. Australian Alcohol Guidelines revised
  10. Cannabis Information and Support

Last updated: September 2024

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