Guide to Requesting Medical Treatment for Addiction

For the medical condition of addiction, medical treatment is the first order of care. Following is a brief guide, informed by research on what helps people manage the symptoms of addiction, for requesting care from a medical professional.

This guide anticipates a 10-minute appointment with a primary care physician, nurse practitioner, or physician’s assistant. Given the likelihood of a short appointment, directness and brevity are essential. People with substance use disorders are encouraged to not use the appointment to explain their situations, but to ask directly for the medical help they specifically need.

“A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.”
– Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 4-1

. . . . .

Greetings, Medical Care Provider.

I have symptoms of, or have been diagnosed with, substance use disorder.

In addition, I have received diagnoses for:

The medications and supplements I currently take are:

An outline of the treatment plan I am following for substance use disorder may be included. In addition, I may be following a more specific treatment plan for alcohol use disorder.

I ask:

  1. to be assessed for suitability for medications for my individual case of substance use disorder, and for other physical and mental conditions;
  2. for help with feeling as physically and mentally stable as possible.

I would like to request:

_____ Physical exam, with screening for skin/soft tissue infections and stigmata of endocarditis.
_____ Diagnostic lab work for:

  • infectious diseases, including STIs, hepatitis C, and HIV
  • liver functioning
  • endocrine system organ functioning, particularly thyroid and adrenal gland (thyroid malfunction, chronic adrenal insufficiency, or excess glucocorticoid production can present as mental illness symptoms)
  • routine labs (blood count, electrolytes, lipid panel, hemoglobin, A1C, etc.)
  • other tests as indicated and recommended.

_____ Referral to a psychiatrist.
_____ Referral for psychological and neurological testing, as indicated.
_____ Other: ____________________

From the following list, I have placed checks by the additional concerns for which I request help. Below each, I have provided a brief description of my concerns.

Diagnosis and treatment, including assessment for medications for:

_____ Substance use disorder*

Primary substance(s) of concern:
Secondary substance(s) of concern:

_____ Physical illnesses:

_____ Mental illnesses:

_____ Physical pain:

_____ Sleep disturbances:

_____ Tobacco/nicotine intake:

_____ Caffeine intake:

_____ Hydration/water intake:

_____ Nutrition, diet, weight:

_____ Movement/exercise

_____ Appointments and referrals for follow-up care and additional treatment

Thank you for your help.

Name: ___________________________
Date of birth: ______________________
Date: ___________________________
Phone: __________________________

*If you would like a history, I may have a copy of a timeline listing: first use of caffeine, cigarettes, alcohol, marijuana, and/or other substances; substance use history: substances used, when, how much, and for how long; any trauma, including deaths in the family, losses, moves, neglect, abuse, witnessing or experiencing an occurrence as memorably shocking or alarming, witnessing emotional, physical, or sexual violence, community violence or natural disaster; onset of any significant physical illnesses or occurrence of any physical injuries; onset of any mental illnesses; substance use and mental health treatment received.

A shortened version of this guide as a printable .pdf is here (opens in new tab). The .pdf was last updated 10/17/18.

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  • Prior to the appointment, make a personal timeline that includes the information listed by the asterisk (*) above.
  • Take a copy of the timeline, not the original, to the appointment.
  • Some medical professionals are unfamiliar with medications for substance use disorder. You can find more information about medical treatment for substance use disorder in the Surgeon General’s Report, Chapter 4, and for alcohol use disorder here.

Sanjay Kishore, M.D. contributed to this post.

Latest revision 10/26/18

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.