How do you tell a patient with a substance use history that you won't prescribe the benzodiazepine they're requesting?

⚪ Clinical pearl: The best strategy is to be direct, validating, and firm. Acknowledge the patient's anxiety while clearly stating the treatment plan will focus on safety. One effective approach is to say: “You need treatment for anxiety, but you have a substance use issue so we are going to use non-addictive anti-anxiety medications.” If the patient mentions past success with a specific agent, you can validate their experience while holding the boundary: “I understand that klonopin has worked for you before, but the risk of worsening your substance use issues is too great for us to use that again.”

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