Substance use disorders — MCQs

A 30-year-old man with schizophrenia stabilized on clozapine presents to establish care at a new clinic. Records show stable psychiatric symptoms for 2 years. Routine urine drug screen is positive for cocaine. He admits to using cocaine 2-3 times monthly at parties but denies it affects his functioning. He has maintained employment, housing, and medication adherence. He refuses substance use treatment, stating 'it's recreational and under control.' His last clozapine level was therapeutic. Evaluate the management approach balancing psychiatric stability, substance use, and patient autonomy.