Substance Abuse

Overview

The harmful use of and addiction to alcohol and other drugs— including prescription drugs— is

one of this nation’s major and most costly health problems. Excluding nicotine, alcohol and other

drug problems are present in 10-20% of ambulatory patients and from 25% to 50% of general

hospital patients. Since over 20% of U.S. adults are regular cigarette smokers, nicotine addiction

adds measurably to the already high prevalence. Despite its high prevalence, physicians (and

sometimes patients themselves) often fail to recognize a substance abuse problem. Also, because

of the stigma attached to substance abuse, people with this problem may not reveal it to their

physician. Making this diagnosis is a high priority since substance abuse and dependence causes

numerous medical problems, may masquerade as other psychiatric diagnoses, and may

complicate ongoing therapeutic management of other diseases. The primary care physician is the

first line of defense in recognizing and treating disorders of substance abuse and addiction.

Common Clinical Presentations

· Repeated injury

· Systolic hypertension (alcohol)

· Chronic insomnia

· Chronic pain without an evident diagnosis

· Fatigue, memory impairment

· Panic or anxiety attacks

· Depression secondary to ETOH/sedative drugs

· Weight loss (stimulant abuse, AIDS)

· HIV+/AIDS

· Substance-abusing health professional

Manifestations of Alcohol/Sedative Withdrawal

· Agitation

· Insomnia

· Seizures

· Delirium

· Hallucinations

Manifestations of Opioid Withdrawal

· Insomnia

· profuse diaphoresis

· Lacrimation, rhinorrhea

· Piloerection (goose flesh)

· Shallow breathing; respiratory arrest

Manifestations of Opioid Intoxication

· Pinpoint pupils

· Clammy skin

· Needle tracks

· Somnolence, confusion

Cocaine or Amphetamine Intoxication

· Agitation

· Dilated pupils

· Rapid mood swings

· Aggressive behavior

Procedure Skills (Including Essential Clinical Skills)

· Interview in order to screen for tobacco, alcohol, and other drug use and any problems

related to their consumption.

· Counseling and management of substance abuse and alcohol abuse, including appropriate

use of referrals.

· Counseling intravenous drug users about HIV risk.

· Skill in presenting a diagnosis of addiction and initiating an appropriate referral for

specialized care.

Primary Interpretation of Tests

· Drug screening via blood and urine tests

· Blood and breath alcohol tests

Ordering and Understanding Tests

· Blood and breath alcohol levels

· Urine tests for drugs

· HIV, Hepatitis

· Mean corpuscular red blood cell volume