Substance use disorder: Principles for recognition and assessment in general medical care
- Michael F Weaver, MD
Michael F Weaver, MD
- Medical Director, Center for Neurobehavioral Research on Addictions
- University of Texas, Health Sciences Center at Houston
- Margaret A E Jarvis, MD
Margaret A E Jarvis, MD
- Medical Director
- Marworth Treatment Center, Waverly, Pennsylvania
All clinicians will encounter patients with substance use disorders (SUD). A study of a nationally representative sample found that eight percent of adults in the US had a SUD in the past 12 months . A study that conducted urine and blood tests on a sample of patients admitted to the hospital estimated that alcohol or drug use was involved in 14 percent of the medical admissions and 26 percent of the psychiatric admissions . Addiction affects adolescents and the elderly, all races, and all socioeconomic strata. Despite the relatively high prevalence of SUD, the disorder frequently goes undetected in clinical care .
Clinicians should evaluate all new patients for unhealthy alcohol use, and other drug use when relevant (eg, high prevalence, consideration of prescribing a potentially addictive medication); drug and alcohol use should also be considered when patients present with new symptoms, recent motor vehicle accidents or physical trauma, mood disorders, weight loss, or ongoing unexplained symptoms.
Principles for recognition and assessment of SUD in general medical care are discussed here. The epidemiology, clinical manifestations, course, diagnosis, and treatment for specific substances are discussed separately. Screening for alcohol and other drug use is also discussed separately. (See "Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis" and "Pharmacotherapy for opioid use disorder" and "Acute opioid intoxication in adults" and "Cannabis use disorder: Epidemiology, comorbidity, and pathogenesis" and "Cannabis use disorder: Clinical features and diagnosis" and "Cannabis use disorder: Treatment, prognosis, and long-term medical effects" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Management of moderate and severe alcohol withdrawal syndromes" and "Medically supervised alcohol withdrawal in the ambulatory setting" and "Screening for unhealthy use of alcohol and other drugs in primary care" and "Brief intervention for unhealthy alcohol and other drug use" and "Prescription drug misuse: Epidemiology, prevention, identification, and management".)
Substance use disorders (SUD) are easy to recognize in the patient who has just been arrested for a motor vehicle violation or who presents with a request to discontinue using drugs. Many more patients with SUD will only be identified if specifically asked about the problem.
Patient denial is a significant barrier to identifying patients needing help for SUD. Denial may exist even when the patient is directly asked about use or confronted with behaviors suspicious for unhealthy substance use. Obtaining history from family members and employers can be helpful, but must be done in compliance with legal regulations protecting patient privacy. In the United States (US), patient privacy regulations (HIPAA and 42CFR) require that the patient sign a release of information that includes the name of the patient and the person the clinician will be communicating with, the specific information to be released to that person, the reason for the release of information, and a time frame within which the release of information remains valid.
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