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物质使用障碍：初级保健机构中的识别及评估原则

Authors
Michael F Weaver, MD
Margaret A E Jarvis, MD
Section Editor
Richard Saitz, MD, MPH, FACP, DFASAM
Deputy Editor
Richard Hermann, MD
Translators
杜江, 副主任医师

引言

所有临床医生都会遇到有物质使用障碍(substance use disorders, SUD)的患者。一项对具有全国代表性的样本的研究发现，在美国8%的成人在过去12个月内有SUD[1]。一项研究对入院患者的样本进行尿液和血液检测，其评估结果发现14%因内科疾病入院的患者和26%因精神疾病入院的患者存在酒精或药物使用[2]。成瘾可影响到青少年和老年、所有种族及所有社会经济阶层的群体。尽管SUD的患病率相对较高，但在临床机构中往往不能被检测出[3]。

临床医生应该评估所有新患者是否有不健康的酒精使用和其他药物使用(当相关时，如高患病率、考虑开具有可能成瘾药物的处方)；当患者出现新症状、近期机动车驾驶事故或者身体创伤、心境障碍、体重减轻或有持续性无法解释的症状时，也应考虑酒精及药物使用。

初级保健机构识别及评估SUD的原则将在此讨论。具体成瘾物质的流行病学、临床表现、病程、诊断及治疗将单独讨论。酒精及其他药物使用的筛查也将单独讨论。 (参见“阿片类物质使用障碍：流行病学、药理学、临床表现、病程、筛查、评估和诊断”和“阿片类物质使用障碍的药物治疗”和“成人阿片中毒”和“Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status”和“大麻使用障碍：临床特征及诊断”和“大麻使用障碍：治疗、预后及远期药理效应”和“成人可卡因使用障碍：流行病学、药理学、临床表现、医疗后果和诊断”和“酒精使用障碍：流行病学、发病机制、临床表现、不良后果和诊断”和“酒精使用障碍的药物治疗”和“酒精使用障碍的心理社会治疗”和“中重度酒精戒断综合征的处理”和“门诊医学监督下的酒精戒断”和“酒精和其他药物不健康使用的筛查”和“Brief intervention for unhealthy alcohol and other drug use”和“处方药使用不当：流行病学、预防、识别和处理”)

概述

在因机动车辆违章刚刚被捕的患者或就诊时要求停止正在使用药物的患者中，很容易发现SUD。但更多的SUD患者只有在被具体询问到该问题时才能发现。

患者的否认是识别因SUD需要相关帮助的患者的明显障碍。即使直接询问患者药物使用相关问题或面对患者怀疑有不健康的成瘾物质使用的行为时，患者仍可能否认。向家庭成员和雇主了解病史可有帮助，但是该过程必须符合保护患者隐私的法律规定。在美国，患者隐私法规[《健康保险流通与责任法案》(Health Insuance Portability and Accontability Act, HIPAA)和《美国联邦法律》第42篇(Code of Federal Regulations 42, 42 CFR)]要求患者签署信息披露协议，包括患者姓名、临床医生将会联系的人、披露给该联系人的具体信息、披露信息的原因，以及信息披露有效的时间范围。

            

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-18.
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