95. Substance Use and Addiction

Question 1

For a patient using alcohol or substances (including those who use them only occasionally), discuss what?

Answer 1

• Discuss the possible impact of their use on themselves and others (e.g., risk to children, sexual indiscretion)
• Discuss harm-reduction strategies in detail (e.g., needle exchange, not drinking and driving, immunizations)

Question 2

For any patient presenting with a functional decline, confusion, or delirium, assess for alcohol/substance use and withdrawal, even when other causes may seem more apparent.

Question 3

Discuss substance use with adolescents and their caregivers when warning signs are present. Name examples.

Answer 3

• school failure
• behaviour change

Question 4

Consider and look for substance use as a possible factor in problems not responding to appropriate intervention.

Name examples.

Answer 4

• alcohol use in patients with hypertriglyceridemia
• inhalational drug use in asthmatic patients

Question 5

For a patient requesting or requiring a new prescription for opioids, stimulants, or tranquillizers.

Assess and explain what?

Answer 5

• Assess alcohol and substance use
• Explain clearly the benefits and risks, and do not prescribe before the risks of misuse have been assessed and mitigated

Question 6

What’s the DX of substance abuse ?

Answer 6

Classified by 2+ of the following within a 12-month period

TRIED ALL CAP

• T – Tolerance (needing more substance to achieve the same effect)
• R – Risky use (continued use despite danger)
• I – Interpersonal issues (social problems due to use)
• E – Excessive use (using more than intended)
• D – Desire to cut down (unsuccessful attempts to stop or reduce use)
• A – Activities given up (important social or recreational activities reduced)
• L – Large amounts/time spent (a lot of time spent using, obtaining, or recovering)
• L – Lack of control (persistent use despite knowing consequences)
• C – Craving (strong desire to use the substance)
• A – Avoiding obligations (failure to fulfill work, school, or home duties)
• P – Physical dependence (Withdrawal) (withdrawal symptoms when stopping)

Mild 2-3, Moderate 4-5, Severe 6+

Question 7

Describe General Approach (5 As) of Substance Abuse

Answer 7

• Ask (Identify and document at each visit)
• Assess
• Advise (brief intervention best provided after asking for permission)
• Assist
• Arrange Follow-up

Question 8

Describe general approach: Ask

Answer 8

Routine screening for substance use in all populations, especially those with risk factors:

• Psychiatric disease, chronic disability, family or personal history of substance use disorder
• Associated symptoms, eg. Functional decline, confusion, delirium, syncope
• Associated medical problems, especially if not responding to appropriate intervention (alcohol in hypertriglyceridemia, inhalation drugs in asthmatic)
• Prescription medication that are commonly misused (opioids, sedatives, hypnotics, or anxiolytics, stimulants)

Substance use history should include

• Amount
• Frequency
• Duration of use
• Last use
• Signs of tolerance/withdrawal
• Affect on function
• Safety of patient and others
• Consider substance-specific screening tools (eg. AUDIT, CAGE)

Question 9

Describe general approach: Assess (4)

Answer 9

• Readiness for change
• Safety and related risks (eg. children, risk of STI through IV drug use or sex)
• Causes for substance use
• Other pertinent medical information (eg. vaccines, medications, past medical and psychiatric history, etc…)

Question 10

Describe general approach: Advise (4)

Answer 10

Provide clear advice to change

Offer feedback on the patient’s personal risk or impairment

Explain benefits of change

Emphasize that the patient is responsible for changing their use; he or she must decide how

• Identify the problem, explain why change is important, ask how their life would improve without substance, advocate specific changes
• Choose a focused goal patient responds to (SMART goal: specific, measurable, achievable, relevant, time-based)
• If abstinence not desired, provide counselling on harm reduction (e.g., no drinking-and-driving, using clean needles, having drug supply tested before use, never using alone)
• Reinforcing the patient’s self-efficacy or belief in his or her competence to change behavior
• Clinician should state their belief that the patient can make a change

Question 11

Describe general approach: Assist (3)

Answer 11

• Identify and address barriers
• Develop care plan (psychosocial and pharmacological therapy)
• Provide resources/providers (referrals)

Question 12

Name general Safety recommendations (5)

Answer 12

• Do not share medication
• Do not receive medications from other sources
• Store medication in secure location (out of reach of children, adolescents)
• Ensure regular visits to healthcare provider, and regular urine samples for drug screens as requested
• Inform your healthcare provider of any changes to health, and if you would like to adjust your prescribed dose

Question 13

Nommez des examples de pharmaco dans l’usage de substance

Answer 13

• méthadone (opioïde)
• acamprosate (ROH)
• naltrexone/revia (ROH)

Question 14

Chez les patients aux prises avec un trouble lié à l’usage de
substances, profitez des occasions pour dépister les comorbidités.

Nommez les. (5)

Answer 14

• pauvreté
• criminalité
• infections transmissibles sexuellement
• troubles de santé mentale
• les complications à long terme (p. ex. cirrhose).