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It is recommended that you discuss the following with your patients:
Yes. Screening is an effective method of preventive care comparable to yearly Pap smears or colonoscopies to identify cancer indicators. It is recommended that providers routinely screen all patients for use of tobacco/nicotine, alcohol and other drugs.
Screening tools typically include written or oral questionnaires and, less frequently, clinical and laboratory tests. Unfortunately most available screening tools either fail to include all substances and/or do not identify the full range of risky users.
All patients who screen positive should receive a diagnostic evaluation by an appropriately trained professional to determine whether they have a substance use disorder.
Health care providers should use standardized criteria such as those in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association.
Patients who screen positive for risky substance use or have a mild substance use disorder may be able to stop or reduce their use and negative consequences through structured discussions that provide them with advice, education and motivation. These interventions can be delivered face-to-face or over the phone or computer-assisted by a broad range of trained health professionals, including doctors, nurses, physician assistants, social workers and counselors.
All patients who are diagnosed with a substance use disorder require a complete and comprehensive assessment to determine:
This is a necessary first step in determining a patient’s treatment needs.
More information is available at the American Society of Addiction Medicine website.
The first step in addressing addiction involving nicotine, alcohol or other drugs is cessation of use and, if necessary, medically managing the clearance of toxic substances from the patient’s system, also known as detoxification. While cessation of use can in some cases be a self-managed process, patients typically need professional assistance. For patients who demonstrate physical dependence on a substance, cessation of use on their own may be unsafe and medically supervised detoxification may be required to manage withdrawal symptoms and complications. For those with addiction involving opioids, cessation of use is often accomplished by immediate transition to medications that reduce cravings and withdrawal symptoms and that may be continued over time.
Effective, clinical treatments for addiction include a range of pharmaceutical and/or psychosocial therapies delivered by qualified health professionals. Due to the complex nature of addiction and its physiological, psychological and environmental risk factors, a multi-pronged approach to treatment tailored to each patient that includes a combination of medications and psychosocial therapies typically yields the best results.
Because of the extent to which addiction co-occurs with a broad range of other health problems, effective medically managed treatment protocols also should address co-occurring disorders, including psychiatric conditions.
Types of Treatment: Medications
Medications for addiction treatment may work by:
Types of Treatment: Psychosocial Therapies
Psychosocial treatments for substance use disorders aim to alter patients’ attitudes, thoughts, feelings, relationships, and behaviors related to tobacco/nicotine, alcohol and other drugs. These therapies enhance patients’ skills in coping with life challenges, navigating high-risk situations, avoiding substance-use triggers, controlling cravings and coping with lapses. Some therapies focus on enhancing patients’ motivations to change their substance-related behaviors. Other therapies focus on helping patients alter their environments in order to reduce pressures and cues to use, or provide positive or negative reinforcements to help patients change their attitudes and behavior. Examples include cognitive behavioral therapy, community reinforcement approach, contingency management and couples/family therapy.
Ideally, you should consult with and/or refer your patients to addiction specialists for advanced treatment options for addiction.
An addiction specialist can be found through these sites: