Substance Use Disorders (SUDs) represent a significant public health challenge. This article reviews screening, assessment, and evidence-based interventions.
DSM5 CRITERIA
A problematic pattern of use leading to significant impairment, with ≥2 of 11 criteria within 12 months:
Impaired Control
1. Using larger amounts or longer than intended
2. Persistent desire or unsuccessful efforts to cut down
3. Great deal of time obtaining, using, or recovering
4. Craving
Social Impairment
5. Failure to fulfill major role obligations
6. Continued use despite social/interpersonal problems
7. Important activities given up or reduced
Risky Use
8. Recurrent use in physically hazardous situations
9. Continued use despite knowledge of physical/psychological problems
Pharmacological
10. Tolerance
11. Withdrawal
Severity: Mild (2-3), Moderate (4-5), Severe (6+)
SCREENING TOOLS
CAGE (Alcohol)
- Cut down attempts
- Annoyed by criticism
- Guilty feelings
- Eye-opener
AUDIT (Alcohol Use Disorders Identification Test)
DAST (Drug Abuse Screening Test)
SBIRT (Screening, Brief Intervention, Referral to Treatment)
ALCOHOL USE DISORDER TREATMENT
Detoxification
- Benzodiazepines for withdrawal (chlordiazepoxide, lorazepam)
- CIWA-Ar protocol for monitoring
- Thiamine replacement (prevent Wernicke-Korsakoff)
Medications for Relapse Prevention
1. Naltrexone - Reduces craving, blocks euphoria
2. Acamprosate - Reduces protracted withdrawal
3. Disulfiram - Aversive conditioning
OPIOID USE DISORDER TREATMENT
MedicationAssisted Treatment (MAT)
1. Buprenorphine (partial agonist)
2. Methadone (full agonist)
3. Naltrexone (antagonist)
MAT is evidence-based and reduces mortality
PSYCHOSOCIAL INTERVENTIONS
- Motivational Interviewing
- Cognitive Behavioral Therapy
- Contingency Management
- 12-Step Facilitation
- Family therapy
SPECIAL POPULATIONS
Pregnant women: Methadone or buprenorphine preferred
Adolescents: Family-based interventions
Dual diagnosis: Integrated treatment for both disorders
HARM REDUCTION
- Needle exchange programs
- Naloxone distribution
- Supervised injection sites
- Reduce morbidity and mortality while engaging patients in care