Chemical Dependency Management

Aka: Chemical Dependency Management, Substance Use Disorder Management

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II. Precautions

  1. Avoid stigmatizing language (e.g. use "person with Substance Abuse" instead of "Drug Abuser")
  2. Evaluate and manage Substance Use Disorder (and misuse) across ethnicities and socioeconomic groups
    1. Recognize unconscious bias in screening and management practices
  3. Address Substance Misuse
    1. Use that is excessive or in hazardous situations, but does not meet criteria for Substance Use Disorder
  4. Manage Substance Use Disorder with the same vigor and attention as for other treatable chronic diseases (e.g. Diabetes Mellitus, CHF)
    1. Many Substance Use Disorders (e.g. Alcohol, Opioid) employ first-line pharmacologic therapy (in addition to non-pharmacologic)

III. Evaluation

  1. See Substance Abuse Evaluation

IV. Management

  1. General
    1. See Chemical Dependency Brief Counseling
    2. See Substance Abuse Aftercare
    3. See Intravenous Drug Abuse
    4. Acute Substance Use Disorder Management
      1. See Substance Withdrawal
      2. Chemical Dependency treatment programs
    5. Behavior Therapy
      1. Cognitive Behavior Therapy (CBT)
        1. Modify unhelpful, maladaptive thinking and behavior
        2. McHugh (2010) Psychiatr Clin North Am 33(3): 511-25 [PubMed]
      2. Contingency Management
        1. Non-substance rewards are used to reinforce positive behavior
        2. Prendergast (2006) Addiction 101(11): 1546-60 [PubMed]
    6. Mental Health Comorbidity management
      1. Major Depression
      2. Anxiety Disorder
      3. Bipolar Disorder
      4. Posttraumatic Stress Disorder
      5. Personality Disorder
    7. Safety Evaluation
      1. Intimate Partner Violence
    8. Medical Comorbidities
      1. See Intravenous Drug Abuse
      2. Viral Hepatitis
      3. HIV Infection
      4. Chronic Pain
      5. Malignancy
      6. Cardiovascular Disease
  2. Cohorts
    1. See Teen Substance Abuse
    2. See Substance Abuse in Pregnancy
  3. Specific Substance Abuse Management
    1. See Alcoholism Management
    2. See Tobacco Cessation
    3. See Opioid Addiction Management
    4. See Methamphetamine Abuse
    5. See Benzodiazepine Abuse
    6. See Cannabis Abuse

V. Resources

  1. See Chemical Dependency Resources

VI. References

  1. Kowalchuk (2024) Am Fam Physician 109(5): 430-40 [PubMed]

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