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Substance Abuse Evaluation
Aka: Substance Abuse Evaluation, Chemical Dependency Evaluation, Illicit Drug
- See Also
- Chemical Dependency
- Drug Abuse in Adolescents
- Drug Abuse in Athletes
- Substance Abuse in Pregnancy
- Alcoholism Screening
- Intravenous Drug Abuse
- Causes: Common Illicit Drugs
- Alcohol Abuse
- Sedative-Hypnotics (e.g. Benzodiazepines)
- Cannabinoids (e.g. Marijuana, K2, Spice)
- Opioids (e.g. Heroin)
- Stimulants (e.g. Cocaine, Amphetamines, Bath Salts)
- Volatile Inhalants (Sniffing, Huffing, Bagging)
- Hallucinogens (LSD, PCP, Ketamine)
- Methylenedioxymethamphetamine (MDMA, Ecstasy)
- Gamma Hydroxybutyrate (GHB)
- History: Medical
- Excessive habits
- Excessive coffee intake
- Excessive Tobacco use
- Excessive Alcohol use
- Exaggerates medical problems
- Simulates symptoms
- History of frequent injury and emergency care
- Trauma
- Burn Injury
- Fractures
- History of unusual infections
- Malaria
- Tetanus
- Hepatitis
- Generally debilitated
- Chronic disease refractory to medical management
- Poorly controlled Diabetes Mellitus
- Poorly controlled Hypertension
- History: Social
- Repeated Driving While Intoxicated (DWI or DUI)
- Family History of Chemical Dependency
- Problems on the job or at school
- Frequent job changes
- Tardiness or absence from work
- Accidents at work
- Family problems
- Divorce
- Child Abuse or neglect
- Changes in friends or relationships
- Spending more time with drug and Alcohol users
- History: Psychiatric
- Mood disturbance (Major Depression or Anxiety Disorder)
- Suicidal thoughts
- Lack of Impulse control
- Thought disorders
- Sexual Dysfunction
- Sleep disorders
- Associated Conditions
- Anxiety Disorders
- Major Depression
- Bipolar Disorder
- Post-Traumatic Stress Disorder
- Dependent Personality Disorder
- Antisocial Personality Disorder
- Intimate Partner Violence
- Symptoms
- Increased Tolerance
- Gulping drinks
- Preoccupation with drinking
- Sneaks substance
- Loss of control
- Alibis (excuses for substance use)
- Avoiding reference (Hiding substance use)
- Previously "on the wagon"
- Reproof or Confrontation about substance use
- Remorse about drinking and consequences
- Aggression
- Changing Substance use pattern
- Avoid consequence
- Escaping to other geographic area
- Resentments
- Blame for the Substance Abuse and consequences
- Maintains substance supply (Stashing away a supply)
- Prolonged Benders (Staying drunk for a while)
- Frequent Blackouts
- Attitude changes
- Apathy
- Blaming
- Anger
- Signs
- Clinic Calls
- Demand to be seen immediately
- Usually a late Friday afternoon appointment
- Calls or presents after regular clinic hours
- Clinic Interaction
- Presenting complaints
- Low Back Pain
- Root canal
- Migraine Headache
- Ovarian Cysts
- Uncontrolled cough ("Needs Codeine")
- Demands
- Must have a specific Narcotic drug right away
- Alternative non-Narcotics are not acceptable
- Other medications do not work
- Medication allergy
- Peptic Ulcer Disease
- Lost or stolen prescription
- Vague about medical history
- Traveling through town or visiting
- No primary medical provider
- Refuses lab tests or changes test (Blood in Urine)
- Signs: Physical findings suggesting Chemical Dependency
- General findings
- See Toxin Induced Vital Sign Changes
- Overt debilitation not related to medical problem
- Physical findings out of proportion to complaints
- Alcohol odor to breath
- Strong odor of mouthwash or after-shave may mask
- Eye findings
- See Eye Examination Signs of Chemical Dependency
- Nasal irritation (due to Cocaine inhalation)
- Cardiovascular changes
- Labile Hypertension
- Tachycardia
- Neurologic changes
- See Toxin Induced Neurologic Changes
- See Altered Level of Consciousness
- See Toxin Induced Altered Level of Consciousness Causes
- See Toxin-Induced Seizure Causes
- Unsteady gait
- Slurred speech
- Mild Tremor
- Inappropriate lapses in conversation
- Skin changes
- See Skin changes suggestive of chemical dependency
- Diagnosis
- Screening Tools
- Drug Abuse Screening Test (DAS-10)
- Single-Question Drug Abuse Screening Test (DAS-1)
- See Alcoholism Screening
- Screen for comorbid conditions
- Intimate Partner Violence (>50% Prevalence)
- Mood Disorder Screening
- Depression Screening
- Anxiety Screening
- Bipolar Disorder
- Post-Traumatic Stress Disorder
- Labs: Screening
- Urine Toxicology Screening
- Findings Suggestive of excessive Alcohol intake
- Blood Alcohol (if acute Intoxication suspected)
- Serum gamma-glutamyl transpeptidase (GGT) increased
- Mean Corpuscular Volume (MCV) increased
- Carbohydrate-deficient Transferrin (CDT) increased
- Labs: As indicated for comorbid conditions
- Urinalysis
- Complete Blood Count
- Syphilis Serology (VDRL, RPR)
- Human Immunodeficiency Virus (HIV Testing)
- Viral Hepatitis Screening
- Serum Chemistry
- Electrolytes with Calcium and Magnesium
- Glucose
- Renal Function Tests
- Blood Urea Nitrogen
- Creatinine
- Thyroid Stimulating Hormone (TSH)
- Stool Guaiac for occult blood
- Management
- See Chemical Dependency Brief Counseling
- See Substance Abuse Aftercare
- See Chemical Dependency Resources
- References
- Shapiro (2013) Am Fam Physician 88(2):113-21 [PubMed]
- Haverkos (1995) Am Fam Physician 52(7):2029 [PubMed]
- Mersy (2003) Am Fam Physician 67(7):1529-32 [PubMed]
- Westreich (1995) Postgrad Med 97(4):111-23 [PubMed]