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Substance Use Disorders

S. Lindsey Clarke, MD, FAAFP Reviewed 06/2018
 


BASICS

DESCRIPTION

Any pattern of substance use causing significant physical, mental, or social dysfunction 
  • Substances of abuse include:

    • Alcohol

    • Tobacco

    • Prescription medications

      • CNS depressants (barbit...

DIAGNOSIS

Substance use disorder (DSM-5 criteria): ≥2 of the following in past year, with severity based on number of criteria present: 
  • Missed work or school

  • Use in hazardous situations

  • Continued use de...

TREATMENT

Determine substances abused early (may influence disposition). 

GENERAL MEASURES

  • Nonjudgmental, medically oriented attitude

  • Motivational interviewing and brief interventions can overcome denial...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Initially frequent visits to monitor for medical stability and adherence and then progressive follow-up intervals 

Patient Monitoring

Verify patient’s adherence wit...

REFERENCES

1
Smith PC, Schmidt SM, Allensworth-Davies D, et al. A single-question screening test for drug use in primary care. Arch Intern Med.  2010;170(13):1155–1160. [View Abstract on OvidMedl...

ADDITIONAL READING

  • Albertson TE, Chenoweth J, Colby DK, et al. The changing drug culture: emerging drugs of abuse and legal highs. FP Essent.  2016;441:18–24. [View Abstract on OvidMedline]

  • Alber...

SEE ALSO

Alcohol Use Disorder (AUD); Alcohol Withdrawal; Tobacco Use and Smoking Cessation 

CODES

ICD10

  • F19.10 Other psychoactive substance abuse, uncomplicated

  • F10.10 Alcohol abuse, uncomplicated

  • F12.10 Cannabis abuse, uncomplicated

  • Z72.0 Tobacco use

  • F13.10 Sedative, hypnotic or anxiolytic abuse...

CLINICAL PEARLS

  • Substance use disorders are prevalent, serious, and often unrecognized in clinical practice. Comorbid psychiatric disorders are common.

  • Substance abuse is distinguished by family, socia...

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