Substance Use Disorders

S. Lindsey Clarke, MD FAAFP and Benjamin J Velky, MD Reviewed 05/2023

BASICS

DESCRIPTION

Any pattern of substance use causing significant physical, mental, or social dysfunction

Substances of abuse include:
- Alcohol
- Cannabis (marijuana, hashish, cannabis oil, extracts); als...

DIAGNOSIS

Substance use disorder (DSM-5-TR criteria): ≥2 of the following in past year; severity graded by number of criteria present:

Using more than intended
Failed attempts to quit
Increased time spe...

TREATMENT

Determine substances abused early (may influence disposition).

GENERAL MEASURES

Treatment should combine pharmacotherapy and cognitive behavioral therapy or another evidence-based modality wh...

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

US Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for unhealthy drug use: US Preventive Services Task Force recommendation statement. JAMA. 2020;323:2301-2309.

Han...

ADDITIONAL READING

Centers for Disease Control and Prevention. E-cigarette, or vaping, products visual dictionary. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/ecigarette...

CODES

ICD10

F18.951 Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations
F11.120 Opioid abuse with intoxication, uncomplicated
F17.201 Nicotine dependence, unspecified, ...

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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