Substance Use Disorders

S. Lindsey Clarke, MD, FAAFP Reviewed 06/2019

BASICS

DESCRIPTION

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

Substances of abuse include:
- Alcohol
- Tobacco
- Prescription medications
  - CNS depressants (barbiturat...

DIAGNOSIS

Substance use disorder (DSM-5 criteria): ≥2 of the following in past year severity based on number of criteria present:

Missed work or school
Use in hazardous situations
Continued use despite ...

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

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 OvidMedli...

ADDITIONAL READING

Albertson TE, Chenoweth JA, 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]
Commi...

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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