Evaluation and Management of Substance Use Disorders

As the physician conducts a history on the patient, he or she will explore prior hospitalizations whether for psychiatric or non-psychiatric issues.  He or she will examine how the use of illicit substances may have led to cognitive, behavioral, psychological, or physiologic impairment in the individual’s ability to function [1].

Social and family histories will also yield valuable information for the treatment team.  Moreover, interviews with family members may be beneficial; written permission from the client is often necessary to do those interviews [1].

In order to determine what substances, whether licit or illicit, the patient may have used, laboratory assays of blood, urine, and breath are quite useful [1].

There are several possibilities that the treatment team will consider for long-term therapy.  Some of these include twelve-step facilitation, psychodynamic psychotherapy, interpersonal therapy, and self-help manuals.  Others may be group, marital, or family therapy.  Behavioral self-control, brief interventions, and case management are useful as well.  Another evidence-based psychosocial treatment includes cognitive-behavioral therapies [1].

Motivational enhancement therapy and behavioral therapies such as community reinforcement and contingency management may also help to bring the patient to improvement in functioning [1].

A variety of treatment settings are possible for these clients.  These may include residential treatment facilities, clinics, hospitals, community-based agencies, and detoxification programs [1].  In conjunction with psychotherapy, there are several types of medications to manage the patient.  Some agents serve as an immediate tool to deal with acute alcohol or drug withdrawal as that condition can be life-threatening.

Some medications have the role of treatment for comorbid psychiatric conditions aside from substance use.  For example, the patient may also have depression, anxiety, bipolar disorder, or schizophrenia in addition to the substance use problem.  Additionally, there are medications to maintain the client on an outpatient basis—such as methadone maintenance [1].

Modern psychiatry has progressed a lot during the 20^th and 21^st centuries, and its major purpose for individuals with substance use disorders is to help them to change the way they live.

1. Work Group on Substance Use Disorders, Kleber, H.D., Weiss, R.D., Anton, R.F., et al.:  APA Practice Guideline for the Treatment of Patients with Substance Use Disorders, Second Edition.  American Psychiatric Association, 2007.
2. The photo shows drug paraphernalia and is reprinted with permission from Centers for Disease Control and Prevention/Debora Cartagena.

The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.