Substance Use Assessment in Healthcare

Substance use assessment is crucial in patient care settings.
Many patients have significant drinking histories impacting health.
Alcohol consumption has dose-related effects; higher risk with more consumption.
Morbidity and mortality increase with excessive alcohol use.
Many medications interact with alcohol.
Alcohol dependence increases the risk of ED visits, ICU admissions, and sepsis.
Binge drinking is associated with rising health risks.
Illicit drug use is categorized into seven main types, including marijuana, cocaine, heroin, hallucinogens, inhalants, and prescription drugs used nonmedically.
Illicit drug use has severe consequences for health, relationships, and future opportunities.
The prevalence of illicit drug use is highest among 12-year-olds and older.
Prescription drug abuse and opioid-related deaths are increasing; this is partially caused by increased prescriptions for pain medication, marketing promoting addictive medications, and misrepresentation of medication addictiveness.
Combination addictions, like drinking and taking alcohol-interactive medications, are also contributing factors.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) provides a gold standard for diagnosis.
Alcohol problems are often underdiagnosed in primary care settings and hospitals.
Excessive alcohol use often goes unrecognized until patients have serious complications.

Alcohol affects brain development and maturity in adolescents.
Alcohol use is associated with increased risks of other high-risk behaviors, such as sexual risk-taking, academic problems, injuries from trauma, and continuing alcohol-related issues later in life.

Alcohol use during pregnancy is harmful to both the mother and the fetus.
Potential adverse consequences of alcohol use on the fetus are well known.
Fetal alcohol spectrum disorders result from alcohol use during pregnancy, characterized by physical deformities and learning/behavioral problems.
No amount of alcohol is safe for pregnant women.
All pregnant or contemplating pregnancy women should be screened for alcohol use and recommended to abstain.

Alcohol use increases in older adults.
Factors increasing risk for older adults include decreased metabolic functions (liver, water & renal), leading to increased alcohol bioavailability in the body and muscle mass decline increasing alcohol concentration.
Polypharmacy (taking multiple medications) can interact with alcohol.
Alcohol increases the risk for falls, depression, and gastrointestinal problems among older adults.

Subjective data is gathered by asking questions related to substance use.
Substance use and withdrawal can complicate the collection of reliable data; ideally, data collection should occur in a non-confrontational, private, and confidential setting.
Questions should focus on the frequency of consumption, amounts consumed, and patterns of heavy use: e.g., "How many times in the past year have you consumed five or more drinks a day?" (men) and four (women).
Using standardized screening tools can help identify problem drinking.

AUDIT (Alcohol Use Disorders Identification Test) is a quantitative tool for identifying problematic alcohol use.
It provides a framework for three key areas: alcohol consumption, drinking behaviour or dependence, and adverse consequences.
The AUDIT-C is a shorter version suitable for acute and critical care units, maximizing score 12.
Its help in detecting less severe alcohol problems, including hazardous and harmful drinking.
Useful in primary care with adolescents and adults. It is reasonably unbiased with regard to sex and cultural backgrounds.
Valuable for ED and trauma patients due to its focus on recent use compared to past issues.

Assessing alcohol use for maladaptive patterns that cause clinical issues is important.
Ask patients about factors like tolerance, withdrawal symptoms, continued use despite problems, and amount of alcohol used.

Helpful for screening for alcohol problems, especially pregnant women.
Key questions (tolerance, worry from others, eye-opener, amnesia, and cutting down) help assess risk levels.

Useful for assessing alcohol use in older adults.
It detects problems in older adults by focusing on social or everyday drinking.
It uses 10 yes/no questions addressing factors relevant for older adults to help identify issues quickly.
Two or more "yes" responses indicate possible alcohol problems.

Substance use problems have very negative consequences on patients and families.
Statements of support and intervention are essential, especially when the assessment identifies at-risk drinking or illicit substance use.

Clinical laboratory data is less sensitive and specific than self-reported questionnaires but can corroborate subjective information.
Blood tests like serum protein, GGT (Gamma-glutamyl transferase), CDT (Carbohydrate-deficient transferring), Serum AST (aspartate aminotransferase), and MCV (mean corpuscular volume) can be used.
Alcohol can cause or worsen various medical problems.

CIWA is a clinical scale used to objectively measure withdrawal symptoms.
It focuses on 10 different criteria with individual scoring to determine a composite score.
It analyzes vital signs and oxygen saturation levels related to these criteria for an overall composite score.
Tracking scores over time provides trends useful for determining monitoring needs.
Scores below 8 for 72 hours allow discontinuation of monitoring.

Substances (non-medical agents) are taken to modify mood or behaviour.
Intoxication is characterized by maladaptive behavioural changes due to CNS effects.
Substance abuse involves repeated use causing impairment and ongoing difficulties.
Dependence results from physiological reliance on substances.
Tolerance involves needing a higher dose to achieve a desired effect.
Withdrawal occurs when substance use stops, leading to physiological effects.

Patient claims ability to quit opiate use whenever desired.
The nurse should interpret this as a possible sign of denial of requiring help or having a problem with opiates.

Patient frequently re-admitted to ED with repeated overdoses; nurse expresses frustration.
The nurse should recognize their own feelings and frustrations to avoid prejudiced treatment.