Counseling Points - September 2007 - (Page 5)

increase in the need for professional intervention in recent years. Depression is often present in patients with a substance use disorder, particularly among women, who are also highly likely to have experienced some type of trauma earlier in life. SAMHSA’s Treatment Improvement Protocol (TIP) 42 from 2005 estimates that between 55% and 99% of women receiving treatment for substance abuse have a history of trauma and 33%59% of these women currently meet the diagnostic criteria for post-traumatic stress disorder. complications of addictive behavior (e.g., liver disorders, hypertension, tachycardia, lymphadenopathy, and coughing with wheezing, rales, and rhonchi); • neurologic impairments (e.g., cognitive deficits or sensory, motor, or memory impairment); and • reproductive disorders in females. Equally important clues to opioid use disorders are evident in drug-seeking behaviors, including: • vague physical complaints and requests for medication to improve sleep, energy, anxiety, concentration, indigestion, etc.; • requests for samples of medications or to refill prescriptions earlier than the recommended schedule; and • increased frequency of visits or calls to the office requesting treatment for the patient or a family member with prescription requests for addictive medications. Screening During Physical Examination Current recommendations are to routinely and periodically screen all patients for problematic use of substances, defined as any illicit drug use, any risky/hazardous or harmful alcohol use, and any misuse of prescribed medication. There are recognizable findings detectable upon physical examination that can raise the suspicion of addiction even if the individual denies substance use.These include: • changes from previous physical exams; • poor nutr itional status (suggested by weight changes); • poor personal hygiene (evidenced by breath or body odor, or unwashed hair or clothing); • intoxicated or abnormal behavior, especially slurred speech and staggering gait; • signs of physical abuse such as bruises, lacerations, scratches, burns, needle marks, sores, or abscesses; • skin rashes or discoloration, hair loss, or excessive sweating; • inflammation or irritation of the head, eyes, ears, nose, and throat (e.g., blanching of any of the mucosa, gum disease, sinus tenderness or sinusitis, rhinitis, or a perforated nasal septum); • disorders of the gastrointestinal tract, immune, cardiovascular, and pulmonary systems, which are often Tools for Identifying At-risk Individuals Identifying at-risk use and substance abuse behavior should be one of the goals of medication management for any illness or injury. Nurses are key to this effort, as they have more points of contact with the patient than physicians. Depending on the skill and comfort level, the nurse can ask verbal questions or have the patient complete a self-report form.The nurse should focus on the screening as a part of an overall health improvement plan, and be able to discuss the benefits of stopping, decreasing, or remaining free of substance use. The nurse will further need to determine when it is appropriate for the patient be referred for specialty treatment. Although the primary focus of screening is on identifying the misuse of prescription medications and the use of illicit opioids, it is important to uncover the full picture of an individual’s use patterns. Several types of SEPTEMBER 2007 5

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Welcome Office-Based Medication-Assisted Treatment of Opioid Dependence Summary Continuing Education Posttest Postest Answer and Program Evaluation Form

Counseling Points - September 2007

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