Substance use disorder: Clinical sciences

Substance use disorder is a medical condition characterized by the inability to control the consumption of a substance despite adverse health and social consequences. The cause of substance use disorder is multifactorial and includes psychological, biological, social, and environmental factors. Based on criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, or DSM-5, you can categorize a substance use disorder as mild, moderate, or severe.

Okay, if a patient presents with a chief concern suggesting a substance use disorder, first perform an ABCDE assessment to determine if the patient is unstable or stable. If your patient is unstable, stabilize the airway, breathing, and circulation, which might require endotracheal intubation with mechanical ventilation. Next, obtain IV access and put your patient on continuous vital sign monitoring, including blood pressure, heart rate, pulse oximetry, and cardiac telemetry.

Here’s a clinical pearl to keep in mind! Patients with substance use disorder might present with a few potentially unstable conditions. For example, cocaine toxicity can cause cardiac ischemia and seizures, whereas heroin or other opioid toxicity can result in severe drowsiness, respiratory depression, and coma. Benzodiazepine toxicity can also cause CNS depression, whereas benzodiazepine or alcohol withdrawal can cause potentially fatal seizures!

Now that we’ve addressed unstable patients, let’s return to the ABCDE assessment and take a look at stable patients. If the patient is stable, first obtain a focused history and physical exam. Next, assess for substance use with a screening test, such as the Drug Abuse Screening Test, or DAST-10. DAST-10 contains ten “yes” and “no” questions about substance use over the past 12 months and includes illicit drugs, prescription medication and over-the-counter medication. However, keep in mind that this screening test excludes alcohol use.