Diagnostic criteria for major common addictive substance disorders

[Emilia Khalil]

The use of previous diagnostic criteria for major common addictive substance disorders including substance abuse and substance dependence has been modified to substance use disorders with the DSM-5 as these states can be recognized as co-existent. In the homeless population, the high prevalence of alcohol and other substance use raises the importance and necessity of routine screening for these disorders, including the CAGE and CAGE-AID which are simple and convenient drug and substance abuse screening tools. It is important to identify substance use disorders in high risk populations to be able to intervene and offer various treatment and rehabilitation options to affected individuals, or even by supportive and empathic listening for those who refuse treatment or deny the disorder. It is important to provide a space with no judgment for these individuals, and offer continuous support and encouragement to seek treatment and expert help with no fear of negative consequences.

[ALi Saker]

All of us have taken care of a patient with substance use disorder at any point. its important not to judge, to understand that its an illness to be treated, not to be biased against the person, try to establish rapport and wean them down as possible. The new state laws and regulations that we have witnessed during the last 2 years were a great support for medical efforts to fight this epidemic.

I agree with Emilia about the points she mentioned.

[Khaled Janom]

We had a great discussion this Monday with Dr. Levine regarding substance use disorder. The discussion expanded to many interesting points fellow residents have raised. I raised the issue about the power that doctors have in terms of facing the problems with current social determinants of health. Large scale intervention should be made by federal and local governments. Doctors can provide care, comfort, a comfort safe zone, and optimal health care and also resources for the patients to use. It all starts with establishing empathy and trust with the patient.

[asil]

Addiction is difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. Biology including: Gender, ethnicity. Second: Environment includes many different influences, from family and friends to economic status and general quality of life. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction

[amir]

Substance abuse differs from addiction. Many people with substance abuse problems are able to quit or can change their unhealthy behavior. Addiction, on the other hand, is a disease. It means you can’t stop using even when your condition causes you harm.Drug abuse is when you use legal or illegal substances.
When patients seeks medical care for addiction, they re looking for trustworthy person to talk to, helping patients speak, with authentic listening and conversations is the key to start.

[Raja Rabadi]

Substance use disorder is an under Diagnosed medical issue. Many of our patients have an addictive personality that doctors are simply unaware of. After our discussion this week, it made many of us, including me, the importance of discussing the use of Narcotics and the significant impact that it can have on their lives. We, as physicians should be mind full of the consequences on prescribing narcotics and should look at the big picture. We should not only focus on pain, but we should also screen our patients for addictive behaviors. For those that have been on pain medications for a long time, we should initiate open communication with them in order to find a reasonable plan to wean off and eventually stop the narcotics. However, our patients in Detroit are not the ideal patients and they are never happy when mentioning titrating down the doses of pain medications or stopping them and it becomes really challenging and frustrating. The best solution is prior to initiating any opioids is to have a lengthy discussion with our patients about the side effects and to attempt other methods of pain relief such as acupuncture, PT and etc.

[Hibah Ismail]

Substance use disorder is a major healthcare problem that we face in our day to day encounters with our patients and results in devastating healthcare outcomes as well as additional costs to our healthcare system. many psychological and physical illness can arise, many of which are life threatening. We need to work as a team in order to diagnose our patient and be able to provide them with necessary resources from their nearby surrounding to provide best possible care to our patients.

[Nadine Abdallah]

Substance use disorder is an issue we commonly encouter in clinic and is often frustrating to deal with. After our discussion on Monday, I saw a patient who presented for chronic pain and was asking for narcotic pain medications by name. I noted a alert on her chart about history of substance abuse. She refused to provide a urine sample for UDS and her MAPs was inconsistent. She had clear signs of substance use despite her denial. The hardest part was to explain to the patient why we were unable to prescribe narcotics and their adverse effects. She was unsatisfied and not willing to listen.I felt helpless and was not satisfied either. I hope that we get access to more resources and traininf to better help this population.

[Brett Trzcinski]

Again, a pleasure discussing this important topic at this Monday’s noon discussion. The penetrance of substance abuse in our society is deep and cuts across all cultural and socioeconomic groups. However, it is most acutely felt in our patient population given lack of overall resources and the general life insecurity and uncertainty that our patients too frequently face. Polysubstance abuse is often a component of our patient’s past medical histories; after today’s discussions I’ll be changing my practice by dedicating more time to this aspect of my history taking and providing more referrals for locally available substance abuse rehabilitation services.

[Mohammad Rauf]

Substance abuse is very important issue. We need to address this, as it can destroy a person’s life not to mention health.

I agree with all the above residents, especially ali and emilia

[Arslan Mahmood]

Substance abuse is a major problem in our patient population. The discussion on Monday helped refresh the definitions of the substance abuse vs substance addiction. I have personally encountered cases in clinic where patients are coming in just to get the narcotics refilled. As a physician it’s hard to judge whether patient is truly needing the meds for his chronic pain or he is abusing them. I will pay more attention to history taking and establish rapport with the patient moving forward.

[Scott Smith]

A large amount of patients I see in both the inpatient and outpatient setting would meet criteria for Substance Use Disorder. Things I have found helpful include speaking to them about their use with open-ended questions to find out about their substance use, as well as talking about substance in a very objective way so as to reduce the feeling of stigma they have. I continually encourage my patients to seek counseling and treatment by letting them know I want to help them. Patients cannot be successful unless they are ready to take action on their addiction. Many patients know they have a problem, but don’t know how to get help.

[Nabeel Rizvi]

Substance abuse continues to rise yearly. It is important to understand the foundation of social determinants that lead to drug use, abuse, and dependence. Our discussion this week in clinic highlighted on the many reasons why we are faced with these struggles. During clinic at DCC this week, I treated an elderly female who came in with multiple episodes of loose diarrhea and vomiting. My initial diagnosis quickly turned to viral gastroenteritis, but upon further questioning she became quiet. She started to cry and admitted to recently starting heroin again to help cope with her chronic back and leg pain. After informing her these symptoms were likely from heroin withdrawal, we had an open discussion about substance abuse. She requested to seek help and I was able to schedule an appointment for her the next day at the suboxone clinic and with a therapist. We need to use the resources available to us to properly address the needs in our community. Having knowledge of these resources will help us provide quality care for our patients.

[Amjad Kanj]

-Assess for substance use disorder which includes Narcotics, alcohol and many other different substances and drugs
-Assess the patient’s understanding of the situation using the trans-theoretical model
-Counsel the patient and provide them with different resources based on where they are in the model (pre-contemplation, contemplation…)
-Understand that substance use disorder may be associated with other disorders (such as mental health diseases) that also need to be addressed
-Understand the importance of a healthy patient-physician relationship when it comes to substance use disorder

[Alaa Akhras]

Today’s social determinant has opened my eyes to patients and substance disorders. I did not know that substance disorder was under an umbrella of multiple diseases. I feel that it is important for us to understand the different types and to find clues that would help us differentiate them . It is also important to see the humanity in our patients and to understand that not all people were privileged. Some patients have lived a life of pain and suffering and it is easy for us to write them off. I will always try my best to understand the full story before i make judgments.

[wsumed]

Street Zen: The Life and Work of Issan Dorsey ~ David Schneider ~ 9781611808476

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