I have worked as a Family Physician, an Emergency Department physician, as a Psychiatrist, and in Addiction Medicine over the years. Inpatient or outpatient, I have often encountered patients whose problems are caused or worsened by their substance use.

Some medical problems associated with heavy drinking include hypertension, gastritis, pancreatitis, insomnia, headaches, myopathy, traumatic injuries, arrhythmias, GI cancers, liver damage, injuries from cold temperatures and others. Associated mental health problems include depression, memory loss, sudden mood or behavior changes, family discord, suicide or homicide and others.

How common is the problem? According to a National Household Survey:

 29% of Maine youth age 12-20 drink and 20% binge drink

 7.59% of people 12 and older meet the criteria for alcohol dependence or abuse and 3.17% meet the criteria for drug dependence or abuse

 14% of people 18-25 have used a prescription pain reliever non-medically

Maine is one of only seven states where past month use of any illicit drug

Compared to Maine:

 only four states have a higher drug dependence rate for people 18-25

 only three states have a higher drug dependence rate for people 12-17

 only two states have greater rates of past month marijuana use among 12-17 year olds

All ages, genders, and presenting concerns may be linked to this issue with the care of the patient compromised if this is not addressed. Laboratory testing can be helpful in the diagnostic process yet taking a good history is the most effective means to open up the topic and connect substance use with the well-being of the patient and their family. Incorporating this into an intake interview or annual checkup as part of your health risk survey is a good way to present it as a normal part of your provision of care. Asking about caffeine consumption then nicotine use then alcohol use then other drug use allows the patient to ease into the questions.

Two sites that particularly focus on the screening and interview process are:

Helping Patients Who Drink Too Much: A Clinician's Guide with Free CME/CE Credits (NIAAA)

www.niaaa.nih.gov/Publications/EducationTrainingMaterials/CME_CE.htm

B.U. Alcohol Screening and Brief Intervention Curriculum www.bu.edu/act/mdalcoholtraining

SAMHSA’s website provides information about screening, brief intervention, and referral (SBIRT) as part of the history process. www.sbirt.samhsa.gov

Patients often try to change their substance use habits because a health care provider educates them about the associated risks and expresses concern for their health. If the patient does not make such a change, the question of loss of control or other significant problems related to use should be considered. If the patient is unable to reduce or quit their use then you can refer them to professional treatment. Treatment programs often prefer the patient call them to discuss an evaluation though you or one of your staff could call with the patient to provide support and then plan for on-going care.

Your intervention in these individuals’ substance use may improve not only their health but the emotional health of those around them, reduce health care costs, and improve the safety of your community. Not a bad return for your effort.

Sincerely,

George Dreher, MD