Substance use, abuse, and addiction

There is no universally accepted definition of substance abuse. The World Health Organization (WHO) defines it as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. This substance use can lead to dependence, which they define as a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) defines it as:A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; suspensions or expulsions from school; neglect of children or household)
2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile when impaired by substance use)
3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

It is important for the Case Manager to assess for substance abuse or addiction since it may complicate the diagnosis and/or treatment of medical conditions. Most patients will not readily admit that they have an addiction problem, so the questions should be worded carefully. Often asking how much and what kind of alcohol is consumed will sound less judgemental than “do you drink alcohol?” When completing the medication profile take note of medications like methadone which is used to treat opioid addiction.

Withdrawal from alcohol can cause anxiety, tachycardia, tremors, grand mal seizures, insomnia, nausea and/or vomiting, and hallucinations. 

The Case Manager’s role is to support the treatment plan, provide encouragement to the patient and their family/caregivers and refer to AA or other organizations.