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Diagnosis and Treatment of Drug Abuse in Family Practice

Final Comment
 

Drug and alcohol disorders can occur in any patient seen in family practice, and they are present in many more patients than are diagnosed. Physician awareness of the potential for such problems is the first step in detecting, evaluating and treating patients who are substance abusers. In some cases, treatment is possible in the office setting. In others, the physician oversees inpatient treatment or makes referrals and provides long-term collaborative follow-up, all of which are essential if the patient is to avoid a relapse. Treatment should be considered part of an ongoing process designed first to help the patient discontinue the self-destructive behavior and then to maintain abstinence from illegal or problematic drug use.

Another role for physicians is that of medical review officer (MRO) for a drug testing program. Screening employees for drugs is required in some regulated industries such as interstate trucking, air transportation, nuclear energy plants and maritime and railroad industries. Drug testing programs regulated by the Department of Transportation and other federal programs are required to employ MROs, who must be licensed physicians with a knowledge of substance abuse disorders and of possible alternative medical explanations for positive urine drug test results. It is likewise recommended that non-federally regulated drug testing programs employ an MRO.

The MRO generally functions as a safeguard against wrongful accusations; therefore, the MRO must thoroughly investigate each positive screen [46]. If a prospective or current employee has an acceptable medical explanation for a positive result, the MRO would report to the employer that the result was negative. Other issues involved in the duties of the MRO include documenting the chain of evidence of clinical samples, reporting verified positive test results and recommending a rehabilitation program for the employee. The duties of an MRO are outlined in booklets published by SAMHSA and the U.S. Department of Transportation.

Before becoming an MRO, a family physician should carefully weigh practical and personal issues [47]. Charting and office policies may need to be modified to meet legal requirements. Because the MRO serves as an adviser to the employer, the physician-patient relationship differs from that in conventional patient care. Moreover, the MRO may be sued by a patient who loses a job or experiences employment problems because of a positive test result. Therefore, becoming certified by one of the organizations that offers courses in this area is highly recommended. Nevertheless, family physicians may find interesting opportunities in the field of occupational drug testing.

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References
  1. Institute for Health Policy, Brandeis University. Substance abuse: the nation's number one health problem; key indicators for policy. Princeton, N.J.: Robert Wood Johnson Foundation, October 1993.
  2. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270:2207-12.
  3. Jaffee J. Opiates: clinical aspects. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance Abuse: A Comprehensive Textbook. 2nd ed. Baltimore: Williams & Wilkins, 1992.
  4. Gold MS. Cocaine (and crack): clinical aspects. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance Abuse: A Comprehensive Textbook. 2nd ed. Baltimore: Williams & Wilkins, 1992.
  5. King GR, Ellinwood EH. Amphetamines and other stimulants. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance Abuse: A Comprehensive Textbook. 2nd ed. Baltimore: Williams & Wilkins, 1992.
  6. National household survey on drug abuse: population estimates 1992. Rockville, Md: Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services; 1993.
  7. Wesson DR, Smith DE, Seymour RB. Sedative-hypnotics and tricyclics. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance Abuse: A Comprehensive Textbook. 2nd ed. Baltimore: Williams & Wilkins, 1992.
  8. Grinspoon L, Bakalar JB. Marijuana. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance Abuse: A Comprehensive Textbook. 2nd ed. Baltimore: Williams & Wilkins, 1992.
  9. Zukin SR, Zukin RS. Phencyclidine. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance Abuse: A Comprehensive Textbook. 2nd ed. Baltimore: Williams & Wilkins, 1992.
  10. Monitoring the Future Study. National Institute on Drug Abuse, Rockville, Md. HHS News, January 31, 1994.
  11. Daghesiani AN, Schnoll SH. Phencyclidine. In: Galanter M, Kleber HD, eds. The American Psychiatric Press Textbook of Substance Abuse Treatment. Washington, DC: American Psychiatric Press, 1994.
  12. Difranza JR, Richards JW, Paulman PM, et al. RJR Nabisco's cartoon camel promotes Camel cigarettes to children. JAMA 1991;266:3149-53.
  13. Hall SM, Munoz RF, Reus VI, Sees KL. Nicotine, negative affect, and depression. J Consult Clin Psychol 1993;61:761-67.
  14. Sharp CW. Introduction to inhalant abuse. In: Sharp CW, Beauvais F, Spence R, eds. Inhalant Abuse: A Volatile Research Agenda. Rockville, Md. NIDA Research Monograph 129, 1992;1-10.
  15. Nelson JE, Pearson HW, Sayers M, Glynn TJ. Research issues 26: guide to drug abuse research terminology. Rockville, Md: National Institute on Drug Abuse, Public Health Service, US Department of Health and Human Services;1982, Publication # ADM 82-1237.
  16. Jacox A, Carr DB, Payne R, et al. Management of cancer pain. Clinical practice guideline No. 9. AHCPR Publication No. 94-0592. Rockville, Md: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, March 1994.
  17. Goldstein A. Addiction: from biology to drug policy. New York: WH Freeman, 1994.
  18. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8-19.
  19. O'Malley PM, Johnston LD, Bachman JG. Adolescent substance use and addictions: epidemiology, current trends, and public policy. In: Adolescent Medicine: State of the Art Reviews. Philadelphia: Hanley & Belfus, 1993;4:227-49.
  20. HHS News. Rockville, Md: US Department of Health and Human Services; January 31, 1994.
  21. Morrison MA. Addiction in adolescents. West J Med 1990;152:543-46.
  22. MacDonald DI. Patterns of alcohol and drug use among adolescents. Pediatr Clin North Am 1987;34:275-88.
  23. Elster AB, Kuznets NJ. AMA Guidelines for Adolescent Preventive Services (AMA-GAPS). Baltimore: Williams & Wilkins, 1994.
  24. Ewing H. Care of women and children in the perinatal period. In: Fleming MF, Barry KL, eds. Addictive Disorders. St Louis: Mosby Year Book, 1992.
  25. Behnke M, Eyler FD. The consequences of prenatal substance abuse for the developing fetus, newborn, and young child. Int J Addict 1993;28:1341-91.
  26. Jessup M. The treatment of perinatal addiction: identification, intervention, advocacy. West J Med 1990;152(special issue):553-58.
  27. Hoegerman G, Wilson CA, Thurmond E, et al. Drug-exposed neonates. West J Med 1990;152(special issue):559-64.
  28. Gambert SR. Substance abuse in the elderly. In: Lowinson JH, Ruiz P, Millman RB, eds. Substance Abuse: A Comprehensive Textbook. 2nd ed. Baltimore: Williams & Wilkins, 1992.
  29. King CJ, Hasselt VBV, Segal DL, Hersen M. Diagnosis and assessment of substance abuse in older adults. Addict Behav 1994;19(1):41-55.
  30. Closser MH, Blow FC. Special populations: women, ethnic minorities, and the elderly. Psychiatr Clin North Am 1993;16:199-209.
  31. Goldstein A. Heroin addiction: neurobiology, pharmacology, and policy. J Psychoactive Drugs 1991;23:123-34.
  32. Trujillo KA, Herman JP, Schaumlfer MK-H, et al. Drug reward and brain circuitry: recent advances and future directions. In: Korenman SG, Barchas JD, eds. Biological Basis of Substance Abuse. New York: Oxford University Press, 1993.
  33. Pratt JA. Psychotropic drug tolerance and dependence: common underlying mechanisms? In: Pratt E, ed. The Biological Bases of Drug Tolerance and Dependence. London: Academic Press, Harcourt Brace Jovanovich, 1991.
  34. Brown RL. Identification and office management of alcohol and drug disorders. In: Fleming MF, Barry KL, eds. Addictive Disorders. St Louis: Mosby Year Book, 1992.
  35. Galanter M. Network therapy for addiction: a model for office practice. Am J Psychiatry 1993;150(1):28-36.
  36. Warner ML, Mooney AJ III. The hospital treatment of alcoholism and drug addiction. Prim Care 1993;20:95-105.
  37. Institute of Medicine. Extent and adequacy of insurance coverage for substance abuse services. Vol I. A study of the evolution, effectiveness, and financing of public and private drug treatment systems. US Department of Health and Human Services, Drug Abuse Services Research Series No. 2. 1992.
  38. Fleming MF. Pharmacologic management of nicotine, alcohol, and other drug dependence. In: Fleming MF, Barry KL, eds. Addictive Disorders. St Louis: Mosby Year Book, 1992.
  39. Alexander B, Perry PJ. Detoxification from benzodiazepines: schedules and strategies. J Subst Abuse Treat 1991;8:9-17.
  40. Schultz J, Barry KL. Alcohol and drug treatment and role of 12-step programs. In: Fleming MF, Barry KL, eds. Addictive Disorders. St Louis: Mosby Year Book, 1992.
  41. Zweben JE, Payte JT. Methadone maintenance in the treatment of opioid dependence - a current perspective. West J Med 1990;152:588-99.
  42. O'Brien WB, Biase DV. Therapeutic Community (TC): a coming of age. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance Abuse: A Comprehensive Textbook. 2nd ed. Baltimore: Williams & Wilkins, 1992.
  43. Drug use among youth: no simple answers to guide prevention. Washington, DC: US General Accounting Office, December 1993, GAO/HRD-94-24.
  44. The Adolescent Assessment/Referral System Manual. DHHS Publication No. (ADM)91-1735. Rockville, Md: National Institute on Drug Abuse, US Department of Health and Human Services, 1991.
  45. Fleming MF, Barry KL. Clinical overview of alcohol and drug disorders. In: Fleming MF, Barry KL, eds. Addictive Disorders. St Louis: Mosby Year Book, 1992.
  46. Clark HW. The role of physicians as medical review officers in workplace drug testing programs. West J Med 1990;152:514-524.
  47. Floren AE. Urine drug screening and the family physician. Am Fam Phys 1994;49:1441-1447.

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