Treatment History and Evaluation for Alcohol and Substance

To diagnose disorder for opioid medical and non-medical usage history for alcohol and drugs is required for a careful evaluation. Disorders for opioids or other (drugs and alcohol) could occur together thus detail and careful assessment if important. For such an assessment, the evaluator should focus on such questions

1- Amount and type of opioids

2- Last use

3- Problems faced due to drug

4- Administration route

5- History of treatment

These questions answer the basic treatment plan. The type of drugs or alcohol used their amount used their regularity to use determine the type of treatment that could be given to the patient. Different amounts contribute to different extents of withdrawal symptoms and the gravity of withdrawal. Medical information about opioid use can be obtained from medical sources one such source is Prescription Drug Monitoring Programs (PDMPs). They have data for prescribed drugs and complete history of the amount of drug, dosage pattern, etc. State monitoring programs are a great way to rein in opioid prescriptions. They are proved to be helpful in unethical prescriptions of opioid-based drugs. Their data is available for pharmacies and govt health officials, clinicians to use. This information can be used in a full assessment of patient history and for further treatment plans. But the access to data is varied due to different rules and regulations of different states.


Assessment for co-occurring alcohol and substance use:


It is often very easy to abuse opioids as well as other substances (alcohol or sedatives, hypnotics, etc.). Their disorder also co-occurs which could prove to be a medical emergency. The signs and symptoms of withdrawal i.e. seizures, hallucinations should be assessed by clinicians. So, it is important to assess the whole history and details of drugs (prescribed and non-prescribed) used by patients. The assessment of co-occurring alcohol and substance usage leads to proper understandings of the level of care and expertise a patient need. The more complicated drug history the more care a patient need. It is also not very easy to overcome the withdrawal of more than one drug. Patients with co-occur history take a long time and show slow progress to treatments. The treatment plans also vary depending upon the type of more than one substance and drug usage. Sometimes it results in complications in treatment plans. However, patients should not be ignored for the treatment of one drug disorder to solve other disorders. (Kyle M. Kampman et al., 2013) (Lions et al., 2014)


If a patient is recovering from one addiction, he should also receive treatment for substance disorder as stated by Guideline Committee.


For example, the use of nicotine in various forms (cigarettes, marijuana) should not become a hindrance to opioid treatment. Such hindrance could result in serious health problems or other accidents (death from overdose) for patients. It is proved by evidence that patients with ongoing treatment for both opioids and other substances are more likely to recover than those whose treatment was stopped due to the usage of nonprescribed (psychoactive) drugs. There is also an ongoing debate to stop all kinds of non-prescribed psychoactive drugs to make assessment and treatment more effective for all patients.


Assessment for tobacco use


Several studies show that Tobacco proves to complicate the procedure of treatments for patients. It is recommended to stop the usage of tobacco to make treatments more effective.

(Prochaska, Judith J. Delucchi, Kevin Hall, 2004) (Baca & Yahne, 2009) (Janice Y. Tsoh,1 Felicia W. Chi,2 Jennifer R. Mertens, 2010)


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