Makindo Medical Notes.com

Substance Use Disorder (SUD) is a medical condition in which the use of one or more substances leads to significant impairment or distress. This can involve drugs such as alcohol, opioids, cannabis, stimulants, sedatives, or other substances. It is characterized by a pattern of compulsive use, cravings, tolerance, withdrawal symptoms, and an inability to stop using despite negative consequences.

Key Features of Substance Use Disorder (SUD)

• Cravings: A strong urge or desire to use the substance.
• Tolerance: Needing more of the substance to achieve the same effect.
• Withdrawal: Physical and mental symptoms when the substance is not taken.
• Loss of Control: Using the substance in larger amounts or for longer than intended.
• Social Problems: Substance use leads to failure to fulfill major responsibilities at work, school, or home.
• Continued Use Despite Harm: Continuing to use the substance even when it causes physical or psychological harm.

Table: Common Substances Misused and Their Management

Substance	Signs and Symptoms	Diagnosis	Treatment
Alcohol	Slurred speech, impaired coordination, liver disease, withdrawal symptoms (e.g., tremors, seizures)	AUDIT questionnaire, liver function tests, clinical history	Detoxification, counseling, medications (e.g., naltrexone, disulfiram), support groups (e.g., AA)
Opioids	Drowsiness, respiratory depression, pinpoint pupils, withdrawal (e.g., sweating, agitation)	Urine drug screen, clinical assessment	Detoxification, methadone/buprenorphine, naloxone for overdose, behavioral therapies
Cocaine	Euphoria, paranoia, chest pain, nosebleeds (if snorted)	Urine drug screen, ECG for cardiac complications	Behavioral therapies, counseling, management of cardiovascular issues
Cannabis	Impaired memory, anxiety, increased appetite, dry mouth	Urine drug screen, clinical history	Counseling, behavioral therapy, support groups
Benzodiazepines	Confusion, drowsiness, ataxia, respiratory depression	Urine drug screen, clinical history	Gradual tapering, counseling, management of withdrawal symptoms

Diagnosis of Substance Use Disorder using DSM-5 Criteria:

To diagnose SUD, a person must have two or more of the following symptoms within a 12-month period:

• Using more of the substance or for longer than intended.
• Unsuccessful efforts to cut down or control use.
• Spending a lot of time obtaining, using, or recovering from the substance.
• Craving or a strong desire to use the substance.
• Failure to fulfill responsibilities due to use.
• Continued use despite problems.
• Giving up important activities because of use.
• Using in hazardous situations.
• Continued use despite physical or psychological problems caused by the substance.
• Tolerance.
• Withdrawal.

Management of Substance Use Disorder

Management of SUD requires a multidisciplinary approach, often involving medication, counseling, behavioral therapies, and support services. The goals of treatment include stopping the use of substances, managing withdrawal, preventing relapse, and improving overall health.

Key Treatment Modalities:

• Detoxification: A supervised withdrawal process to safely remove substances from the body.
• Medications: To manage withdrawal symptoms, reduce cravings, or block the effects of the substance (e.g., methadone for opioid addiction, disulfiram for alcohol addiction).
• Cognitive Behavioral Therapy (CBT): Helps individuals identify and change harmful thought patterns and behaviors.
• Motivational Interviewing: Encourages individuals to find internal motivation to change their behavior.
• Support Groups: Peer support programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

Prevention and Harm Reduction:

• Education on the risks of substance use.
• Screening for substance use in at-risk populations.
• Access to treatment services for early intervention.
• Needle exchange programs and supervised consumption rooms to reduce harm in drug users.