| Suggested Pre-Referral Evaluation and Management Guidelines |
Alcohol and other drug use is prevalent among patients in many clinical settings, contributing to increased risk for injury and illness, reduced adherence to medical and psychiatric treatments, and untoward patient outcomes. Periodic screening and assessment for substance use is consistent with the delivery of good medical care. Many patients can eliminate or reduce their substance use in response to supportive prompts from a health care provider. It has been recommended that all health care professionals know how to provide Brief Interventions to their patients. A number of helpful pamphlets and brochures are available from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) http://www.niaaa.nih.gov/ and the National Institute on Drug Abuse (NIDA) http://www.nida.nih.gov/
If you suspect that substance use may be a problem, then avoid prescribing potentially addictive substances, such as benzodiazepines (e.g., Ativan, Valium, or Xanax) or opioids (e.g., codeine, Vicodin, or OxyContin).
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| Suggested Additional Test/Management Prior to Specialty Visit |
Some patients may require additional assistance. Consider recommending a trial abstinence period, or mutual-help group attendance, such as SMART Recovery, Women for Sobriety, Alcoholics Anonymous (AA), or Narcotics Anonymous (NA). Lab tests may include blood work for liver function tests, including ALT, AST, and GGTP for alcohol, and urine drug screens for other substances.
Medications, such as disulfiram (Antabuse), naltrexone (ReVia, Vivitrol), or buprenorphine (Suboxone) may be helpful, but are most effective when administered in conjunction with a therapy component, or specialized addictions treatment.
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