Attending to Co-Occurring Conditions ..............................................................................
Individuals who engage in risky use or who have
addiction frequently suffer from other co-
occurring health conditions.* 31 Therefore, any
attempt to identify risky use of addictive
substances, evaluate an individual’s risk for
developing addiction or assess a substance
user’s need for intervention or treatment must
involve identification of co-occurring conditions
and plans to address them. Being informed of a
patient’s health conditions that might be caused
or exacerbated by substance use or that might
cause or exacerbate the patient’s addiction will
help medical professionals determine
appropriate interventions and provide effective
care.^32 Similarly, medical professionals treating
patients with medical conditions that frequently
co-occur with risky use and addiction--such as
hypertension, gastritis and injuries--should be
prompted to screen for risky use of addictive
substances that may cause or aggravate these
conditions.
Patient Education and Motivation
Educating patients and motivating them to
reduce their risky use of addictive substances is
a critical component of preventive care.^33 As
part of routine medical practice, medical and
other health professionals should educate their
patients (and parents of young patients) about:
The adverse consequences of risky use and
the nature of addiction--that it is a disease
that can be prevented and treated
effectively; The risk factors for substance use, tailoring
the information to the patient’s age, gender,
mental health history and other relevant
medical, social and demographic
characteristics; Times of increased risk for substance use,
such as adolescence, key life transitions
and stressful life experiences; and- See Chapter II.
Steps patients can take to prevent risky use
of addictive substances and the onset of
addiction, e.g., by delaying initiation of
substance use, following guidelines for the
safe use of alcohol and of controlled
prescription medications, being vigilant for
signs and symptoms of risk and seeking
professional help at the first sign of trouble.Screening†
Screening, a staple of public health practice that
dates back to the 1930s,^34 serves to identify early
signs of risk for or evidence of a disease or other
health condition and distinguish between
individuals who require minimal intervention
and those who may need more extended
treatment.^35 It is an effective method of
preventive care in many medical specialties, and
risky use of addictive substances is no
exception. Screening for risky use of addictive
substances is comparable to offering regularly
scheduled pap smears or colonoscopies to
identify cancer indicators.^36† Despite the distinction between screening and
assessment tools, the term screening often is used to
subsume the concept of assessment or
interchangeably with the term in the clinical and
research literatures. Nevertheless, Chapter V
addresses assessments specifically. In addition,
while there is some overlap between screening or
assessment procedures used to identify risky use of
addictive substances and methods used to diagnose a
clinical addiction, a formal diagnosis of addiction is
based on the demonstration of specific symptoms
included in the most recent versions of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) or
the International Statistical Classification of Diseases
(ICD). (See Chapter II.)