Diagnosis of Drug Dependence

Intoxication, withdrawal, and tolerance are the most prevalent substance-related disorders. Intoxication is the development of a substance-specific syndrome that disturbs perceptions and develops immediately after ingestion. Intoxication is also manifested by socially maladaptive behavior such as impaired judgment, cognitive impairment, loss of impulse control, and impaired social and occupational control. Withdrawal is a substance-specific condition resulting from the cessation or reduction of the substance causing intoxication (9).

Tolerance is the requirement of ever-increasing amounts of the drug to deliver the same pharmacological effect. Eventually, the abuser develops tolerance to the substance's effects and a cross-tolerance to effects of substances in the same class (3,8).

To make the diagnosis of substance dependence requires three symptoms from a list of seven, present during the same 12-month period: intoxication; withdrawal; tolerance; a personal desire or unsuccessful effort to cut down; drug-seeking behavior; social, occupational, or recreational consequences; and persistent substance use despite knowledge that it is making the user's health worse (see Tables 10.1 and 10.2) (7).

The history may not be useful in making the diagnosis as the patient may deny drug use or lie about its extent. In addition, the classic signs and symptoms of intoxication and withdrawal may be clouded by polydrug abuse and the concurrent presence of psychosis, depression, or anxiety (16).

Secondary signs of drug use may also be helpful in making a diagnosis. These may include track marks (the scars caused by injecting drugs), distinctive tattoos (especially on the arms to hide track marks), jewelry, and drugs on the person or at the workplace. Paraphernalia found on the worker's person or at the workplace may include roach clips (used to hold marijuana cigarettes), cigarette papers, bongs for smoking hashish, syringes for injecting drugs such as heroin and "crack," and spoons for "cooking" heroin before injection. However, care must be exercised not to become overzealous and make a diagnosis based on misinterpretation of secondary signs. Drug-related jewelry may be worn innocently, diabetics may carry syringes, and former drug users, bikers, and almost anybody may have tattoos.

0 0

Post a comment