Table 3. Assessment of Substance Use Disorders Body system
Assessment Findings
Testing
General Health
a. Poor hygiene—odors on clothes/skin b. Significant weight changes c. Changes in mental status ● Increased arousal ● Agitation ● Psychosis ● Sedation ● Slurred speech ● Pinpoint/Dilated pupils d. Gait changes e. Unusual behaviors a. Signs of head trauma b. Scrapes, scabs, or bruising c. Conjunctival infection d. Pupil constriction/dilation e. Abnormal eye movements, along with imbalance and memory problems (Wernicke’s encephalopathy) f. Glue sniffers rash around nose and mouth—long-term intranasal drug use such as cocaine use g. Teeth grinding/Jaw clenching—signs of MDMA or amphetamine use h. Tobacco-stained teeth a. Crackles in the lung bases b. Respiratory depression c. Sleep apnea d. Lung injury due to vaping e. Heart murmur—new onset murmur and increased temperature should raise suspicion for endocarditis f. Atrial fibrillation a. Liver enlargement (alcohol-induced or viral hepatitis) b. Liver small, hard—consistent with cirrhosis a. Injection sites or scars b. Cellulitis c. Abscesses d. Sores or burns on hands, fingers, or mouth from pipes e. Jaundice f. Tattoos that may obscure injection sites
Urine toxicology screen Breathalyzer Blood alcohol level
Head and Neck
IV or IM thiamine
Chest
Chest x-ray Vital signs EKG
Abdomen
Comprehensive metabolic profile
Skin
Complete blood count
Neurological
a. Cognitive evaluation b. Neuropathy c. Seizures d. Cerebral vascular accident
MRI as indicated
(Carlat Addiction Treatment Report, 2019)
ALCOHOL USE DISORDER
Alcohol addiction is a chronic relapsing disorder associated with compulsive drinking (National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2021). Alcohol use is a common disorder defined by a cluster of behavioral and physical symptoms and can include withdrawal, tolerance, and craving (APA, 2013). Approximately 66.9% of ages 18 and older reported drinking alcohol in the past year, with 51.7% in the last month (NIAAA, 2023). Alcohol is a potent drug that causes physiological changes in almost every body system. The severity of the disorder is based on the number of diagnostic criteria in a given individual, along with changes in the severity of alcohol
use across time, reflected by reductions in the frequency of alcohol consumed (APA, 2013). Alcohol use disorder has a variable course characterized by remissions and relapses (APA, 2013). Alcohol use disorder is associated with increased risks of accidents, violence, and suicide (APA, 2013). Severe alcohol use is associated with co-morbid conditions such as depression or other disinhibitions of feelings, contributing to suicide attempts and completed suicides (APA, 2013). Other disorders associated with alcohol use disorders include psychosis, bipolar disorders, anxiety disorders, sleep disorders, and neurocognitive disorders (APA, 2013)
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