Overview
Substance dependence involves compulsive use of substances despite harmful consequences, affecting individuals across all age groups and impacting various aspects of healthcare delivery, from primary care to specialized treatment settings. 25Diagnosis
Clinical Assessment: Comprehensive history taking focusing on substance use patterns, side effects, and impact on daily functioning. 2
Screening Tools: Utilize validated screening instruments to identify substance misuse, particularly tailored for older adults. 2
Drug History: Detailed inquiry into substance use history, including type, frequency, and duration, crucial for identifying prescribing cascades and misuse. 13Management
First-Line Treatments: Cognitive Behavioral Therapy (CBT) and motivational interviewing for behavioral change. 2
Pharmacological Interventions: Methadone or buprenorphine for opioid dependence, dose-adjusted based on clinical response. 2
Special Considerations: For patients with substance misuse undergoing procedures, assess risk and consider specialist referral to ensure safe management. 3Special Populations
Elderly: Require age-sensitive approaches with tailored assessment tools and interdisciplinary care involving primary and secondary care providers. 2
Comorbidities: Close monitoring and integrated care addressing dual diagnoses, emphasizing collaboration between healthcare providers. 2Key Recommendations
Implement age-specific training for healthcare providers to enhance knowledge and skills in assessing and managing substance misuse in older adults. (Evidence: Moderate 2)
Develop and utilize clinical audit tools to establish standardized care pathways for older adults with substance misuse, particularly those with dual diagnoses. (Evidence: Moderate 2)
Enhance collaboration between primary care and specialized services to improve detection and management of substance misuse, especially in working populations. (Evidence: Weak 4)
Consider specialist referral for patients with substance misuse undergoing procedures requiring intravenous sedation to ensure comprehensive safety measures. (Evidence: Expert opinion 3)References
1 Farrell BJ, Jeffs L, Irving H, McCarthy LM. Patient and provider perspectives on the development and resolution of prescribing cascades: a qualitative study. BMC geriatrics 2020. link
2 Rao R, Crome I, Crome P, Iliffe S. Substance misuse in later life: challenges for primary care: a review of policy and evidence. Primary health care research & development 2019. link
3 Noone J, Critchley E, Cullingham P, Coulthard P, Saksena A. The implications of substance misuse for intravenous conscious sedation practice. British dental journal 2015. link
4 Van Royen K, Remmen R, Vanmeerbeek M, Godderis L, Mairiaux P, Peremans L. A review of guidelines for collaboration in substance misuse management. Occupational medicine (Oxford, England) 2013. link
5 Darke S. Oxycodone poisoning: not just the 'usual suspects'. Addiction (Abingdon, England) 2011. link
6 MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009. link
7 Kenkare ZN, Federman DG. Over-the-counter sports supplements: what clinicians need to know. Comprehensive therapy 2002. link
8 Cohen J, Schamroth A. General practice management of drug misusers. The Practitioner 1989. link
9 Knowles PL. Inpatient versus outpatient treatment of substance misuse in hospitals, 1975-1980. Journal of studies on alcohol 1983. link