Substance Use Disorders

General overview — see Alcohol, Opioids, Benzodiazepines, Zolpidem and Zopiclone, Cannabis, and Stimulants for substance-specific detail.

Problems arising from licit and illicit drug use include: intoxication and overdose; chronic physical health effects from drug toxicity; social and legal problems as dependence emerges; physical dependence and withdrawal; precipitation or worsening of psychiatric illness; and blood-borne virus risk (HIV, hepatitis B/C) from sharing injecting equipment.

Psychiatric comorbidity is common in problem drug use — most often depression, anxiety disorders (particularly social phobia), PTSD, and personality disorders. Conversely, many (perhaps most) patients with a primary psychiatric illness use alcohol, tobacco, cannabis, or amphetamines in ways detrimental to their health.

Management principles

Psychosocial interventions should combine general counselling/CBT principles with strategies specific to substance use:

• Motivational interviewing facilitates open communication and patient participation in goal-setting and decision-making.
• Relapse prevention is a central focus, with strategies planned in advance for responding to relapse when it occurs.
• Self-help groups (Narcotics Anonymous, Alcoholics Anonymous, SMART Recovery) help many patients, alongside readily available phone and online support.