Drug and Alcohol Dependence Assessment

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The following summarises substance dependence. The emergency section of this guide contains information on alcohol withdrawal. See mhGAP Intervention Guide (2016) for detail on assessment and management of this and other substance-use disorders such as harmful use, acute intoxication, and overdose.

Dependence is when the use of a drug takes on a much higher priority for a person than other behaviours that once had greater value. It is characterized by a strong craving (urge) to use the substance and a loss of control over its use. It is often associated with high levels of substance use (tolerance) and withdrawal symptoms occur when the drug is stopped suddenly.

IMPORTANT:

People with substance-use disorders are ill rather than bad:

  • some people have a vulnerability to substance-use disorder
  • excessive drinking or drug use progresses through stages and at the advanced stage the person can no longer control their use
  • excessive drinking or drug use can lead to physical and mental illness

 

People become dependent on many types of drugs e.g.: alcohol, cannabis/chamba, inhalants, opioids, sedatives, hypnotics and benzodiazepines.

Of note, health-workers are more likely to become dependent on pethidine and benzodiazepines, largely due to easy accessibility.

Simplified Assessment

Comorbid mental disorders are very common so assess carefully for signs or symptoms of these. In addition to the general psychiatric assessment and mental state examination outlined earlier in the guide, ask questions about the following features of dependence:

  • High levels of frequent substance use
  • A strong craving or sense of compulsion to use the substance
  • Difficulty self-regulating the use of that substance despite the risks and harmful consequences
  • Increasing levels of use and withdrawal
  • symptoms on cessation

A ‘unit’ of alcohol (10 mL, 8 g) is roughly a 25ml single measure of spirits, a little less than a bottle of regular strength (4%) beer, or a small glass of wine.

Recent studies indicate that any amount of alcohol is potentially harmful but the conventional safe drinking limits are 14 units per week for men and women, with at least two drink-free days each week.

Drinking any amount of alcohol during pregnancy can seriously harm the unborn baby.

Risk

Depends on level of use and harm being caused. Often high risk of harm to person’s home, work and social lives as well as person’s mental and physical health.

High risk of suicide. Risk of accidental death due to acute intoxication, overdose and/or withdrawal.

Harm Reduction Strategies

  • Do not drive while intoxicated
  • Advise on safer sexual practices when intoxicated
  • Have a low threshold for screening for infections like HIV/AIDS, TB and hepatitis
  • Treat comorbidities