Substance Abuse and Dependence Health Article

Diagnosis

The most difficult aspect of diagnosis involves over-coming the patient's denial. Denial is a psychological trait whereby a person is unable to allow him- or herself to acknowledge the reality of a situation. This may lead a person to completely deny his or her substance use, or may cause the person to greatly underestimate the degree of the problem and its effects on his or her life.

One of the simplest and most common screening tools practitioners use to begin the process of diagnosing substance abuse is the CAGE questionnaire. CAGE refers to the first letters of each word that forms the basis of each of the four questions of the screening exam:

• Have you ever tried to cut down on your substance use?
• Have you ever been annoyed by people trying to talk to you about your substance use?
• Do you ever feel guilty about your substance use?
• Do you ever need an eye opener (use of the substance first thing in the morning) in order to start your day?

Other lists of questions may be used to assess the severity and effects of a person's substance abuse. Certainly, it is also relevant to determine whether anybody else in the user's family has ever suffered from substance or alcohol addiction.

A physical examination may reveal signs of substance abuse in the form of needle marks, tracks, trauma to the inside of the nostrils from snorting drugs, or unusually large or small pupils. With the person's permission, substance use can also be detected by examining an individual's blood, urine, or hair in a laboratory. Drug testing is limited by sensitivity, specificity, and the time elapsed since the person last used the drug.

Treatment

Treatment has several goals, which include helping a person deal with the uncomfortable and possibly life-threatening symptoms associated with withdrawal from an addictive substance (called detoxification), helping an abuser deal with the social effects that substance abuse has had on his or her life; and efforts to prevent relapse (resumed use of the substance). Individual or group psychotherapy may be helpful.

Ridding the body of toxins is believed to be aided by hydrotherapy (bathing regularly in water containing baking soda, sea salt, or Epsom salts). Hydrotherapy can include a constitutional effect where the body's vital force is stimulated and all organ systems are revitalized. Herbalists or naturopathic physicians may prescribe such herbs as milk thistle (Silybum marianum), burdock (Arctium lappa, a blood cleanser), and licorice (Glycyrrhiza glabra) to assist in detoxification. Anxiety brought on by substance withdrawal is thought to be lessened by using other herbs, which include valerian (Valeriana officinalis), vervain (Verbena officinalis), skullcap (Scutellaria baicalensis), and kava (Piper methysticum).

Other treatments aimed at reducing the stress a person suffers while attempting substance withdrawal and throughout an individual's recovery process include acupuncture, hypnotherapy, biofeedback, guided imagery, and various meditative arts (including yoga and t'ai chi).

Use of acupuncture to treat addiction is becoming more common. In 2002, a study was undertaken in Maine to treat substance abuse users who were dually diagnosed with chronic mental illness and substance abuse problems with ear acupuncture. The technique appears to cleanse organs and to aid in relaxation, which eases many of the stresses believed to lead these patients to maintain their reliance on the drugs. Another clinical trial in the same year, however, found that acupuncture was not effective alone for treating cocaine-dependent adults. However, the study did conclude that acupuncture may be effective for these patients when used in combination with other treatments. New research also suggests that qigong therapy may be an effective alternative for patients with heroin addiction.

Allopathic treatment

Detoxification may take from several days to many weeks. Detoxification can be accomplished "cold turkey," by complete and immediate cessation of all substance use, or by slowly decreasing (tapering) the dose which a person is taking, to minimize the side effects of withdrawal. Some substances absolutely must be tapered, because "cold turkey" methods of detoxification are potentially life-threatening. Alternately, a variety of medications may be utilized to combat the unpleasant and threatening physical symptoms of withdrawal. A substance (such as methadone in the case of heroin addiction) may be substituted for the original substance of abuse, with gradual tapering of this substituted drug. In practice, many patients may be maintained on methadone and lead a reasonably normal life. Because of the rebound effects of wildly fluctuating blood pressure, body temperature, heart and breathing rates, as well as the potential for bizarre behavior and hallucinations, a person undergoing withdrawal must be carefully monitored.