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9 - Drug misuse in medical patients

from Part II - Common psychiatric problems across the general hospital

Published online by Cambridge University Press:  10 December 2009

By
Ilana Crome  and
Hamid Ghodse
Edited by
Geoffrey Lloyd  and
Elspeth Guthrie
Geoffrey Lloyd
Affiliation:
Priory Hospital, London
Elspeth Guthrie
Affiliation:
University of Manchester
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Summary

Introduction

There has been an increasing interest in and awareness of drug problems in the UK over the last decade. This has been reflected in a raft of policy initiatives which include:

  • Purchasing Effective Treatment and Care for Drug Misusers (1996)

  • Clinical Guidelines on the Management of Drug Misuse and Dependence (1999)

  • Substance Misuse Detainees in Police Custody (2000)

  • Safer Services (1999)

  • Safety First (2001)

  • Tackling Drugs to Build a Better Britain (1998)

  • National Drugs Strategy (1999, 2000, 2001)

  • Recommendations from the British Association of Psychopharmacology (2004).

Substance problems may present in a variety of different medical settings in both primary care and secondary care. Indeed, no speciality is exempt from drug misusers presenting; accident and emergency, paediatrics, geriatrics, cardiology, dermatology, neurology, gastroenterology, infectious disease, obstetrics, neonatology, trauma and orthopaedic surgery, and general surgery will all be seeing patients who are using, misusing or are dependent on drugs. All psychiatric specialities, including liaison psychiatry, will have their fair share; in particular those dealing with general psychiatry, child and adolescent psychiatry, old age psychiatry, forensic psychiatry, learning disability, and eating disorders, will be assessing and treating patients with substance problems. Thus, the liaison psychiatrist will undoubtedly come across patients with drug problems.

For the purposes of this chapter, we will concentrate on illicit drugs and the misuse of prescribed medication. Thus, we include central nervous system depressants, e.g. benzodiazepines, solvents and gases, opiates and opioids, drugs that alter perception, e.g. LSD (lysergic acid diethylamide), hallucinogenic mushrooms, cannabis, khat, central nervous stimulants, e.g. amphetamines, cocaine, and ecstasy.

Keywords

anxietydepressionillicit drugsopiateswithdrawal syndromepharmacotherapysubstance misuse
Type
Chapter
Information
Handbook of Liaison Psychiatry , pp. 180 - 220
Publisher: Cambridge University Press
Print publication year: 2007

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References

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders IV. Washington DC: American Psychiatric Association.
Andrews, G. and Jenkins, R. (1999). Management of Mental Disorders. Sydney: World Health Organization Collaborating Centre for Mental Health and Substance Abuse.
Appleby, L., Dysonk, V., Luchinsk, D. J., et al. (1997). The impact of substance use screening on a public psychiatric inpatient population. Psychiatric Services, 48, 1311–16.Google Scholar
Association of Forensic Physicians and Royal College of Psychiatrists. (2006). Substance Misuse Detainees in Police Custody: Guidelines for Clinical Management, 3rd edn. London: Royal College of Psychiatrists.
Aubrey, L. (1998). Motivational Interviewing with Adolescents Presenting for Outpatient Substance Abuse Treatment: Doctoral Dissertation. University of New Mexico Dissertation Abstracts DAI-B 59–03 1357.
Banerjee, S., Clancy, C. and Crome, I., eds (2002). Co-existing Problems of Mental Disorder and Substance Misuse (Dual Diagnosis): an Information Manual. London: Royal College of Physicians, College Research Unit.
Beckett, J., Kouimtsidis, C., Reynolds, R., et al. (2002). Substance misuse in elderly general hospital in-patients. International Journal of Geriatric Psychiatry, 17, 193–6.Google Scholar
Bien, T. H., Miller, W. R. and Tonigan, J. S. (1993). Brief interventions for alcohol problems: a review. Addiction, 88, 315–36.Google Scholar
Bosio, P., Keenan, E., Gleeson, R., et al. (1997). The prevalence of chemical substance and alcohol abuse in an obstetric population in Dublin. Irish Medical Journal, 90, 149–50.Google Scholar
Brookoff, D., Cook, C. S., Williams, C., et al. (1994). Testing reckless drivers for cocaine and marijuana. New England Journal of Medicine, 331, 518–22.Google Scholar
Brown, R. L., Leonard, T., Saunders, L. A., et al. (1998). The prevalence and detection of substance use disorders among inpatients ages 18 to 49: an opportunity for prevention. Preventive Medicine, 27, 101–10.Google Scholar
Canning, U. P., Kennell-Webb, S. A., Marshall, E. J., et al. (1999). Substance misuse in acute general medical admissions. Quarterly Journal of Medicine, 92, 319–26.Google Scholar
Carey, K. B. and Correia, C. J. (1998). Severe mental illness and addictions: assessment considerations. Addictive Behaviours, 23, 735–48.Google Scholar
Clerici, M. and Carta, I. (1996). Personality disorders among psychoactive substance users: diagnostic and psychodynamic issues. European Addiction Research, 2, 147–55.Google Scholar
Cohen, J., Runciman, R. and Williams, R. (1999). Substance use and misuse in psychiatric wards. Drugs: education, prevention and policy, 6, 181–94.Google Scholar
Cornelius, J. R., Salloum, I. M., Ehler, J. G., et al. (1997). Fluoxetine in depressed alcoholics: a double-blind placebo controlled trial. Archives of General Psychiatry, 54, 700–5.Google Scholar
Crome, I. B. (1997). Editorial: young people and substance problems – from image to imagination. Drugs: Education, Prevention and Policy, 4, 107–16.Google Scholar
Crome, I. B. and Day, E. (1999). Substance misuse and dependence: older people deserve better services. Reviews in Clinical Gerontology, 9, 327–42.Google Scholar
Crome, I. B., Ghodse, A.-H., Gilvarry, E., et al. (2003). Young People and Substance Misuse. London: Gaskell.
Day, E., Porter, L., Clarke, A., et al. (2003). Drug misuse in pregnancy: the impact of a specialist treatment service. Psychiatric Bulletin, 27, 99–101.Google Scholar
Las Cuevas, C., Sanz, E. J., Fuente, J. A., et al. (2000). The Severity of Dependence Scale (SDS) as screening test for benzodiazepine dependence: SDS validation study. Addiction, 95, 245–50.Google Scholar
El-Guebaly, N., Armstrong, S. J. and Hodgins, D. C. (1998). Substance abuse and the emergency room: programmatic implications. Journal of Addictive Diseases, 17, 21–40.Google Scholar
Frischer, M., McArdle, P. and Crome, I. B. (2004). The epidemiology of substance misuse in young people. In Young People and Substance Misuse, ed. Crome, I. B., Ghodse, H., Gilvarry, E., et al. London: Gaskell, pp. 35–50.
Gfroerer, J., Penne, M., Pemberton, M., et al. (2003). Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort. Drug and Alcohol Dependence, 69, 127–35.Google Scholar
Ghodse, A. H. (1997). Substance misuse by the elderly. British Journal of Hospital Medicine, 58, 451–3.Google Scholar
Ghodse, A. H. (2002). Drugs and Addictive Behaviour, 3rd edn. Cambridge: Cambridge University Press.
Ghodse, A. H., Oyefeso, A. and Kilpatrick, B. (1998). Mortality of drug addicts in the United Kingdom 1967–1993. International Journal of Epidemiology, 27, 273–8.Google Scholar
Ghodse, A. H., Mann, S. and Johnson, P. (2000). Doctors and Their Health. Surrey: Reed Business Information.
Gossop, M., Marsden, J. and Stewart, D. (2000). Treatment outcomes of stimulant misusers: one-year follow-up results from the National Treatment Outcome Research Study (NTORS). Addictive Behaviors, 25, 509–22.Google Scholar
Gossop, M., Marsden, J., Stewart, D., et al. (2003). The National Treatment Outcome Research Study (NTORS): 4–5 year follow-up results. Addiction, 98, 291–303.Google Scholar
Herring, R. and Thom, B. (1999). Resisting the gaze?: nurses' perceptions of the role of accident and emergency departments in responding to alcohol-related attendances. Critical Public Health, 9, 135–48.Google Scholar
Hodgson, R., John, B., Abbasi, T., et al. (2003). Fast screening for alcohol misuse. Addictive Behaviors, 28, 1453–63.Google Scholar
Hulse, G. K., Robertson, S. I. and Tait, R. J. (2001). Adolescent emergency department presentations with alcohol- or other drug-related problems in Perth, Western Australia. Addiction, 96, 1059–67.Google Scholar
Kellogg, S. H., McHugh, P. F., Bell, K., et al. (2003). The Kreek-McHugh-Schluger-Kellogg scale: a new, rapid method for quantifying substance abuse and its possible applications. Drug and Alcohol Dependence, 69, 137–50.Google Scholar
Kemper, K. J., Greteman, A., Bennett, E., et al. (1993). Screening mothers of young children for substance abuse. Journal of Developmental and Behavioural Pediatrics, 14, 308–12.Google Scholar
Knight, J. R., Shrier, L. A., Bravender, T. D., et al. (1999). A new brief screen for adolescent substance abuse. Archives of Pediatrics & Adolescent Medicine, 153, 591–6.Google Scholar
Kouimtsidis, C., Reynolds, M., Hunt, M., et al. (2003). Substance use in the general hospital: a survey of a large general hospital population. Addictive Behaviours, 183, 15–21.Google Scholar
Lind, J., Oyefeso, A., Pollard, M., et al. (1999). Death rate from use of ecstasy or heroin (Letter). The Lancet, 354, 277–82.Google Scholar
Lingford-Hughes, A., Welch, S. and Nutt, D. J. (2004). Evidence-based guidelines for the pharmacological management of substance misuse, addiction and comorbidity: recommendations from the British Association of Psychopharmacolgy. Journal of Psychopharmacology, 18, 293–335.Google Scholar
Longabaugh, R., Woolard, R. F., Nirenberg, T. D. D., et al. (2001). Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. Journal of Studies on Alcohol, 63, 806–16.Google Scholar
Marquet, P., Delpla, P. A., Kerguelen, S., et al. (1998). Prevalence of drugs of abuse in urine of drivers involved in road accidents in France: a collaborative study. Journal of Forensic Science, 43, 806–11.Google Scholar
Martino, S., Grilo, C. M. and Fehon, D. C. (2000). Development of the drug abuse screening test for adolescents (DAST-A). Addictive Behaviours, 25, 57–70.Google Scholar
McCann, B., Simpson, T. L., Ries, R., et al. (2000). Reliability and validity of screening instrument for drug and alcohol abuse in adults seeking evaluation for attention-deficit/hyperactivity disorder. The American Journal on Addictions, 9, 1–9.Google Scholar
McGovern, M. P. and Morrison, D. H. (1992). The Chemical Use, Abuse and Dependency Scale (CUAD): rationale, reliability and validity. Journal of Substance Abuse Treatment, 9, 27–38.Google Scholar
McHugo, G. J., Drake, R. E., Burton, H. L., et al. (1995). A scale for assessing the stage of substance abuse treatment in persons with severe mental illness. The Journal of Nervous and Mental Disease, 183, 762–7.Google Scholar
McInnes, E. and Powell, J. (1994). Drug and alcohol referrals: are elderly substance abuse diagnoses and referrals being missed?British Medical Journal, 308, 444–6.Google Scholar
McLellan, A. T., Luborsky, L., Woody, G. E., et al. (1980). An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index. The Journal of Nervous and Mental Disease, 168, 26–33.Google Scholar
McLellan, A. T., Hagan, T. A., Levine, M., et al. (1999). Does clinical case management improve outpatient addiction treatment?Drug and Alcohol Dependence, 55, 91–103.Google Scholar
Monti, P. M., Colby, S. M., Barnett, N. P., et al. (1999). Brief interventions for harm reduction with alcohol positive older adolescents in a hospital emergency department. Journal of Consulting and Clinical Psychology, 67, 989–94.Google Scholar
Moos, R. H. and Moos, B. S. (2003). Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders. Addiction, 98, 325–37.Google Scholar
Nunes, E., Weissman, M., Goldstein, R., et al. (1998). Psychopathology in children of parents with opiate dependence and/or major depression. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1142–51.Google Scholar
Oyefeso, A., Ghodse, A. H., Clancy, C., et al. (1999). Suicide among drug addicts in the UK. British Journal of Psychiatry, 175, 277–82.Google Scholar
Project MATCH Research Group. (1997a). Matching alcoholism treatments to client heterogeneity: project MATCH post treatment drinking outcomes. Journal of Studies on Alcohol, 58, 7–29.
Project MATCH Research Group. (1997b). Project MATCH secondary a priori hypotheses. Addiction, 92, 1671–98.
Raistrick, D., Bradshaw, J., Tober, G., et al. (1994). Development of the Leeds Dependence Questionnaire (LDQ): a questionnaire to measure alcohol and opiate dependence in the context of a treatment evaluation package. Addiction, 89, 563–72.Google Scholar
Richmond, R. L. and Anderson, P. (1994). Lessons from conducting research in general practice for smokers and excessive drinkers: the experience in Australia and the United Kingdom: 1 Interpreting the results. Addiction, 89, 35–40.Google Scholar
Robins, I. N., Helzer, J. E., Przybeck, T. R., et al. (1988). Alcohol disorders in the community: a report from the epidemiologic catchment area. In Alcoholism Origins and Outcomes, ed. Rose, R. and Barret, J.. New York: Raven, pp. 15–29.
Rosenberg, P. O. (1995). Alcohol and Other Drug Screening of Hospitalized Trauma Patients. (Treatment Improvement Protocol (TIP) Series 16.)
Rosenberg, S. D., Drake, R. E., Wolford, G. L., et al. (1998). Dartmouth Assessment of Lifestyle Instrument (DALI): a substance use disorder screen for people with severe mental illness. The American Journal of Psychiatry, 155, 232–8.Google Scholar
Royal College of Physicians. (2001). Alcohol – Can the NHS Afford It?London: Royal College of Physicians.
Schuckit, M. A., Smith, T. L., Radziminski, S., et al. (2000). Behavioural symptoms and psychiatric diagnoses among 162 children in alcoholic and non alcoholic families. American Journal of Psychiatry, 157, 1881–3.Google Scholar
Senft, R. A., Freeborn, D. K., Polen, M. R., et al. (1997). Brief intervention in a primary care setting for hazardous drinkers. American Journal of Preventive Medicine, 13, 464–70.Google Scholar
Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behaviours, 7, 363–71.Google Scholar
Smith, G. C., Clarke, D. M. and Handrinos, D. (1995). Recognising drug and alcohol problems in patients referred to consultation-liaison psychiatry. The Medical Journal of Australia, 163, 307–12.Google Scholar
Soderstrom, C. A., Dischinger, P. C., Kerns, T. J., et al. (1995). Marijuana and other drug use among automobiles and motorcycle drivers treated at a trauma center. Accident Analysis and Prevention, 27, 131–5.Google Scholar
Stein, M. D., Wilkinson, J., Berglas, N., et al. (1996). Prevalence and detection of illicit drug disorders among hospitalized patients. American Journal of Drug and Alcohol Abuse, 22, 463–71.Google Scholar
Sugrue, M., Seger, M., Dredge, G., et al. (1995). Evaluation of the prevalence of drug and alcohol abuse in motor vehicle trauma in South Western Sydney. Australia and New Zealand Journal of Surgery, 65, 853–6.Google Scholar
Topp, L. and Mattick, R. P. (1997). Choosing a cut-off on the Severity of Dependence Scale (SDS) for amphetamine users. Addiction, 92, 839–45.Google Scholar
Vidal-Trecan, G., Varescon, I., Nabet, N., et al. (2003). Intravenous use of prescribed sublingual buprenorphine tablets by drug users receiving maintenance therapy in France. Drug and Alcohol Dependence, 69, 175–81.Google Scholar
Vuori, E., Henry, J. A., Ojanpera, I., et al. (2003). Death following ingestion of MDMA (ecstasy) and moclobemide. Addiction, 98, 365–8.Google Scholar
Wolff, K., Farrell, M., Marsden, J., et al. (1999). A review of biological indicators of illicit drug use, practical considerations and clinical usefulness. Addiction, 94, 1279–98.Google Scholar
Wolford, G. L., Rosenberg, S. D., Drake, R. E., et al. (1999). Evaluation of methods for detecting substance use disorder in persons with severe mental illness. Psychology of Addictive Behaviours, 13, 313–26.Google Scholar
World Health Organization. (1992). International Classification of Diseases 10 (ICD-10). Geneva: World Health Organization.

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