Substance Use

Disorders due to psychoactive substances use are wide and varied. They differ in severity and clinical presentations. Identify substances used from the history and as many other sources of information as possible this can include examiantion, chemical investigations and reports from informed third parties.

'Can you tell me about the recreational drugs you have taken…’

‘When did you first start using (cocaine, cannabis...)?

'How much do you take (drink, smoke...) on average in a day?' How much does this cost you?'

'Have you ever taken much more than usual? How often does this happen?

'Where do you normally use the drug? who do you use the drug with?

'Who supplies you with the drug?'

 

The categories F10-F19 allow you to select the substance in question only, not the resulting disorders. Only in cases where patterns of psychoactive substance use are chaotic, inextricably mixed and indiscriminate should the diagnosis of multiple drug use (F19.-) be used.

There are several disorders which can result from. The list below shows the different diagnoses associated with substance uses. features of dependence syndrome and all the biopsychosocial complications. Establish the above information you can see if the patients pattern of use and the consequences thereof meet ICD-10 criteria for a substance misuse problem.

.1 Harmful Use
Pattern of psychoactive substance use causing damage to health which can be physical (e.g. phlebitis, hepatitis) or mental (e.g. anxiety, depression). A diagnosis will be made on the basis of a good history and careful examination and direct questions.

'Has taking (drinking, smoking...) affected you health or the way you feel in yourself?'

‘What changes have you noticed in yourself since taking (drinking, smoking...)?

'Have you experienced any money, work or family problems due to your use?’

'Have you eve been in trouble with the police due to taking (drinking, smoking...)?'

.2 Dependence Syndrome
Behavioural, cognitive, physiological phenomena develop after repeated substance use that typically include: -

 

 

'Does it ever feel its really difficult not to have a drink (smoke, hit...)?'

'How important is drink to you?'

'Do you ever feel compelled to have a drink (smoke, hit...)?'

'Have you ever tried to cut back the amount you drink (smoke, take...)? What happened?'

'Do you know that drink is harmful to your health? does this alter things?'

'Have you found yourself drinking instead of doing other thing you would normally do?'

'Have you ever had a drink in the morning to get you going?'

'Have you found you have to drink more to get the same effect?'

.3 Withdrawal State

Symptoms of variable clustering and severity occurring on withdrawal substance after persistent use. The onset and course of the withdrawal state are time-limited and are related to the type of psychoactive substance and dose being used immediately before cessation or reduction of use. The withdrawal state may be complicated by convulsions.

'Have you ever stopped drinking (smoking, taking...) for a period of time only to find you could not keep away?'

'Do you ever get shakes, sweating, muscle cramps, anxiety if you don’t have a drink (smoke, hit...)?' - 'Does a drink (smoke, hit...) help to relive these?'

‘What happens if you don't have your normal cannabis (alcohol, cocaine…)?'

‘How do you feel when the effects have worn off?'

‘Have you ever experienced a blackout after stopping your normal pattern of use?'