Substance Abuse: CNS Depressants - Alcohol

Problem Assessment

History and Physical
Most people will admit to drinking, but few will admit their addiction. Therefore, appropriate questions need to be asked regarding problems in the areas of physical and emotional health, family relationships, socialization, occupation, legal status, medical history to include medications and/or illicit drugs. The medications and drugs inventory is of great significance in treating the withdrawal syndrome. A psychiatric evaluation is needed if symptoms persist over many weeks into sobriety, or immediately if suicide or homicide is a threat.

The alcohol-abusing patient often presents smelling of alcohol and is a middle-class man or woman with complaints of insomnia, nervousness, depression, and/or interpersonal problems. Medical problems such as ulcers, high blood pressure, and anemia are common, and medical emergencies may include toxic reactions, overdose, or accidents.

The history and physical should always include assessment for concurrent drug abuse complicating the withdrawal process. Drugs concurrently abused by alcoholics in descending order of frequency are marijuana, cocaine, PCP, benzodiazepines, barbiturates, and psychedelics.

In addition to the history and physical, other diagnostic tests may be needed, for example, an electrocardiogram (EKG) and laboratory tests such as basic hematology studies and/or liver function tests. Each facility will have its own protocols for lab and/or diagnostic tests to be performed. Be aware of these protocols and follow them when admitting a patient to an inpatient or outpatient program.

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