Substance Use: Treatment and Morbidity
The medical professionals are in a unique position to offer treatment and referral for patients with substance use disorders as they present in crises situations. Substance-using patients who miss their outpatient follow-up appointments rely on the emergency room physician, who is, at times, the first and last line of defense against chronic, debilitating medical illnesses. The implementation of systemic screening and treatment strategies has been promising, but more needs to be done to decrease emergency room utilization for substance use disorders. Nonjudgmental, patient-centered strategies are a key to the effective initiation of treatment, successful referral for substance use services, and spiritual and biological recovery. Physical exam and appropriate diagnostic studies are paramount during emergency room encounters with substance-using patients. The sequelae of substance use disorders put patients at risk for specific syndromes such as delirium tremens, gastrointestinal (GI) bleeding, psychosis, suicidality, abscesses, and sexually transmitted infections. Additionally, patients with substance use disorders tend to fail to follow up with the treatment for comorbid medical and psychiatric illness (Barthwell 1997) so that they may present in diabetic ketoacidosis for diabetes mellitus, acute chronic obstructive pulmonary disease exacerbations, as well as psychiatric decompensation. This is also why treatment and referral strategies are so important in the emergency setting: effective prevention and treatment of substance use disorders has the potential to decrease morbidity, mortality, and healthcare utilization system wide. The era when many healthcare professionals remain reluctant to engage and treat substance-using patients is hopefully coming to an end with the advent of systemic quality improvement initiatives, “ meaningful use,” and adherence with “core measures” (National Academies of Sciences, Engineering, and Medicine 2016). On a personal level, it is up to every healthcare professional to treat the substance-using patient with the same dignity as any other patient.
Reducing the number of premature deaths requires integrated action. This includes risk-factor reduction, screening, early intervention, and evidence-based treatments for substance use and comorbid disorders.
The social, economic, and geographic attributes of psychiatric illness and substance use disorders are constantly evolving, with new substances and behaviors appearing and growing. While the treatment for substance use disorders is effective and normalizing, only 1 of 4 users have ever received any treatment for these conditions in their lifetimes (Batts et al. 2014). Effective emergency room education, referral, and treatment strategies can improve the prognosis for patients, families, and society as a whole (Botvin 2004).