(精选)Substance Use Disorders教学课件.pptVIP

Substance Use Disorders ;How common are substance use disorders?;What are the risk factors? ;Unhealthy substance use;What personal, community, and health system measures are effective in preventing substance use disorders? ;What health system measures are effective in reducing or preventing unhealthy substance use? ;How can opioids for chronic pain be prescribed safely and effectively?;Use risk management strategies Optimize alternatives to opioid treatment for chronic pain Assess for risk for aberrant drug-related behaviors Structure appropriate treatment and monitoring plan Consider a medication agreement Regularly assess opioid benefit and decision to use Regularly assess drug-related behaviors, using urine drug testing, pill counts, state prescription monitoring data Discontinue (tapering) if benefits are not commensurate with risks or if drug taking behaviors are aberrant Seek appropriate specialist assistance ;Complications;Complications;Complications;Complications ;;How should withdrawal be approached in the outpatient setting?;Alcohol: criteria for outpatient detoxification CIWA score 8 - 15 without seizures or delirium tremens Ability to take oral medications Presence of reliable support person who can stay throughout the detox period and monitor symptoms Ability to commit to daily medical visits No unstable medical condition and not pregnant Not psychotic, suicidal, or cognitively impaired No concurrent substance use that may lead to withdrawal No history delirium tremens or alcohol withdrawal seizures Contraindications: 60 y, evidence alcohol-related end-organ damage Benzodiazepines may help manage symptoms and prevent complications ;Opioids Treating as outpatients depends on treatment goals and treatment availability Refer patients experiencing withdrawal and interested in methadone / buprenorphine treatment for such care For oral naltrexone use, patient must be opioid abstinent 3–7 d before initiation; for intramuscular formulation ≥7 d Patients o