Defining Terms for the Medically Ill
Undertreatment
Sociocultural influences
Disease-related factors
Redefining abuse and addiction for the medically ill
The following issues make assessing substance abuse among patients who are
receiving treatment for medical illness more difficult.
Undertreatment
If cancer pain is not adequately treated, a patient may use drugs recklessly in
an attempt to seek relief. Many patients may not receive effective treatment
for their pain. When the prescribed treatment is adjusted and pain is
controlled, the patient's need to use drugs in a manner in which they were not
prescribed disappears.
People who have a history of drug abuse may revert to the use of an illegal
drug when their pain is not adequately treated. Some of these patients may
develop an addiction to prescribed drugs.
Sociocultural influences
Because the terminology used to describe drug abuse is not intended to include
people without a history of drug abuse who are using medications therapeutically, many questions have yet to be answered. For example, while it
is clear that a patient who forges a prescription, or injects a drug that was
meant to be taken by mouth, is displaying deviant behavior, it is not clear if
the same may be said about a patient who increases the dosage to control
unrelieved pain, or takes a pain medication to fall asleep at night.
Health care professionals may make assumptions about the risk of drug abuse
based on a patient's social group. If the patient belongs to a social group in
which there is a high incidence of drug abuse, or if the patient has a history
of drug abuse, it may be incorrectly assumed that the patient is at risk for
abusing drugs prescribed for therapeutic purposes.
Disease-related factors
Substance abuse may be difficult to identify if the disease is progressing and
causing the patient to have physical and mental changes. Treatment for disease
may also cause these changes; radiation therapy to stop brain metastases, for
example, can cause the patient to become withdrawn and experience mental
changes.
To determine the cause of drug-related behaviors in patients who have advanced
medical disease, the patients may be asked if the drug in question has been
used at other times in the patient's life, whether drug use interfered with the
patient's ability to complete treatment for the disease, and whether drug use
prevented the patient from establishing a relationship with the health care
team or family members.
Redefining abuse and addiction for the medically ill
The behavioral characteristics that are present in substance abusers, such as
loss of control over drug use, compulsive drug use, and continued drug use
despite harm, should be monitored in patients who are using drugs for medical
conditions. Should a patient develop these behaviors, the health care provider
should re-evaluate the patient's drug regimen.
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