Involve a multidisciplinary team
Set realistic goals for therapy
Treat related psychiatric disorders
Prevent or minimize withdrawal symptoms
The impact of tolerance
Treat chronic pain
Recognize drug abuse behaviors
Use nondrug approaches
Taking a substance abuse history

The following issues refer to palliative care for patients who are actively abusing alcohol or other drugs, or who are in a drug-free recovery or methadone program.

Patients with histories of substance abuse are best treated for progressive medical illness by a team of health care providers. A team of one or more physicians, nurses, social workers and, if possible, an expert in addiction medicine, will address the many medical, psychosocial, and administrative problems that patients with drug histories and progressive illness may have.

Patients who have drug abuse and addiction problems experience periods of recovery and relapse. The risk of relapse is increased when patients have a life-threatening disease and have access to pain medication. In this situation, the goal of treatment may not be the complete prevention of relapse, but may be to provide a structure that will limit any harm done by abuse of the drugs. Some patients who have severe substance abuse and related psychological problems may never be able to use therapeutic drugs as prescribed. The health care team should monitor and revise treatment goals for these patients as often as necessary to avoid treatment that is not successful.

Alcoholics and patients with substance abuse histories are very likely to also suffer from depression, anxiety, and personality disorders. The risk of relapse may be decreased if the patient also receives treatment for anxiety and depression.

Many patients with a history of drug abuse consume multiple drugs. The health care provider must be made aware of all drug use so the patient may be effectively monitored to prevent withdrawal symptoms.

Patients who are actively abusing drugs may have developed a tolerance that limits the effectiveness of drugs prescribed for a medical condition.

Opioid regimens used for long-term control of medical symptoms are individualized for each patient so that the dosage is large enough to control symptoms. In patients with substance abuse histories, prescribing dosages that are not large enough may result in undertreatment of the symptoms. The undertreatment does not relieve the patient's pain, and may encourage drug abuse in an effort to control the symptoms. This behavior may cause the physician to become more cautious in prescribing opioids. The physician and patient must work together closely to determine the necessary dosage and to agree on guidelines for responsible use of therapeutic drugs.

While all patients who are prescribed drugs that may be abused must be monitored closely, monitoring is especially important for people who have a history of substance abuse. The patient may be reassessed frequently, and the patient's significant others may be asked to provide observations about the patient's drug use. The physician may find it appropriate to test the patient's urine for illegal or unprescribed drugs. If a patient is agreeable to drug testing and monitoring and uses prescribed drugs responsibly, a trusting relationship may be established with the physician. A physician who is confident that the patient will not abuse drugs is more likely to adjust therapies to control symptoms.

The patient may benefit from nondrug approaches, such as learning about the complexities of the medical system, communicating with the medical staff, and learning relaxation and coping techniques.

To avoid offending a patient, a health care provider may choose not to ask about drug abuse. The health care provider may assume that the patient may become offended, angry, threatened, or may not tell the truth. Such attitudes are not helpful in establishing truthful communication between health care provider and patient and may cause problems in monitoring therapy.

A patient may withhold information about his or her drug use because of negative attitudes the health care provider may have about drug users. The patient may not trust the health care provider, or the patient may fear that if his/her drug abuse history is known, inadequate medication may be prescribed to control symptoms. The physician must know the patient's drug use history in order to control symptoms and to keep the patient comfortable by prescribing adequate medication to prevent withdrawal symptoms and reduce pain. The physician needs to know which drugs the patient has taken, the length of time drugs have been used, the frequency of drug use, and the situations that cause the patient to use drugs.

Glossary Terms

Uncontrollable craving, seeking, and use of a substance such as a drug or alcohol.

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

A disease in which a person craves alcohol, is unable to limit his or her drinking, needs to drink greater amounts to get the same effect, and has withdrawal symptoms after stopping alcohol use. Alcoholism affects physical and mental health, and causes problems with family, friends, and work. Also called alcohol dependence.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

The methods a person uses to deal with stressful situations. These may help a person face a situation, take action, and be flexible and persistent in solving problems.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

The amount of medicine taken, or radiation given, at one time.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

The use of illegal drugs or the use of prescription or over-the-counter drugs for purposes other than those for which they are meant to be used, or in large amounts. Drug abuse may lead to social, physical, emotional, and job-related problems.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

A drug used to treat moderate to severe pain that does not respond to other types of pain medicine. It is also used to help people who are addicted to opioid drugs such as heroin. Methadone hydrochloride binds to opioid receptors in the central nervous system. It is a type of analgesic agent and a type of opioid.

In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).

A health professional trained to care for people who are ill or disabled.

A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.

Medical doctor.

A doctor's order for medicine or another intervention.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

To become well and healthy again.

A treatment plan that specifies the dosage, the schedule, and the duration of treatment.

The return of signs and symptoms of cancer after a period of improvement.

A method used to reduce tension and anxiety, and control pain.

A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.

The use of illegal drugs or the use of prescription or over-the-counter drugs or alcohol for purposes other than those for which they are meant to be used, or in excessive amounts. Substance abuse may lead to social, physical, emotional, and job-related problems.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Having to do with treating disease and helping healing take place.

Treatment.

Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.