PHYSICAL-EXAMINATION OF SUBSTANCE-ABUSERS - HOW TO GATHER EVIDENCE OFCONCEALED PROBLEMS

Physicians examining substance abusers should avoid immediately ascrib ing all complaints to the substance abuse itself. Rather, they should consider all possibilities for the medical presentation. By focusing e xamination on medical conditions specific to the substance of abuse, p hysicians can streamline diagnosis and provide better, prompter care. Vital signs, behavior, and general appearance give impressions of the patient's lifestyle and possible substance-abuse profile. Much support ing or disproving evidence can then be gathered from examination of va rious organ systems, For example, the eyes in particular provide many clues; specific combinations of signs often indicate the substance of abuse. Irritated nasal mucosa and sinusitis suggest long-term inhalati on of cocaine. Bruises, abscesses, and hyperpigmentation of the skin m ay signal intravenous drug use; burns and scars may signal alcoholism. Documented evidence of the harm done by substance abuse may be used t o bring home the realities of addiction and to encourage the patient t o seek appropriate therapy.