Role of the primary care physician in problems of substance abuse

Patients with substance abuse problems are common in general medical practi ce and include people of all ages and socioeconomic groups. Initial diagnos is and treatment of addiction problems are often done by the primary care p ractitioner before referral to a specialist. This article provides informat ion to help in recognition of addiction, guidelines for treatment of intoxi cation and withdrawal of various drugs of abuse (such as opioids, sedative- hypnotics, stimulants, hallucinogens, and volatile inhalants), and techniqu es for brief intervention as well as long-term care of substance-abusing pa tients. The physician can be a powerful influence for getting the patient t o accept treatment, especially when the physician is empathic without being judgmental. Addiction is a chronic disorder with remissions and relapses l ike any other chronic disease, so exacerbations should not be seen as failu res but as time to intensify treatment. Patients with substance abuse probl ems can be frustrating to treat, but it can also be a rewarding experience when a physician helps a substance-abusing patient return to normal and pro ductive functioning in society.