Addiction: Part II. Identification and management of the drug-seeking patient

The medications most often implicated in prescription drug abuse are opioid analgesics, sedative-hypnotics and stimulants. Patients with acute or chro nic pain, anxiety disorders and attention-deficit disorder are at increased risk of addiction comorbidity. It is important to ask patients about their substance-use history, including alcohol, illicit drugs and prescription d rugs. Patients who abuse prescription drugs may exhibit certain patterns, s uch as escalating use, drug-seeking behavior and doctor shopping. A basic c linical survival skill in situations in which patients exert pressure on th e physician to obtain a prescription drug is to say "no" and stick with it. Physicians who overprescribe can be characterized by the four "Ds"-dated, duped, dishonest and disabled. Maintaining a current knowledge base, docume nting the decisions that guide the treatment process and seeking consultati on are important risk-management strategies that improve clinical care and outcomes.