Foundations in Continuing Education

Substance Abuse and Chemical Dependency

Chapter Nine - Conclusion

Chapter 1: Background Terminology

Chapter 2: Epidemiology

Chapter 3: Pathophysiology of Addiction

Chapter 4: Classification and Characteristics of Psychoactive Substances

Chapter 5: Treatment

Chapter 6: Identification of the Abusing Patient

Chapter 7: Implications for Dental Treatment

Chapter 8: Impaired Oral Health Team Members

Chapter 9: Conclusion

Appendices

Post Examination

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Providing quality dental care, preventing complications, and helping patients avoid relapse should be the primary goals of dental practitioners who treat chemically dependent individuals. Table 15 is a modified version of The National Institute on Alcohol Abuse and Alcoholism's screening and intervention procedures. 29


Table 15: Screening and Intervention
ASK about drug
and alcohol use
 Use the health history and verbally inquire about drug and alcohol use. CAGE or other screening inventories may be used.
ASSESS for drug
and alcohol
related problems		 Determine whether there is a maladaptive pattern of alcohol use, causing clinically significant impairment or distress. Note any behavioral or clinical manifestations of substance abuse such as premalignant oral lesions or unexpected drug interactions.
ADVISE and ASSIST State your conclusion and recommendation clearly: "You are drinking more than is medically safe." Relate to patient's concerns and medical findings. "I am concerned that that the sore you brought to my attention may be related to your smoking and alcohol intake; we will refer you for a biopsy. I strongly recommend that you quit.")

Gauge readiness to change abuse status "Are you willing to consider making changes in your drinking and or smoking?"
At Follow-up:
Continue Support		 Provide ongoing support for the patient. Monitor efforts to cut down or abstain. Reinforce positive behavior.

Remember, your role as an oral health team member is not the diagnosis or treatment of individuals with a substance abuse problem. Your role includes identification of substance abuse and dependency, education of the patient as to risks related to substance abuse, and making necessary modifications in dental treatment to prevent harm or relapse.

Actions you can take include:

  • Review your office health questionnaire and make sure it includes questions regarding current and previous drug and alcohol use.
  • Ask other dental professionals about ways in which they screen patients for substance abuse.
  • Discuss potential drug and alcohol interactions with your patients.
  • Offer your patients alternatives for pain and anxiety control.
  • Make printed information about substance abuse prevention available in your practice.
  • If you educate oral health team members, include courses on chemical dependency in your curriculum.
  • Find out what community substance abuse resources are available for information and treatment referral.
  • Screen patients for signs of substance abuse and educate patients as to the potential risks of the use and abuse of alcohol, tobacco and drugs.
  • Be aware of the connection between alcohol and /or drug abuse and infectious diseases (Hepatitis, tuberculosis, HIV).
  • Examine your own health behavior, and do not engage in activity that is illegal or unhealthy.
  • Become involved in a peer-assistance program.

The problem of chemical dependency directly or indirectly affects every individual in the United States. It is a long-term problem with no clear-cut solution. Our communities suffer through lost workplace productivity, unsafe highways, criminal activity, higher health care costs and disease transmission. A commitment to understanding the nature of addiction, providing a supportive climate and active participation in efforts to reduce the destructive effect of substance abuse is the obligation of every dental professional.

Continue on to Appendix A: Glossary