Treatment of opiate addiction; It is very important for clinicians to periodically and regularly screen all patients with opiate addiction for substance and alcohol use disorders.
After the client is evaluated in the psychiatry outpatient clinic, neuropsychiatric and psychological tests are performed to clarify the diagnosis of opiate addiction.
After the diagnosis of opiate addiction is clarified, the person is evaluated psychosocially and a family interview is conducted. After the evaluations, the person is admitted to an outpatient treatment program.
Opiate addiction treatment is a disease that requires a long treatment process and rehabilitation.
In addition to outpatient treatmentfor opiate addiction , medication is administered as an adjunct.
Initial screening should consist of objective screening instruments, laboratory evaluation and interview.
If the initial evaluation suggests a problem with opiate addiction, further evaluation should be initiated.
Early diagnosis and interventionin the treatment of opiate addiction facilitates treatment.
In addition, screening for abuse or possible side effects of opiate addiction treatment is important when prescribing opiate-containing medications for pain, either by general practitioners or specialists.
Comprehensive and in-depth interviews and standardized assessments are effective for gathering more information.
WHAT ARE THE STAGES OF EVALUATION IN OPIATE ADDICTION TREATMENT?
- Assessment for Intoxication and Opiate Overdose
Assessing the physical signs of opiate intoxication, overdose and withdrawal during physical examination is vital for people in treatment for opiate dependence .
Opiate overdose requires urgent medical treatment.
In opiate addiction treatment, further investigations may be performed if indicated based on physical examination and history.
Appropriate counseling and consent should be obtained before screening for infectious diseases such as hepatitis and HIV.
While medical problems are screened with laboratory methods, opiate addiction should be managed as in patients without treatment .
- Pharmacologic Factors in Opiate Addiction Treatment
Opiate effects such as analgesia, respiratory suppression, mood changes, insensitivity to expected pain, drowsiness, decreased concentration are seen in opiate addiction treatment.
In opiate addiction, there is a decrease in anxiety, increased self-confidence, better coping skills with daily problems and a decrease in the feeling of distress.
The rush, which is a phenomenon considerably shorter than a general perception of euphoria, lasts only 1 to 2 minutes and is felt only with rapid drug intake, as in intravenous or intrapulmonary administration.
At least one study using Positron Emission Tomography (PET) has shown that all opioids cause a decrease in cerebral blood flow in selected brain regions of people with opiate dependence treatment.
- Psychosocial Factors in Opiate Addiction Treatment
Although the incidence of opiate addiction is higher in low socioeconomic classes compared to high socioeconomic classes, opiate addiction is not limited to low socioeconomic classes.
Social factors associated with increasing poverty in cities also increase opiate addiction.
It is known that approximately 50% of heroin users in urban heroinaddiction treatment are single parents because their parents are divorced or deceased and at least one other family member has a substance-related disorder.
There are some persistent behavioral patterns in adolescentstreated for opiate addiction. These patterns are called heroin behavior syndrome. These patterns include: failure, low self-esteem, hopelessness and aggression.
- Biological and Genetic Factors
A person with disorders associated with opiate dependence may have a genetically determined hypoactivity of the opiate system.
Biological predisposition to opiate dependence-related disorders may be related to impaired functioning in dopaminergic or noradrenergic neurotransmitter systems.
- Psychodynamic Theory
In the psychoanalytic literature, the behavior of people with narcotic addiction has been explained in terms of libidinal fixation with regression to pregenital, oral or even more archaic levels of psychosexual development.
PATIENT EVALUATION PROCESS
- Screening: It is important that clinicians periodically and regularly screen all patients for substance and alcohol use disorders. Early diagnosis and intervention facilitates treatment.
Goals of Screening;
- To recognize groups at risk of developing substance and alcohol-related problems
- Identify individuals requiring further evaluation for medical and opiate addiction treatment
- Diagnosis of opiate addiction or other substance use disorders
Initial screening should consist of objective screening instruments, laboratory assessment and interview. For opiate addiction treatment, comprehensive and in-depth interviews and standardized assessments are effective for gathering more information.
- Screening Tools in Substance Abuse
- COWS (Clinical Opiate Withdrawal Scale) (Wesson et al. 1999)
- SOWS (Subjective Opiate Withdrawal Scale) (Bradley et al. 1987; Gossop 1990; Handelsman et al 1987)
- DAST-10 (Drug Abuse Screening Test) (Skinner 1982)
- CINA (Clinical Institute Narcotic Assessment Scale for Withdrawal Symptoms) (Peachey and Lei 1988)
- CAGE-AID (adapted version for CAGE items) (Brown and Rounds 1995)
- NWS (Narcotic Withdrawal Scale) (Fultz and Senay 1975)
Assessment: If screening tests reveal a condition related to opiate addiction treatment, further evaluation is needed to define the patient's condition and to identify comorbid conditions.
Goals of Assessment in Opiate Addiction Treatment;
- To establish the diagnosis,
- Determine treatment appropriateness,
- To make initial treatment recommendations and plan,
- Consult other departments during early treatment if necessary to identify other medical comorbidities and conditions,
- If necessary to reveal psychiatric, psychosocial conditions, to consult other departments during early treatment.
Parts of the Assessment
- Full history
- Physical examination
- Mental status examination,
- Laboratory tests
- Psychiatric evaluation.
- Interviewing and History Taking in Addicted Patients
The clinician's approach to the opiate dependence treatment patient, who may be ambivalent and reluctant to disclose substance use and related problems, is crucial.
Characteristics of an Effective Addiction Treatment Provider
- Impersonal warmth,
- Warmth,
- Reality
- Respect,
- Do not be affirming,
- Empathy,
- Patient-oriented approach
- Physical Examination
Opiate addiction treatment should focus on physical symptoms.
Treatment of opiate addiction should be completed while planning the treatment of physical complications.
Laboratory Evaluation
The laboratory is an important part of the evaluation of addicted patients. It does not diagnose addiction but evaluates comprehensively.
Further examinations may be performed if indicated according to physical examination and history.
- Evaluation of Substance Use
It cannot replace clinical interview and medical assessment.
The literature supports the clinical utility of substance screening.
Laboratory results can be used to reinforce the goals of treatment, disease denial and substance-free time in the patient-doctor relationship.
- General Comorbid Medical Conditions
Individuals with opiate addiction may have the same chronic diseases as the general population.
Infectious diseases are common in opiate addicts, substance abusers, and injecting drug users.
Individuals with alcohol and substance use disorders may exhibit high-risk sexual behaviors and may be at risk for sexually transmitted diseases such as gonorrhea and syphilis.