This is the final part of a 3-part series to help you prepare for exam questions on addictive disorders (see our archives at www.thereviewcourse.com/studytips for the previous posts on this topic), since we know not every resident gets comprehensive training on addictions medicine.
To get bonus points on your substance use history exam, or to identify further problem areas in patients of your practice, there are 3 things you can do for a more comprehensive addictions history:
1) Quantify their substance use
2) Find out if there is another addictive disorder
3) Find out how severely their use impacts their life
Today we’ll cover Topic #3; here's how.
3) Find out how severely their use impacts their life
A person suffering from an addictive disorder may have mild or severe addiction. One way to quantify the impact on their life is to ask about the domains that could be impacted. If they use cocaine “recreationally” resulting in mild anxiety and not much else, this is quite a different situation than someone who is impacted in all 8 domains – missing work, running out of cash, showing bodily signs of damage, or getting arrested, for example.
The mnemonic for these domains is Mrs. WELP$
M - Mental
R - Relationships
S - Spiritual
W - Work
E - Emotional
L - Legal
P - Physical
$ - Money
Asking about all of these domains will give you a very broad understanding of the impact of the addictive disorder on your patient's life.
PEARLS FOR PRACTICE
How do you manage patients with addictive disorders?
Most importantly, you'll want to utilize The Review Course Management Mnemonic (OPQRST, which you'll learn at The Review Course - and it's already been sent out to all the residents who have registered for the course).
Under R for Refer, you'll want to find out if the patient is able to access:
Inpatient or outpatient programs
1:1 counseling
Mutual self help
EFAP (Employee family assistance programs - also a great resource for treatment of your patients with mental health & addiction concerns, if they have access to one!)
Don't forget that management needs to take the patient's wishes in to consideration. You may have a patient with an alcohol use disorder for whom you recommend abstinence - the patient may be happy to compromise with a short term trial of abstinence, or cutting down their drinking, but if you don't inquire what they are willing to do (crucial for the exam... and for future practice!) you'll miss out on more effective management.
We hope you found this 3-part series on addictive disorders helpful! We are your colleagues - we’re family doctors and recent grads, and we are eager to hear if there’s anything we should do more or less of with these blog posts. Feel free to drop us a line!
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Many, many thanks to Dr. Paul Sobey MD CCFP ABAM, the President-Elect of the Canadian Society of Addictions Medicine, for his inspiration on this topic. I attended his excellent lecture on addictions last month and he kindly granted permission for me to use many of his tips in this series. If this was helpful, let me know – even just a simple “thank-you” - and I’ll pass on your thanks to him!