Mitzi Perdue

Substance Abuse and Women: There’s A Lot You Can Do

SUBSTANCE ABUSE IS LIKELY TO AFFECT MANY OF YOUR PATIENTS

At any given time in the U.S., about 15% of the population has a diagnosable substance use disorder. The lifetime rates are nearly 30%. At some point over the course of 4 years of college, nearly half of students may have a diagnosable disorder. In view of these statistics, be alert to the fact that many of your patients may have a substance abuse problem, whether it’s prescription medications, street drugs, alcohol, or nicotine.

WOMEN HAVE SPECIFIC VULNERABILITIES RELATING TO SUBSTANCE ABUSE

Substance abuse greatly increases the odds of a woman’s being a victim of sexual violence and/or domestic abuse. In the case of women as mothers, substance abuse impacts their pregnancies and their ability to function in their maternal role. Also, the same amount of a drug or alcohol taken by a woman is likely to cause more physical damage than it would to a man. In addition, the time it takes from the onset of use to actual physical impairment is generally faster for women than for men.

YOUR PATIENT MAY TRY TO HIDE HER ADDICTION

She may feel stigmatized by her addiction and be unwilling to bring it up. If you see medical symptoms that are related to substance abuse such as liver, coronary, or breathing problems, use these as an entryway to a discussion of alcohol, drugs, or smoking. Make your evaluation nonjudgmental, like any other medical condition. Try to let her know that you’re not casting blame and that she’s safe talking about it with you. Let her know that you view this as a medical disorder that impacts her life and needs treatment.

EVEN TEN MINUTES OF DISCUSSION CAN HAVE A BIG IMPACT

For an individual who is not severely addicted but is over-using, there’s strong evidence that a physician’s simply spending five or ten minutes recommending that she cut down or stop can really help. A follow-up conversation within a month makes this intervention even more effective. On the other hand, if the addiction is severe, refer your patient to a specialist. Check her insurance plan to find out who are the providers for mental health and addiction issues.

ATTITUDES TOWARDS PRESCRIBING OPIOIDS HAVE CHANGED

Ten years ago, the attitude was that we should be aggressive about treating pain. In some cases, patients were told that taking a painkiller was similar to taking blood pressure medication, and it was simply something to take from now on.

The problem with this approach is too many people became addicted. Individuals may find that they require higher and higher doses to achieve the same degree of relief. There’s also some evidence that long-term opioid use actually makes individuals more sensitive to pain.

An additional problem is accidental overdosing, as can happen when a patient experiences severe pain and doubles or triples the dose. Maybe she also took a drink to relax, or she was taking some other medication as well. She falls asleep and never wakes up.

Health care providers need to be cautious about prescribing opioids. There are appropriate uses, for example, immediately following surgery, or in cases such as severe cancer-related pain. However, when possible we suggest other approaches to pain management. For example, with chronic back pain, some combination of the following may be helpful: relaxation and coping skills training; rest; physical exercise; physical therapy; and non-narcotic anti-inflammatory medications. Antidepressant medications may also sometimes be helpful.