Substance

Related Disorders

Substance abuse is the regular use of a drug other than its accepted medical purpose or in
dosages greater than those that are considered appropriate
The most common drugs of abuse are alcohol and prescription drugs
There is no classic cultural, socioeconomic, or educational profile for a substance abuser
Alcohol
Clinical Pattern of Alcohol Use

• Abstinence and low risk

• Increased consumption
• Moderate alcohol use: 2 drinks per day for men, 1 drink per day for women. The
individual is able to function appropriately in work, family, and social situations
• Unhealthy alcohol use: Early stage problems such as hypertension, depression,
insomnia
• Alcohol dependency and alcoholism: This stage develops after periods of unhealthy
alcohol abuse
Etiology

• Genetics: GABRA2 & CHRM2 are the 2 genes involved in the predisposition. ALDH2
substantially, but not completely, protects carrier from developing alcoholism by making
them ill after consuming.
• Biopsychosocial: Parent-child influences
• Environmental: psychological stress, family, peers, and social forces. Lifestyle, culture,
and advertisements

Signs of Alcoholism

• Craving: A strong need or compulsion to drink.

• Loss of control: The inability to limit one's drinking on a given occasion
• Physical dependence: Withdrawal symptoms, such as nausea sweating, shakiness, and
anxiousness when alcohol use is stopped after a period of heavy drinking.
Effects of Alcohol

• Behavioral Changes: aggressiveness, mood instability, impaired judgment, impaired

social or occupational functioning, impaired attention and memory, coma or stupor
• Physical Characteristics: slurred speech, lack of coordination, unsteady gait, nystagmus
• Complication: irresponsible actions in work and family settings
 • Accidents with resultant bruises, fractures, or brain trauma
• Vehicular accidents
• Suicide
Pharmaceuticals
Prescription drug abuse: taking prescription medication that is not prescribed for that
person; using a prescription for reasons or in dosages other than prescribed
Street abuse: taking drugs or substances purchased illegally from non-medical sources
and/or for non-medical reasons.

Most commonly abused drugs:
Depressants Dissociative Anesthetics
• Barbituates • Ketamine
• Benzodiazepines Stimulants
• Flunitrazepam • Amphetamines
Opioids and Morphine • Cocaine
Derivatives • Methamphetamine
• Codeine • Methylphenidate
• Fentanyl Other compounds
• Morphine • Anabolic steroids
• Opium
• Others

Recreational Drugs
A recreational drug is used without medical justification for its psychoactive effects often in
the belief that occasional use of such a substance is not habit-forming or addictive
Most commonly abused are marijuana, cocaine, heroin, and ecstasy.
Treatment
Drug addiction is a treatable disorder, however, there is no single treatment appropriate for
all individuals
Medical detoxification is only the first stage of treatment
Treatment is tailored to the individual needs and may involve behavioral changes and
medications. No single treatment is appropriate for all individuals. Treatment does not have
to be voluntary to be effective and remaining in treatment for an adequate period of time is
essential.
Effective treatment includes:
• Individual, group counseling, and behavioral therapies
• Use of treatment medications
• Integration treatment for any coexisting mental disorders
• Infectious disease assessment and counseling (HIV/AIDS/Hepatitis)
• Monitoring of possible drug use during treatment
 • Medical, social, vocational, legal, and family counseling
Recovery can be a long-term process and relapses can occur
Medications are used to suppress craving for drugs and withdrawal symptoms
Medications include: Methadone, LAAM, Naltrexone, Phenobarbital or Diazepam,
Disulfiram

Dental Hygiene Process of Care

Dental professionals often have the first opportunity to treat early signs and symptoms of oral
complications for the substance abuser. It is very important to recognize the characteristics of each
patient before treatment as it is rare that a patient will disclose information about an addiction.

• Assess the patient by gathering a thorough medical history, keeping in mind that it may
be less reliable because many patients with drug abuse problems are in denial.
• Interview the patient and be motivational, empathetic, and non-judgmental. Patient's need to
understand the importance of the information as a health-safety measure and that all
information will remain confidential.
• Screen the patient using the CAGE questionnaire & 5 A's – Ask, Advise, Assess, Assist, Arrange
– used in tobacco intervention but may also be used with substance abusers.
• Vital signs are important because high blood pressure and fluctuations are common in
substance abusers
• Durning the Extraoral Exam, look for signs of substance abuse such as: red puffy eyes, dilated
or constricted pupils, needle track marks, slurred speech, drowsiness
• Intraoral exam looking for drug induced xerostomia, generalized poor oral hygiene,
chipped or fractured teeth, rampant carries
• Dental Hygiene Diagnosis: this consists of making your decision of patient care based on
the patient's oral condition and abuse habits.
• Develop a treatment plan to meet the induvial needs of the patient as identified by the
dental hygiene diagnosis. Priorities and goals are determined by the severity of the
problem.
• Implement – The clinical procedures are greatly influenced by the many health
problems that can result from drug use
• Evaluate by developing a continuing care plan to prevent progression or reoccurrence of disease

Dental Implications

Xerostomia is often a side effect of opiates, amphetamines, barbiturates, hallucinogens, marijuana, and
alcohol. The resulting decreased salivary flow makes users much more susceptible to dental caries and
periodontal diseases. Chemically dependent patients often crave sugar, which leads to the consumption
of large quantities of sweetened carbonated beverages, thereby increasing enamel erosion. Drug addicts
may also be at a higher risk of bruxism, dentin hypersensitivity, and NUG.

Dental Considerations

• Use precaution for potential drug interactions

• Limited use of local anesthesia
• Limit use of alcohol containing products
 • Educate patients on safeguarding prescriptions
• Be mindful of prescription shopping

Treatment

• Consult patient's physician to determine if pre-antibiotic is needed

• Avoid use of power instruments in patients with compromised immune system
• High power suction is essential
• Contraindications: Nitrous oxide/oxygen, local anesthetics with vasodilators
• DOCUMENT
• Recall is determined on an individual basis

Review Questions
True/False: The most common drugs of abuse are alcohol and prescription drugs

True/False: Local anesthetic should be used on all substance abusing patients

Xerostomia is a common side effect of which abused substance?

A) Opiates

B) Amphetamines

C) Barbiturates

D) Marijana

E) All of the above