Substance Abuse
نویسندگان
چکیده
The use and abuse of psychoactive substances are not unique to our country or century. People used hallucinogenic plants to achieve altered states of consciousness in prehistoric times, and psychoactive substances have been used in all eras and cultures. As Osler remarked, “The desire to take medicine is, perhaps, the great feature which distinguishes man from other animals.” The human cost of substance abuse is high, and deaths secondary to the use of psychoactive substances are common. In the United States, illicit drug use results in thousands of deaths each year (Box 186-1). A major barrier to appropriate recognition and treatment of substance abuse is the lack of a precise definition. The American Psychiatric Association defines it as a maladaptive pattern of drug use associated with some manifest harm to the user or others. Physicians have a difficult time recognizing such abuse when up to 44% of emergency department (ED) patients report underlying chronic pain syndromes. Chronic pain may not manifest the typical overt sympathetic changes or physical findings of acute pain. Therefore, emergency physicians constantly walk a tightrope between undertreating legitimate pain and inappropriately rewarding substance abusers with controlled medications.
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