Substance-related Disorders

Primary care physicians noted increased stress among patients during the pandemic and worry that telehealth visits may have hidden signs of drug misuse.

IDWeek 2021: Young people who inject drugs can be cured of hepatitis C virus infection, according to 2 new studies.

The annual NIH-supported survey revealed changing substance use trends among college students and college-aged adults. Find key results for primary care in our quick slideshow.

COVID-19 has dealt in-person addiction treatment a blow, but the chief medical officer of Groups Recover Together tells a telemedicine success story with a hybrid ending.

Find out how much you know about substance use among US high school students with our 9-question true/false quiz based on the 2019 CDC Youth Risk Behavior Survey results.

The perception of marijuana's risks and benefits may be changing within the US adult population. Are you up to date? 

They may determine the presence of alcohol and drug dependence better than longer screening tools, according to a new study.

The goal is better developing the necessary skills for evaluating and managing patients who have persistent pain.

Is hydrocodone less likely to cause addiction than morphine or hydromorphone? The US DEA wants the FDA to reclassify the Schedule 3 opioid to Schedule II.

A 38-year-old man with a history of alcoholism, intravenous drug use, and cerebrovascular accident was referred for assessment of possible endocarditis, based on history, fever 39 °C (102.9 °F) and mildly elevated troponin level.

A 71-year-old woman presents to the emergency department for evaluation of a blistering, intensely pruritic generalized rash that started 5 days earlier. Multiple ruptured and intact hemorrhagic bullae are obvious on the hands, arm, neck, chest, back, and abdomen and to a lesser extent on the lower extremities. The mucous membranes are spared. The Nikolsky sign is absent. The patient reports recent use of furosemide for periodic leg swelling.

A 71-year-old African American man presented to the emergency department (ED) with chest pain, dyspnea, and hemoptysis. He had had a few ED visits for similar symptoms within the previous 4 weeks.

The patient has a history of hospital admissions for complications of alcoholism, including pancreatitis and trauma from falls. What's your diagnosis?

A 38-year-old man found lying on the floor in his home was hospitalized because of alcohol intoxication. A chest radiograph showed a large calcified lesion in the left upper abdomen. A CT scan with intravenous contrast revealed a large, well-defined, cystic mass with mural calcification in the spleen. The CT findings were not consistent with a vascular malformation or echinococcal cyst-specifically, the mass was sharply demarcated, unilocular without septations, and round with a thin wall and attenuation similar to water. Urine Histoplasma antigen test results were negative.

A 51-year-old man was hospitalized for subacute alteration of mental status. The patient had a history of alcohol abuse. He had no other medical disorders. Vital signs were normal. The patient scored 15 out of 30 on the Mini-Mental State Examination. He had an ataxic gait; all other physical findings were normal. The family reported that he had been treated in the emergency department 3 days earlier for hypoglycemia. Results of a complete metabolic profile and complete blood cell count were normal.

Cocaine abuse is associated with many dermatological manifestations, vasculitides, and infections. Consider this diagnosis in patients with unexplained chronic skin lesions, an ambiguous medical history, previous examinations that found no source of symptoms, labile affect, and delusional behavior.

For 3 days, a 45-year-old woman with HIV infection who was noncompliant with her antiretroviral medications had cough, yellowish sputum, fever, and dyspnea. She denied hemoptysis, weight loss, or recent hospitalization. She had a long history of heavy smoking and alcohol and intravenous drug abuse.

CHICAGO -- Two new Current Procedural Terminology (CPT) codes will allow physicians to report specific services they provide to screen and counsel patients with alcohol or drug abuse problems.

AKRON, Ohio -- Myocardial infarction, although rare, can occur in adolescents even in the absence of congenital heart defects or drug abuse.

BETHESDA, Md. -- Alcoholism diminishes brain activity related to interpretation of negative emotions, in addition to its adverse effects on cognition, results of a brain imaging study suggest.

The diagnostic criteria for major depression are anhedonia, depressed mood, feelings of worthlessness or inappropriate guilt, inability to concentrate, fatigue, insomnia or hypersomnia, psychomotor agitation or retardation, significant weight loss or gain, and recurrent thoughts of death or suicide. Five or more of these symptoms must be present for at least 2 weeks, and one of them must be anhedonia or depressed mood. Conditions that can present with depression include dysthymia, bipolar disorder, cyclothymia, and adjustment disorder. Depression may also result from substance abuse or from the physiological conditions associated with a medical disorder, such as spinal or head injury, AIDS, or cancer.

SAN FRANCISCO -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions.

PHILADELPHIA -- Those who try to foil urine drug tests with massive doses of niacin -- it doesn't work -- may wind up in a hospital emergency department.

DALLAS, April 3 -- Amphetamine and cocaine abuse appear to promote the risk of stroke among young adults, according to a large hospital database.

BETHESDA, Md. -- When out-of-control gambling marks Parkinson's disease patients who are started on dopamine agonists, they may have a younger disease onset, with a history of thrill-seeking behaviors and a family history of substance abuse.

For a week, a 39-year-old woman with a history of intravenous heroin use had generalized pain, fever, chills, and a nonproductive cough. She rated the pain at 10 on a scale of 1 to 10; it was sharp, constant, and unrelieved by heroin. She also reported dyspnea at rest, pleuritic chest pain, and a 15-lb weight loss over the past month. She had no significant medical history or drug allergies, smoked a half pack of cigarettes per day, and denied alcohol use.

Salivary gland enlargement, most commonly involving one or both parotid glands, is sometimes seen in association with HIV infection. Enlargement of the parotid gland may be due to diffuse infiltrative lymphocytosis syndrome; lymphoepithelial cysts; or malignant tumors, such as squamous cell carcinoma, Kaposi sarcoma, and Hodgkin and non-Hodgkin lymphomas.1,2 Non–HIV-related causes of parotid enlargement include acute and chronic viral infection, granulomatous disease, malnutrition, alcoholism, and diabetes mellitus.3,4 Here we report the case of a 41-year-old HIV-infected man with fat maldistribution syndrome associated with type 2 diabetes and hyperlipidemia. Sialadenosis developed presumably as a result of HIV infection and hypertriglyceridemia.

The false sensation of bugs crawling on or within the skin is a sensory hallucination commonly associated with psychostimulant drugs. It was first reported in chronic cocaine users in 1889. Patients with this disorder often have self-induced dermatosis caused by intense picking and scratching of the skin.

A 50-year-old man with alcohol-induced cirrhosis was hospitalized with lower GI bleeding. On examination, he was pale, heart rate was 100 beats per minute, and blood pressure was 100/60 mm Hg. He was anemic (hemoglobin level, 9 g/dL) and thrombocytopenic (platelet count, 112,000/µL).

Alopecia was noted on the right anterior scalp of a 53-year-old man who had been hospitalized for jaundice of 2 weeks' duration. The hairs in the affected area were broken off at various lengths.