Module Components

• Overview
• Learning Activities

Topics

• History
• Differential Diagnoses
• Treatment
• Pediatric Considerations

NDNP 870 - Diagnosis and Management 1: Differential Diagnosis of Mental Disorders Across the Lifespan

Module 5: Substance Use Disorders

Treatment

Motivational Interviewing

Motivational interviewing (MI) includes three stages: engaging, evoke and plan. First ask permission and gather the patient's perspective about the behavior that warrants change. Use open ended questions and active listening skills, while reflecting back to the individual what you heard him/her say about the substance use. Effective MI requires a nonjudgmental manner without any statements that involve blame or guilt. In the evoke stage, further the conversation by identifying the individual's motivation to change. This involves acknowledging that people are naturally ambivalent about substance use behaviors, highlighting discrepancies between wanting and not wanting to change, and/or acknowledging and addressing any resistance to change. It provides an opportunity to provide feedback and advice, such as defining what is too much to drink or the physiology of drug use and its health consequences—helping the patient form connections between use and medical problems or other potential risks. Ask open ended questions about what the individual gets from using the substance and what problems has the substance caused in his/her life. The plan stage involved the individual who identifies steps to take towards change the provider summarizes them with future steps.

Here is a video on interviewing for substance abuse and motivational interviewing.   

Pharmacological Treatments

• Tobacco withdrawal: nicotine replacements, buproprion (Zyban), varenicline (Chantix)
• Alcohol withdrawal: benzodiazepines, gabapentin--Maintenance: disulfiram, naltrexone, acamprosate
• Opioid withdrawal: buprenorphine, clonidine--Maintenance: methadone, buprenorphine and naloxone (Suboxone)
• For phencyclidine and stimulant withdrawal, symptomatic treatment

Pharmacotherapy is likely not beneficial without concurrent psychosocial therapy. Behavioral Therapies include harm reduction, cognitive-behavioral therapy, multidimensional family therapy and contingency management. 12-step peer groups have evidence of their effectiveness for sobriety.