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Screening Methods
The screening method for alcohol and drug problems may be a formal or informal procedure and can occur in many settings. Written or verbal tests, observation of behavior, health questionnaires, physical exams or laboratory tests can be used to assess an individual's current or previous drug use. The dental professional will mostly likely rely on observation of behavior, physical findings and verbal or written tests to aid in identification of substance abusers.
Written Assessments
The CAGE Questionnaire (Table 13) consists of four questions and inquires only about alcohol use. 19
Table 13: CAGE Questionnaire |
Have you ever felt you should Cut down on your drinking or drug use?
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| Have people Annoyed you by criticizing your drinking or drug use? |
| Have you ever felt bad, or Guilty about your drinking or drug use? |
| Have you ever taken a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover? (Eye opener). |
| Two or more positive answers suggest that the individual may have an alcohol or drug-related problem. |
NIDA recommends use of several drug use questionnaires, one of which is the Drug Abuse Screening Test (DAST-10.) This questionnaire provides definitions of drug abuse prior to the questions section to promote clarity. Although not generally used in the private dental practice settings, these instruments may be useful and can be administered in 10 to 15 minutes with minimal special training.
Health History
Questions regarding current or previous drug and alcohol use (licit or illicit) should be a part of a dental health history questionnaire. The American Dental Association is a resource for such form.20 Since patients may be reluctant to answer honestly, they should be reassured that honest responses are both kept confidential and are necessary to in order to provide the best oral heath care possible. When patients sign HIPAA documents the office manager or receptionist may reiterate this to the patient.
Verbal questioning should be handled in a private, non-threatening to ensure patient confidentiality. An empathic and nonjudgmental style is critical to gathering accurate information about alcohol and drug use. The dental professional should convey confidence in the patient's ability to be responsible for their drug and alcohol use. If patients are not ready to change their behavior, it is necessary for you to restate your concern for their heath. Reinforce your willingness to help and monitor alcohol, tobacco, and drug use at future visits.
Physical Assessment
As previously discussed, certain drug-related and alcohol-related behaviors may help identify the substance-abusing patient. Alcohol and most other drugs produce intraoral signs and symptoms and are discussed in Table 14 of this text.
Signs and Symptoms of Substance Abuse
Behavioral: Changes in work habits such as absenteeism, tardiness, inattention to detail, mood swings, decline in personal hygiene, social isolation, and apathy may appear. Heavy cigarette smoking may predict heavy alcohol abuse or alcoholism. 21
Cognitive and Psychomotor Function: Inability to recall information, slurred speech, uncoordinated body movement, changes in handwriting and instrumentation* (*impaired professional) may also indicate substance abuse.
Physiological Changes: Were discussed under each drug or drug group.
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