|Responding to Drug and Alcohol Problems in the Community (WHO, 1991, 109 pages)|
|1. Assessment of drug and alcohol abuse in the individual and the family|
Primary health care (PHC) workers in countries around the world differ markedly in their levels of training and skill. The common factor about them is that they are all very busy people, able to devote only a few minutes or so to each patient. I hey are also expected to handle all the health and social problems that arise in their area. These problems will almost certainly include substance abuse, which seems to be on the increase in many parts of the world. PHC workers are coming into contact with these problems with increasing frequency and are expected to deal with them.
The purpose of this chapter is therefore:
· to increase the awareness of PHC workers to the possible existence of substance abuse among members of their community;
· to help them explore (or rule out) the possibility of substance abuse in their patients;
· to provide PHC workers with the skills to recognize substance use disorders by thorough assessment of patients and their families, and to formulate a plan of action.
The importance of this assessment cannot be overemphasized. The recognition of substance abuse is the first and most important step in the management and prevention of these problems. The assessment process, however, is not always straightforward. While the prototype of the "alcoholic" or the "drug addict" ("junkie") may not be difficult to recognize, such patients are relatively few, and the average PHC worker is not likely to come across them frequently. The majority of drug dependent persons, particularly those in the early stages, can be very difficult to recognize. The psychological, social, and physical manifestations vary widely, depending on the particular substance or substances used, the amounts used or frequency of use, and other factors, such as the age and physical health of the user. The early stages of substance abuse may mimic the symptoms of many psychiatric and physical illnesses, such as anxiety, depression, paranoia, and vague physical complaints.
This chapter will guide the PHC worker through these specific problems and provide a framework for the assessment interview. The overall objective is to facilitate effective treatment and rehabilitation of the patient once the problem has been recognized.
This manual will help to:
· increase awareness of drug and alcohol