Co-occurring patients



Co-occurring patients

Introduction

Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes, which include physical, psychological and social implications. A review of literature on the prevalence of 'heavy drinking' among drug users enrolled in a methadone maintenance treatment found prevalence rates of 13% to 25%, while more recent cross sectional studies report prevalence from one-third up to 50% in this setting. Problem alcohol use is an expression which represents a spectrum of distinct drinking patterns (i.e. hazardous, harmful and dependent drinking). Hazardous drinking 'is likely to result in harm should present habits persist', while harmful drinking, which is an ICD- 10 diagnosis, 'causes harm to the health (physical or mental) of the individual' without the presence of dependence. The term 'dependent drinkers' refers to individuals who meet criteria for the alcohol dependence syndrome under DSM-IV or ICD-10 criteria (DSM-IV, 2003).

Problem drug users are at high risk of liver disease resulting from hepatitis C (HCV) infection because of its high prevalence in this population. Problem alcohol use is an important factor in determining poor prognosis among people with HCV as it impacts on progression to hepatic cirrhosis, increased HCVRNA levels or fatal opiate overdose in opiate users. Drug users have higher rates of mood, anxiety and personality disorders, all of which are exacerbated by alcohol use. In addition, there exists some evidence that alcohol may have a negative impact on outcomes of addiction treatment (Cholakis, 2007). The emerging understanding of a high prevalence of problem alcohol use among current or former drug users, allied to the clear health implications of this problem for this population, necessitates a public health response to this issue.

Signs and symptoms of drug abuse and drug addiction

You're neglecting your responsibilities at school, work, or home (e.g. flunking classes, skipping work, neglecting your children) because of your drug use.

You're using drugs under dangerous conditions or taking risks while high, such as driving while on drugs, using dirty needles, or having unprotected sex.

Your drug use is getting you into legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit.

Your drug use is causing problems in your relationships, such as fights with your partner or family members, an unhappy boss, or the loss of old friends (Cholakis, 2007).

Impact on Relationships

Substance abuse has a huge impact on interpersonal relationships. It can destroy families and lead to disharmony at the workplace. The substance abuser will usually find solace in the company of other heavy drinkers or drug users. This group will support the substance abuse, and provide the individual with the sense of belonging to a community. Belonging to such a group can make it more difficult for the individual to break away from addiction. In order to be successful in recovery it will usually be necessary to build a new network of friends who support sobriety.

Drug abuse creates many problems in the family and it shows great effect on the family ...