|
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), describes the primary feature of substance dependence as continued substance use "despite [the patient's] knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance" or, in classic terms, "continued use despite harm."1,2
The criterion of "continued use despite harm" is particularly useful for avoiding misdiagnosis of those patients who display other symptoms characteristic of opioid dependence. For example, while a number of patients may become tolerant to or even physically dependent on opioids during the course of treatment, only a small portion of them will ever display any evidence of the destructive behaviors known as "opioid dependence."3 Similarly, patients whose pattern of use is adaptive (eg, drug use is necessary to manage a health issue such as chronic pain), a diagnosis of opioid dependence should not be made, regardless of any physical tolerance or dependence.4 Patients whose pain is inadequately treated may exhibit behaviors that can be misinterpreted as drug dependence. These patients may appear focused on acquiring their pain medication, may "watch the clock" for the next dose, behave in a "drug-seeking" fashion, or deceive others about drug use—even use illicit drugs.3 However, these behaviors resolve when the pain is effectively treated, and patients are unlikely to meet the other DSM-IV criteria for opioid dependence. Consequently, this condition is often referred to as "pseudo addiction."3 Opioid dependence is distinguished by the patient's subordination of his or her own social, mental, and/or physical health. By contrast, patients who are appropriately using opioids to treat chronic pain will often report improvements in their overall quality of life, notably in the areas of social and physical functioning.4,5 Open communication with patients is generally the most effective means of assessing whether or not opioid use has become a problem (for more information about starting a conversation with patients, visit www.Suboxone.com/hcp). Back to Top
References
|
 |