DESCRIPTION
Substance misuse is a general term which encompasses a range of substance use patterns including:
- Hazardous use – a risk of harmful consequences (social, mental, physical) to the user or others;
- Harmful use – the substance use causes harm to the user or others, may be continuous or episodic (e.g. interpersonal violence after an alcohol binge).
- Dependence - characterised by a loss of self-regulation, repeated use despite harm, substance-induced mental illness, and withdrawal syndromes.
People with substance misuse present for related or comorbid health problems e.g. to emergency rooms, infectious disease services (e.g. TB, HIV, Hepatitis, etc.), antenatal clinics, STD services, and mental health services. Early identification and intervention of the substance use is advised to prevent further harm or dependence.
GENERAL MEASURES
- Screen for substance use disorders as a routine part of patient assessment, e.g. with WHO ASSIST. The outcome of the screen should determine the level of intervention that is recommended– e.g. brief advice, a brief intervention (ASSIST linked brief intervention ) or referral to a local substance treatment programme (through a social worker or a registered NGO).
- Elective detoxification: plan in conjunction with a comprehensive substance treatment plan, co-ordinated by the Department of Social Development.
- Unplanned withdrawal: may occur during treatment for another medical condition or may be the presenting complaint. Provide brief intervention counselling and refer to a substance treatment programme.
- Injection drug use: counsel on harm reduction measures and refer to needle and syringe programmes, e.g. StepUp project (TB HIV Care), OUT, Anova and COSUP.
REFERRAL
- All patients treated for substance withdrawal should be referred to Social Services and/or a rehabilitation service for management of their substance use and aftercare.
- Discuss those with comorbid severe mental disorders services with a psychiatrist; refer to specialist dual diagnosis services where available.