The primary care physician will see patients who exhibit both covert and overt signs of addiction, often on a regular basis, without ever making the diagnosis of a substance use disorder (SUD). Indeed, research indicates that 9 out of 10 primary care physicians fail to recognize addiction even in patients who present with the classic symptoms of the disease (1). Of course, making this diagnosis is frequently a formidable task in the brief period of time most primary care physicians are afforded in a typical practice. Covert, or hidden, signs of addiction make this difficult task even more daunting. For example, few physicians would suspect that the elderly female patient with a sweet disposition, supportive family, and some trouble with concentration has an SUD. Only by further investigating the cause of her impairment in concentration can the underlying SUD be detected. Overt symptoms, such as obvious intoxication, signs of withdrawal, elevated liver enzymes, and so forth can assist in making the diagnosis of an SUD more readily apparent.
KeywordsUrine Drug Screen Central Pontine Myelinolysis Nandrolone Decanoate Cage Questionnaire Ethyl Glucuronide
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