Essential Information for Patient and Family

• Abstinence is the goal; the patient and family should concentrate on this.
• Stopping or reducing drug use will bring mental and physical benefits.
• Using drugs during pregnancy will harm the baby.
• For intravenous drug users, discuss risk of getting or giving HIV infection, hepatitis of other bloodborne infections. Discuss appropriate precautions (use condoms, do not reuse needles).
• Relapse is common. Controlling or stopping drug use often requires several attempts.

Specific Counselling to Patient and Family

• For those willing to stop now:
  • Set a definite day to quit.
  • Discuss strategies to avoid or cope with high-risk situations (e.g. social situations, stressful events).
  • Make specific plans to avoid drug use (e.g. how to respond to friends who still use drugs).
  • Identify family or friends who will support stopping drug use.
• If patient is unwilling to quit, discuss ways to decrease use:
  • Negotiate a clear goal for decreased use(e.g. at least 3 days between periods of drug use).
  • Discuss strategies to avoid or cope with high-risk situations (e.g. social situations, stressful events).
  • Introduce self-monitoring procedures and strategies to control drug use(e.g. time restrictions, use of smaller quantities).
• For patients not willing to stop or reduce now:
  • Do not reject or blame.
  • Clearly point out medical and social problems caused by drugs.
  • Make a future appointment to discuss drug use.
• For patients who do not succeed or relapse
  • Identify and give credit for any success
  • Discuss situations which led to relapse.
  • Return to earlier steps above.
• Self-help organizations (e.g. Narcotics Anonymous) are often helpful.

Medication

• Withdrawal from sedatives may require transfer to an equivalent dose of diazepam and a reduction of 10% of the preceding dose every three days. Severe benzodiazepine withdrawal (with hallucinations and autonomic instability) may require hospitalization.
• Withdrawal from stimulants, cocaine, or opiates may be distressing, but is rarely dangerous but may require medical supervision. Withdrawal from opiates is often managed with a 10-14 day tapering dose of methadone or naltrexone and long term stabilisation may be required by approved prescribers. Hallucinogens and cannabinoids do not cause a physical withdrawal reaction.

Specialist Consultation


Specialised counselling programmes for drug dependence should be considered, if available.

What a doctor might say to a person with a drug use disorder