Presenting Complaints

• Patients seldom complain of drug use but may present with:
  • Depressed mood.
  • Nervousness.
  • Insomnia.
  • Physical complications of drug use.
  • Accidents or injuries due to drug use.
• There may also be:
  • denial of drug use.
  • unexplained change in behaviour, appearance, or functioning
  • complaints of pain or direct request for prescriptions for narcotics or other drugs.
  • legal and social problems due to drug use(marital problems, missed work).
• Signs of drug withdrawal may be present, i.e.,
  • Opiates - nausea, sweating, tremors
  • Sedatives - anxiety, tremors, hallucinations ·
  • Stimulants - depression, moodiness
• Family may request help before patient presents (e.g. irritable at home, missing work).

Diagnostic Features

• Heavy or frequent use of illicit drugs or sedatives
• Continued use of drugs despite clear physical harm( e.g. injuries while intoxicated) psychological harm (e.g., psychiatric symptoms due to drug use) or harmful social consequences (e.g. loss of job)
• Difficulty controlling drug use.
• Strong desire to use drugs.
• Tolerance (can use large amounts of drugs without appearing intoxicated).
• Withdrawal (anxiety, tremors, or other withdrawal symptoms after stopping use)

Differential Diagnosis

• Drug use disorders commonly coexist with alcohol disorders (see Alcohol use disorders).
• Symptoms of anxiety or depression may occur with heavy drug use. If these continue after a period of abstinence (e.g., about four weeks), see sections on Depression, and Generalized Anxiety.