Alcohol and drug dependencies are among the most difficult diagnoses physicians will ever have to make. Patients with these problems usually present with other primary concerns. They may seek medical attention for GI problems, sleep disorders, bone fractures, high blood pressure and many other problems, which may have their etiology in substance abuse or dependence.

In addition to the criteria listed below, personality changes also can indicate that a patient may be dependent on drugs or alcohol. These changes include mood swings, irritability, defensiveness, paranoia and forgetfulness. Also, noticeable changes in work behavior can add credence to the diagnosis of dependence. Frequent sick days, tardiness, deteriorating work performance, in addition to other symptoms, can help physicians make accurate diagnoses.

As difficult as making an accurate diagnosis may be, getting a patient to do something after you have helped identify the problem can be difficult.

According to the 2004 National Survey on Drug Use and Health from the Department of Health and Human Services, more than 23 million Americans had a need for alcohol or drug treatment. Of these individuals, more than 21 million did not receive treatment. Of those not receiving treatment, 34.5 percent reported that cost and insurance limitations were barriers to treatment. About 40 percent in this same group reported that they did not receive treatment because they were not ready to stop using drugs or alcohol.

"Our understanding of addiction and its treatment is better than ever," said Markus Dietrich, L.M.H.C., C.R.C., C.A.A.P., director of business development at Shands Vista. "Patients need to realize that addiction is treatable and recovery is possible. Like any chronic progressive illness, substance dependence needs to be managed over a life span."

Shands Vista is the site of the Florida Recovery Center, a collaborative program between Shands HealthCare and the University of Florida College of Mediciane department of psychiatry. This program includes comprehensive inpatient detoxification and rehabilitation that continues through different levels of care ranging from inpatient to partial hospitalization, intensive outpatient treatment and outpatient treatment. The Center is directed by Ken Thompson, M.D., A.S.A.M., UF College of Medicine associate professor of psychiatry and Scott Teitelbaum, M.D., A.S.A.M., UF College of Medicine assistant professor of psychiatry.

For more information or to refer a patient, call (888) 391-7181.

Supplemental Information

According to the DSM-IV R*, a patient needs to meet three or more of the following criteria (adapted) in a 12-month period to be diagnosed with substance dependence:

• A high tolerance as defined by the need of markedly increased amounts of the substance to reach desired effect or diminished effect with continued use of the same amount.*
• Withdrawal syndrome for the substance or substance is taken to relieve or avoid withdrawal symptoms.*
• The substance is often taken in larger amounts or over a longer period than intended.*
• Efforts to cut down or control the substance are unsuccessful.*
• A great deal of time and energy is spent to obtain the substance or recover from its effects.*
• Important social, occupational or recreational activities are given up or reduced because of substance abuse.*
• Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem.*

*Reference: Diagnostic and Statistical Manual of Mental Disorders- Revised, American Psychiatric Association, Washington D.C., 2000.

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