Clinical Management

Synopsis

It is tempting to think of the clinical management of people with drug problems in terms of specific actions, particularly of prescribing drugs. We are conditioned, as a society, to think in terms of medical treatment being some sort of action by ‘the doctor’ on ‘the patient’. While such a medical model can have its uses, particularly in minimising paralysing guilt over actions committed under the influence of drugs, the ultimate goal of any treatment and rehabilitation must be to enable the drug user to regain responsibility for the areas of life which have become out of control. Prescribing drugs, admission to hospital etc. may be part of this, but their role in relation to the whole process needs to be carefully weighed, particularly when faced with a person anxious for immediate answers to urgent problems but who, in reality, has long-standing difficulties which may take considerable time and effort to begin to tackle.

In attempting to manage a patient with a drug problem, it is important to consider the individual rather than the stereotype. Individuals need careful assessment and need to be involved with any decision about treatment. This latter does not necessarily include drug treatment, and any prescription for drugs must be considered as part of an overall treatment plan. Treatment may be long term but can be considered in terms of shorter-term achievable goals which must be reviewed at regular intervals. Many patients can be treated in a general practice setting, but more complex problems should receive specialist intervention.

This chapter will deal with the management of the medical problems arising from the excessive use and abuse of drugs described in chapter 2. However, it must be borne in mind that any medical treatment should be regarded as an adjunct (and sometimes only a minor adjunct) to ongoing counselling and rehabilitation.