frequency of abuse. General findings are weight loss, constant
fatigue, red eyes, little concern for hygiene, lab abnormalities,
unexpected abnormalities in vital signs, depression, anxiety,
and/or difficulty with sleep.
2 Table 3 lists drug-specific clinical
findings. Many illicit drugs have oral side effects that are likely
to be encountered by dental professionals, so knowledge of these
substances is important for comprehensive treatment planning.
Opioids (heroin, codeine,
Pinpoint constricted pupils, bradycardia,
hypotension, decreased body
temperature, respiration depression, and
oral disease. 11, 12
Dilated pupils, hypertension, increased
respiration, tachycardia, Parkinson’s-like
characteristics, and oral disease. 11, 12
Hallucinogens (lysergic acid
tachycardia, muscle rigidity, and oral
disease. Reddening of the conjunctivae
with marijuana use. 11, 12
Jaundice (due to liver damage),
diminished immune response,
gastrointestinal damage (bleeding
lesions, acute gastritis, diarrhea), weight
loss, tremors, xerostomia, seizures,
nutritional deficiencies (especially
B1 thiamine), electrolyte imbalance,
cardiovascular diseases, cancer, brain
damage, oral disease, diminished
reproductive function, fetal alcohol
syndrome, spider petechiae on nose,
rhinophyma, and rosacea. 11, 12
Bradycardia, hypotension, respiration
depression, drowsiness, and lack of
coordination. 11, 12
Jaundice (from liver disease), coronary
artery disease, stunted growth, muscle
strains or ruptures, altered sex drive,
prostate enlargement, irreversible breast
enlargement, painful erections, shrinkage
of the testicles, abnormal sperm
production, acne, baldness, stretch marks,
and roid-rage. 11, 12
Table 3. Drug-Specific Clinical Findings
The relapse rates for chemical dependency are over 60 percent
for those who have sought treatment; therefore, goals for recovery
are aimed at reducing patients’ risk for relapse.
11, 22 A comprehensive
review of both inpatient and outpatient alcohol treatment outcome
studies found that only one third of patients maintained abstinence
from alcohol one year following treatment.
22 The United States gov-
ernment is the largest funder of alcohol and drug abuse prevention
and treatment research in the world, with the majority of work being
conducted through the Department of Health and Human Ser-
19 However, only one third of that government money is actu-
ally allocated to the treatment, education, and research of chemical
19 with two thirds allocated to law enforcement.
American health-care model has always been one of treating disease
rather than preventing it23 and if this does not change in the years to
come, those seeking treatment for chemical dependency are likely
to relapse. Due to the high relapse rates in this population, some
chemical dependency treatment programs are looking to alternative
modalities such as meditation and yoga as a component of a patient’s
Access to care for chemical dependency treatment is a problem
many Americans face due to the limitations, cost , and lack of insurance and treatment.
19 There are community-based services, but
they often have long waiting lists.
19 Thirteen to 16 million Americans need substance abuse treatment, but only three million receive
it each year.
19 Social workers commonly see these patients in their
practice, but only a small number are properly trained to render appropriate treatment.
19 Fifty percent of sentenced inmates in federal
prison in 2014 were serving time for drug offenses.
24 More prisons
are conducting chemical and dependency treatment programs with
a substantial number of probationers and parolees also participating
in various programs.
Treatment programs may include both inpatient and/or outpatient and selection can be based on the type of substance being
2 Initially, detoxification may be necessary with long-term
follow-up management or recovery-oriented systems of care.
Long-term management includes psychological counseling (to
address the issues that contributed to the chemical dependency
problem), supportive meetings such as Alcoholics Anonymous, and
continued medical supervision.
2 Specific treatment may be based on
the patient’s age, overall health status, extent of symptoms, extent of
dependence, type of substance being abused, tolerance for medica-tions/procedures/therapies, patient expectations for the course of
the condition, as well as overall opinions and preferences.
Many pharmaceutical medications are used in the treatment of
chemical dependency. Certain neurotransmitters are involved in
drug actions, and medications can lessen withdrawal symptoms,
reduce cravings, and promote normal brain function.
12, 19 Medications used in the direct treatment of chemical dependency include,
but are not limited to:
1. Methadone (Diskets, Methadose, Dolophine): Used to treat
narcotic drug addiction by suppressing symptoms and drug
11 Drug is an opioid agonist that can help taper patients
off of a substance in a step-down fashion.
12 This drug will also
lessen withdrawal symptoms.
2. LAAM (Levo-alpha-acetylmethadol): Suppresses withdrawal
symptoms and drug cravings.
3. Naltrexone (Revia, Vivitrol): Opioid antagonist that can block
receptors but does not eliminate drug cravings.
4. Anxiolytics/sedatives such as phenobarbital or diazepam
(Valium, Diastat): Used to treat withdrawal symptoms.
Medications specific to alcohol treatment include:
1. Alcohol-sensitizing agents such as disulfiram (Antabuse):
Causes adverse reactions when combined with alcohol,
such as nausea, vomiting, and hypotension.
11 Drug acts as a