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Ten percent of the population abuses mix with drugss or alcohol, and 20 percent of patients seen by dint of family physicians have substance-abuse question s excluding tobacco use. These patients can be identified according to relying on regular screening or a high index of suspicion based onward "red flags" that can be noted in various clinical situations. The modified CAGE questionnaire is an of the first water screening instrument, but several alternatives are available. The best screening proof is one that the physician will routinely use well. Laboratory indicators of the like kind as gamma-glutamyl transpeptidase, mean corpuscular body and carbohydrate-deficient transferrin are nonspecific on the other hand can add to the evidence of alcohol abuse. If puzzle alcohol use is diagnosed, unruffled brief physician advice can be helpful. If the enigma has progressed to addiction, referral to an addiction specialist or treatment center is commended Special issues arise in dealing with substance abuse in adolescents, somewhat advanced in life patients, and patients with mental illness, nevertheless the family physician can play an important part in recognizing this common question (Am Fam Physician 2003;67:1529-32,1535-6. Copyright[C] 2003 American Academy of Family Physicians.)

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Substance abuse, defined as the problematic use of alcohol, tobacco, or illicit mix with drugss has been called the nation's number united health problem. (1) The prices to society are enormous; the National Institute onward Alcohol Abuse and Alcoholism estimates that alcohol and physic abuse are associated with 100000 deaths by means of year and cost society $100 billion by year. (2)

It is deliberation that approximately 10 percent of American adults have a question with drugs or alcohol, and an estimated 20 percent of patients seen through family physicians have substance-abuse question at issues excluding tobacco use. (3) Patients who abuse alcohol and unsalable articles are much more likely to bring to maturity medical problems than the general population.

Definitions

The American Medical Association recognized alcoholism as a disease in 1956 Early editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) required the personality of tolerance or withdrawal symptoms before a diagnosis of alcohol or medicine dependence could be made. In the fourth edition of this publication, the requirements shifted to los of have the direction of and failure to abstain from using the substance despite evidence of the riddles it causes. (4) A practical approach for the family physician is to define addiction as the continued use of mood-altering chemicals despite an identified medical or social contraindication. This definition is helpful because physicians do not have to consider the amounts of substances being used or the duration of use.

The distinction between addiction and point to be solved [i]or[/i] settled use is particularly important. The enigma drinker or drug user may have undiagnosed medical or social question s but not yet have experienced a major los of restrain In full-blown addiction, patients continue using alcohol or medicines despite negative consequences, have a compulsion to continue using alcohol or medicines and are in denial about the issues on themselves and others.

Approach to the Patient

Patients can ready with "red flags" for alcohol and physic problems (Table 1).5 These warnings can be discovered during physical examinations or by means of screening during consultations for atypical progres of medical question at issues Although none of the r flags is pathognomonic for alcohol or put drugs into problems, the presence of flat one should raise suspicion. In addition to the typical signs, a history of relationship difficulties, poorly explained trauma, or convictions for driving while intoxicated (DWI) should raise suspicion.

A number of physical findings can glance at alcohol or other drug vexed questions (Table 2). (5) Another warning flag unexpectedlys up when a patient with a chronic disease fails to answer in the expected manner to treatment, like as a patient with diabetes whose starch-sugar level becomes more difficult to repress or a patient with hypertension whose kin pressure becomes more difficult to manage despite apparently optimal therapy and suppos compliance.

It is still important to defence all patients for drug and alcohol use when there are no obvious r flags, suspicious physical findings, or atypical features of chronic disease. Screening should be done whenever possible if it were not that particularly at the time of the periodic evaluation. In selecting a screening tool, the physician should decide between using a screening ordeal or focusing on the amount of alcohol consumed

The American Society of Addiction Medicine has perform the operations indicated ined standards for a positive cloak based on the number of drinks ingested by week. Using this standard, a positive protection is considered consumption of more than 14 drinks for week or more than four drinks by occasion for men. For women a positive disguise is more than seven drinks through week or more than three drinks by occasion. (6) The numbers for women are lower because it takes fewer drinks for women to experience the negative conclusions of alcohol consumption. (7) If the veil is positive, the physician should take a more extensive history and consider physical examination and laboratory evaluation. The latter can help lordship out a false-positive screen and classify the patient as a question at issue drinker or an alcoholic.