Dr. Stewart is a physician whom has owned his own practice for about twenty years now. John has been a patient of Dr. Stewart’s for about ten years. John has come to see Dr. Stewart for his yearly checkup. Dr. Stewart asks John the regular questions:
- How are you feeling?
- Anything out of ordinary you would like to tell me about?
- How’s the wife and kids?
Dr. Stewart then does a full physical which includes a review of body systems. He palpates John’s abdomen and finds what feels like an enlarged liver. He makes note of this. He then has the medical technician draw blood for labs which includes a chemistry and CBC or complete blood count. A few days later, John’s blood work results come back. The AST and ALT levels are a bit elevated. AST and ALT are both indicators of liver function. If the test results come back high, this could be indicative of issues with liver function. Dr. Stewart sits down and looks at John’s chart. Has his patient ever had an incidence of high LFT (liver function tests)? He checks, no not really. Then Dr. Stewart starts thinking about John’s appearance. His eyes were blood shot; he was dressed a little sloppy. John had mentioned that his job was not going all that well. He seemed to be under general strain. When Dr. Stewart thought about having seen John in the past it occurred to him that he had looked better.
Dr. Stewart goes through the list of prescription medications that John takes. Nothing on the list would cause an inflamed liver or high LFT results. The only other option Dr. Stewart can think of is possible substance abuse.
Drinking can cause a variety of different health issues the most common and likely are liver issues. A fatty liver can develop which happens when the liver cannot break down fats properly. Extra fat is left in the liver which it then becomes inflamed. Scar tissue can also be formed when the liver attempts to heal itself. Eventually, this can lead to cirrhosis which is when the connective scar tissue develops and can attack healthy cells. This also results in high liver enzyme levels.
It is up to Dr. Stewart to speak to John about his test results. It is also a good idea for Dr. Stewart to breach the subject of substance abuse with John. It’s an embarrassing proposition for Dr. Stewart to consider. He has been treating John for years; they run in the same social circles, their kids even go to school together. Bringing up John’s possible substance abuse issue is uncomfortable to say the least. Dr. Stewart is worried of offending John and more than anything else, he is afraid of being wrong.
Dr. Stewart’s issue is one that many physicians face when there is a possibility of substance abuse. Modern medicine training programs are full of valuable and helpful information. As a doctor one must have a wealth of knowledge about the human body and treatment issues one might be confronted with. This leaves little time for additional classes or information. This is a huge problem in regards to substance abuse screening. Doctors are a great way to stop a problem from progressing.
In an effort towards prevention of drug disorders, the NIH (National Institute of Health) has developed a program for training physicians on how to screen for drug abuse disorders and how to help inpiduals in this predicament. As Dr. Nora Volkow, Director of NIDA (National Institute on Drug Abuse) has said:
“Physicians can be the first line of defense against substance abuse and addiction, but they need the resources and the training. "Our long term goal is for doctors to incorporate screening for drug use into routine practice like they currently screen for other diseases; to help patients that are abusing to stop; and to refer more serious cases to specialized treatment."
According to NIDA there are three patterns that need to be addressed in terms of substance abuse and physician screening:
- Recognition of substance abuse disorders can be fixed by proper communication between physician and patient.
- Teaching physicians how to screen for substance abuse disorders is also imperative in terms of other disorders that physicians may treat.
- The importance of physicians identifying substance abuse issue can help with an inpidual not actually developing a disorder.
With the popularity of prescription drug use, physicians should be on the outlook for substance abuse more than ever before. In the story above, it is quite possible that Dr. Stewart ignored earlier signs of John’s alcohol problem. Dr. Stewart eventually does speak to John and finds out that he does need help. He gets him the help of a counselor. John eventually goes into a substance abuse outpatient treatment program.
If the NIDA’s program is utilized, then hopefully more inpiduals like John will have their substance abuse caught early by their physician. This in turn could lead to less damage done to one’s body, life, family and job.
Rachel Hayon, BSN, MPH, RN
Kingston, A.H., Jorm, A.F., Kitchener, B.A., Hides, L., Kelly, C., Morgan, A.J., Hart, L.J., Lubman, D.I. (2009). Helping someone with problem drinking: Mental health first aid guidelines - a Delphi expert consensus study. BMC Psychiatry, 9:79
NIDA Launches New Substance Abuse Resources to Help Fill Gaps in Medical Education http://www.drugabuse.gov/newsroom/09/NR11-06.html. Retrieved 2010-01-05
Van der Wagt, E. What Causes High Enzyme Levels in the Liver? http://www.ehow.com/facts_5636400_causes-high-enzyme-levels-liver_.html. Retrieved 2010-01-04