Substance Use Disorders

Description

General Measures 

Medicine Treatment 

Referral

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ICD-10 code: F10.0-F19.9 + (R40-R46/Z65.0-5/Z65.8-9/Z81.0-4/Z81.8)

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Consult National Policy guidelines on detoxification of psychoactive substances.

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Description

Substance use disorder consists of mental and physical symptoms caused by the use of one or more substances, despite significant substance-related problems (including abuse and dependence). Substance-induced disorders include intoxication, withdrawal, and other substance/medication-induced mental disorders.

Alcohol withdrawal

See: Alcohol withdrawal (uncomplicated)

Methamphetamines (tik), cocaine (crack), methaqualone (mandrax), cannabis

These patients usually do not require hospitalisation unless signs of severe withdrawal are present, e.g. seizures or severe irritability/agitation resulting in aggressive behaviour.

General Measures

Reassure and support the patient and family.

Medicine Treatment

For severe anxiety, irritability and insomnia:

• Benzodiazepine, e.g.: (Doctor prescribed)
• Diazepam, oral, 5–10 mg as a single dose or 12 hourly for 3-5 days

For seizure control and /or sedation:

• Diazepam, slow IV, 10 mg. (Doctor prescribed)

LoE:IVb²⁸

Referral

• Severe alcohol dependence.
• Past history of withdrawal seizures or a history of epilepsy.
• Past history of delirium tremens.
• Younger (< 12 years of age) or older age (> 60 years of age).
• Pregnancy.
• Significant polydrug use.
• Cognitive impairment.
• Lack of support at home or homelessness.
• Previous failed community detoxification attempts.
• Opioid substance use disorder.

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Standard Treatment Guidelines and Essential Medicines List for South Africa Primary Healthcare Level_Chapter 16: Mental Health Conditions_NEMLC Recommendations for Medicine Amendments 2020_2023