Rationale

Substance withdrawal has been shown to cause significant morbidity and mortality worldwide and enormous impacts on public health. Depending on the type of substance, there are withdrawal syndromes, which are important to identify and treat.

Causal Conditions

(list not exhaustive)

1. Chemical dependency (e.g., alcohol, illicit drugs, tobacco, prescription drugs)

Key Objectives

Given a patient with suspected substance withdrawal, the candidate will be able to identify the issue, potential consequences and the need to provide immediate and continuing support and intervention.

Enabling Objectives

Given a patient with suspected substance withdrawal, the candidate will

1. list and interpret critical clinical findings, including those derived from:

   1. a thorough medical, family and social history (see also Substance-Related and Addictive Disorders);

   2. collateral history, if indicated;

   3. a physical examination with particular attention to mental status examination and autonomic instability;

2. list and interpret critical investigations, including

   1. drug screening;

   2. use of appropriate screening tools (e.g., MMSE, CAGE, withdrawal assessment tools);

   3. laboratory or other investigative tests to screen for organ damage and other complications as appropriate (e.g., liver function tests, chest radiography);

3. construct an effective management plan, including

   1. supportive measures if required acutely (e.g., airway, fluid resuscitation, pain management);

   2. a safe environment (e.g.: hospitalization, recovery centers);

   3. appropriate pharmacological intervention (e.g., thiamine, long-acting benzodiazepines, sedation);

   4. referral for specialized care (e.g., addiction programs, family counselling, mental health services), if necessary.