Addiction Medicine

This edition of FP Essentials addresses substance use disorders, a group of conditions that many physicians are increasingly familiar with. In this edition, use disorders involving tobacco, alcohol, opioids, and benzodiazepines are covered. As the authors of this edition detail, these conditions are common, but the way they present has changed with time.

The use of tobacco products is a clear example of these changes. Data from 2023 show that roughly 10% of adults older than 18 years smoke cigarettes, compared with more than 20% in 2005 and more than 33% in 1979.^1,2 This is good news, but it is offset by increased use of electronic nicotine delivery systems (eg, e-cigarettes), particularly among young people. In 1990, nearly 30% of 12th graders reported smoking cigarettes. In 2020, that percentage had decreased to 7.5%, but 24.7% reported vaping. In the same period, more than 10% of 8th graders reported vaping tobacco within the previous 30 days.³ Section 3 covers tobacco use disorder and how to help patients reduce or quit tobacco use.

Alcohol use has also changed. The overall rate of use has decreased substantially. In 2000, 50% of 12th graders reported using alcohol and 30% reported binge drinking, compared with 33% reporting recent use and approximately 17% reporting binge drinking in 2023. Even so, approximately 50% of US adults older than 18 years drink alcohol regularly, and 25% report binge drinking within the previous year.⁴ Section 1 details the harms of alcohol use and explains what is known about the risks.

Opioid use disorder and nonmedical use of prescription drugs (specifically benzodiazepines) are also covered in this edition. Both conditions are commonly seen in primary care, although they are less common than tobacco or alcohol use disorder.⁵ The mortality rate from opioid overdose has increased steadily for at least the past 20 years and surged during the COVID-19 pandemic.⁶ The Centers for Disease Control and Prevention has noted an increase in overdose deaths from legal and illegal use of benzodiazepines and opioids.⁷ Sections 2 (benzodiazepines) and 4 (opioids) review how to diagnose and manage these use disorders.

Substance use disorders are common and impactful to our patients and their families. They are lifelong, chronic conditions, and family physicians are truly best positioned to care for patients with these conditions. I hope you find this edition useful in your practice.

Kate Rowland, MD, FAAFP, Associate Medical Editor
Vice Chair of Education and Associate Professor
Department of Family and Preventive Medicine
Rush University, Chicago, Illinois

Maureen O. Grissom, PhD, is a practicing psychologist and clinical professor in the Department of Behavioral and Social Sciences at the Tilman J. Fertitta Family College of Medicine at the University of Houston. She has collaborated on two other editions of FP Essentials and has taught students in family medicine residency, undergraduate medical education, and graduate level psychology courses about substance use disorders.

Michelle A. Carroll Turpin, PhD, is a clinical associate professor of pharmacology in the Department of Biomedical Sciences and assistant dean of admissions at the Tilman J. Fertitta Family College of Medicine at the University of Houston. Her PhD spans pharmacology, toxicology, and neuroscience. Her teaching and scholarship are focused on treatment of pain and the neurobiology of addiction. She has coauthored three book chapters and presented multiple seminars on substance use disorders and addiction.

Steven M. Starks, MD, MBA, is a geriatric psychiatrist and clinical assistant professor in the Department of Clinical Sciences at the Tilman J. Fertitta Family College of Medicine at the University of Houston. He has designed programs that integrate mental health practice into home-based care, long-term care, and primary care practice settings to ensure individuals with mental health and substance use disorders receive compassionate and effective psychiatric care and treatment. His work in medical education and mental health policy aims to create a culture where health care is compassionate, accessible, equitable, and free of barriers.

Brian C. Reed, MD, is a practicing family physician, and a professor in and chair of the Department of Clinical Sciences at the Tilman J. Fertitta Family College of Medicine at the University of Houston. Throughout his career, he has worked within health care safety net organizations and medical education, and has published several book chapters on substance use disorders. He currently codirects a preclerkship medical student course with Dr. Starks focused on substance use disorders.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Define alcohol use disorders using criteria from the Diagnostic and Statistical Manual of Mental Disorders.
• Prescribe medications appropriate for the treatment of alcohol use disorder.
• Identify patients at risk of benzodiazepine use disorder.
• Describe treatment modalities for benzodiazepine use disorder.
• Recommend appropriate therapy that is tailored to the needs of patients with tobacco use disorder.
• Use the 5 Rs framework for motivational intervention in patients who are not ready to attempt smoking cessation.
• Implement screening tools for opioid use disorder.
• Use medications to treat opioid use disorder.