Undertreatment
Sociocultural influences
Disease-related factors
Redefining abuse and addiction for the medically ill

The following issues make assessing substance abuse among patients who are receiving treatment for medical illness more difficult.

If cancer pain is not adequately treated, a patient may use drugs recklessly in an attempt to seek relief. Many patients may not receive effective treatment for their pain. When the prescribed treatment is adjusted and pain is controlled, the patient's need to use drugs in a manner in which they were not prescribed disappears.

People who have a history of drug abuse may revert to the use of an illegal drug when their pain is not adequately treated. Some of these patients may develop an addiction to prescribed drugs.

Because the terminology used to describe drug abuse is not intended to include people without a history of drug abuse who are using medications therapeutically, many questions have yet to be answered. For example, while it is clear that a patient who forges a prescription, or injects a drug that was meant to be taken by mouth, is displaying deviant behavior, it is not clear if the same may be said about a patient who increases the dosage to control unrelieved pain, or takes a pain medication to fall asleep at night.

Health care professionals may make assumptions about the risk of drug abuse based on a patient's social group. If the patient belongs to a social group in which there is a high incidence of drug abuse, or if the patient has a history of drug abuse, it may be incorrectly assumed that the patient is at risk for abusing drugs prescribed for therapeutic purposes.

Substance abuse may be difficult to identify if the disease is progressing and causing the patient to have physical and mental changes. Treatment for disease may also cause these changes; radiation therapy to stop brain metastases, for example, can cause the patient to become withdrawn and experience mental changes.

To determine the cause of drug-related behaviors in patients who have advanced medical disease, the patients may be asked if the drug in question has been used at other times in the patient's life, whether drug use interfered with the patient's ability to complete treatment for the disease, and whether drug use prevented the patient from establishing a relationship with the health care team or family members.

The behavioral characteristics that are present in substance abusers, such as loss of control over drug use, compulsive drug use, and continued drug use despite harm, should be monitored in patients who are using drugs for medical conditions. Should a patient develop these behaviors, the health care provider should re-evaluate the patient's drug regimen.

Glossary Terms

Uncontrollable craving, seeking, and use of a substance such as a drug or alcohol.

Cancer that has spread from the original (primary) tumor to the brain.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

An uncontrollable urge to say or do something without an obvious reason. A person may repeat a behavior, such as hand-washing, over and over.

The amount of medicine taken, or radiation given, at one time.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

The use of illegal drugs or the use of prescription or over-the-counter drugs for purposes other than those for which they are meant to be used, or in large amounts. Drug abuse may lead to social, physical, emotional, and job-related problems.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).

A doctor's order for medicine or another intervention.

Cancer that is growing, spreading, or getting worse.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

A treatment plan that specifies the dosage, the schedule, and the duration of treatment.

The use of illegal drugs or the use of prescription or over-the-counter drugs or alcohol for purposes other than those for which they are meant to be used, or in excessive amounts. Substance abuse may lead to social, physical, emotional, and job-related problems.

Having to do with treating disease and helping healing take place.