Assessment and Management of Substance Use Disorders

Immediate Safety Assessment

The American Academy of Family Physicians recommends assessing for physical dependence on alprazolam by determining frequency, duration, and daily dose of street Xanax use, as withdrawal can be life-threatening with seizures, severe anxiety, altered mental status, and autonomic instability 1, 2
The American Academy of Family Physicians suggests screening for withdrawal risk factors, including history of seizures, concurrent alcohol use, duration of benzodiazepine use, and daily dose consumed 1, 3

The American Academy of Family Physicians recommends a planned gradual taper over 8-12 weeks with conversion to long-acting benzodiazepine for patients with benzodiazepine dependence 1
The World Health Organization suggests using validated screening tools, such as the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), to quantify severity of cannabis use disorder 4
The American Academy of Family Physicians recommends brief psychosocial intervention as first-line treatment for cannabis use disorder, incorporating motivational principles, individualized feedback, and advice on reducing or stopping cannabis use 1, 7

The American College of Physicians recommends SSRIs as first-line treatment for anxiety in patients with substance use history, due to their strong efficacy evidence and no abuse potential 6
The American College of Physicians suggests prescribing escitalopram, sertraline, paroxetine, or fluvoxamine for anxiety treatment in this population 6

The Centers for Disease Control and Prevention recommends educating patients on risks associated with early marijuana use, including increased risk of psychotic illness and mood disorders 4, 9, 10
The American Academy of Family Physicians suggests referring patients to mutual help groups, such as Narcotics Anonymous (NA) or SMART Recovery, for support in recovery 11, 3

The American Academy of Family Physicians recommends close monitoring during benzodiazepine taper, with weekly visits initially to assess withdrawal symptoms and medication adherence 1
The American Gastroenterological Association suggests verifying cannabis abstinence after 6 months abstinence (or duration equal to 3 typical symptom cycles) to confirm CUD diagnosis 5