Managing substance misuse in the general hospital

About the course

Substance misuse is a major problem in general hospitals in the UK, with 20% of patients meeting criteria for harmful use of alcohol and 10% for alcohol dependence. Substance misuse is associated with complications which are difficult to manage, such as withdrawal delirium and prescribing of potentially toxic medication. Yet assessment and management of patients with substance misuse is an area where many medical and nursing staff feel less confident. This course aims to address this by offering clinicians a comprehensive approach to managing substance misusing patients safely in the general hospital. Real-life case examples and group activities will be ensure that learners have an opportunity to apply their knowledge to complex clinical scenarios.

In the morning we will review the comprehensive assessment of substance misuse, including diagnostic criteria for harmful use and dependence. An overview of the structure and remit of addictions services will be included. The first session will then focus on alcohol withdrawal and associated complications including Wernicke-Korsakoff Syndrome, alcohol withdrawal seizures, and delirium tremens. The second session will focus on opioids, covering the background and rationale for opioid substitution (OST) prescribing, and optimising the safety of OST. Again, learners will have the opportunity to apply this knowledge through clinical cases.

After lunch, we will discuss novel psychoactive substances, stimulants, and cannabinoids.  These are more rarely encountered but can prove a management problem because of their association with severe behavioural disturbance.  We will include a detailed complex case presentation involving GBL overdose and withdrawal comorbid with stimulant-induced psychosis.  The afternoon sessions will shift focus on to the whole patient, providing a brief overview of the physical and psychiatric comorbidity associated with substance misuse, and relevant national guidelines.