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Chemical dependency is a common, chronic disease that affects up to 25 percent of patients seen in primary care practices.
Bismuth subsalicylate (Pepto-Bismol) and loperamide (Imodium) are safe for recovering patients to use. Caution is advised when using antiemetics such as prochlorperazine (Compazine)19 because they may affect the central nervous system.
As with addiction, obesity is a chronic illness that requires a comprehensive management approach, including education about the health risks associated with obesity, laboratory and other diagnostic studies to evaluate potential causes or complications of obesity, and assessment of the patient's readiness to make significant lifestyle changes.
Many recovering addicts have had negative experiences with health care professionals.10 Some negative experiences may be attributable to problems in physicians' attitudes, behaviors, or expertise in addiction medicine.
Another possibility is inadvertent harm, such as relapse precipitated by a prescribed medication that altered the patient's vigilance and judgment.11 Physicians must be cautious, sensitive, and nonjudgmental when caring for addicted patients.
When medications are necessary for medical conditions in recovering patients, mood-altering or addictive drugs should be avoided whenever possible.
Even nonaddictive, nonprescription medications may alter the patient's judgment, triggering relapse behavior.If appropriate, physicians should recommend nonpharmacologic treatment (e.g., lifestyle changes), as initial therapy.Patients may require referrals to learn stress reduction and relaxation techniques, and healthy eating and exercise habits.First-line therapy generally includes dietary education and appropriate exercise instruction that can be incorporated into the patient's schedule.Medications such as phentermine (Fastin), phenylpropanolamine, ephedra, and sibutramine (Meridia) are systemic psychostimulants with the potential for abuse or addiction, and should not be used in recovering patients.20 Orlistat (Xenical), a nonsystemic medication, may be used in conjunction with lifestyle changes in recovering patients who have no contraindications to the drug.20In patients recovering from chemical dependency, psychiatric symptoms are common but may be difficult to evaluate.Heightened awareness of addiction and its ramifications, in addition to open discussion with addicted patients, should encourage trust and lay the foundation for a solid physician–patient relationship.