Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 23. Evaluation of the Patient with Alcohol or Drug Addiction Paul S. Pagel, MD, PhD, Judith A. May, MD, and David C. Warltier, MD, PhD

Key Points

"1. Addiction is a very common medical illness. It is characterized by loss of control over an abusable substance, including an inability to voluntarily self-regulate drug use, compulsive preoccupation with obtaining or using a drug, and continued use despite adverse consequences.

2. Addiction may be managed successfully as a chronic disease, and many patients respond positively to treatment with long periods of abstinence.

3. Consultation with an addiction medicine specialist is encouraged when providing care for active or recovering alcohol or drug abusers during the perioperative period.

4. Preoperative assessment of all patients presenting for surgery should include a routine evaluation for alcohol or drug abuse.

5. Establishing a supportive, nonjudgmental but firm approach to the patient with active alcoholism or drug addiction is vital for successful care.

6. Preoperative history, physical examination, and laboratory testing should be guided by the known medical consequences of alcohol and drug addiction.

7. A blood alcohol concentration and a urine drug screen should be obtained in all active and most recovering alcohol or drug abusers.

8. Polysubstance abuse is common among alcohol or drug users.

9. Infectious diseases..."