To make the dx of SUD, you can use the DSM criteria or if you like mnemonics, look for the 4 R’s (Role failure, Relationship trouble, Risk of bodily harm, Repeated attempts to cut back) and 4 C’s ((loss of) Control, Craving, Compulsion to use, Consequences of use) in a patient’s history to make a SUD diagnosis.
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The finding of cocaine (or its metabolite, benzoylecgonine) in the urine drug screen is not a diagnosis and warrants a conversation with the patient; a patient using cocaine intermittently without chaotic use or a cocaine use disorder present may continue buprenorphine as treatment for an opioid use disorder.
Naltrexone is an FDA-approved medication for patients with alcohol use disorder that is first line for patients trying to drink less or stop drinking; it can be taking daily orally or monthly as injection.
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