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An Introduction to Substance Use Disorders for Dental Professionals

Course Number: 545

Causative Factors or Etiology

The difference in susceptibility to addiction is considered to be related to genetic influences. Very few people are able to return to occasional use after becoming addicted. Patients with a substance use disorder often begin taking a substance to achieve a desirable pharmacologic effect. When the drug use is continued to relieve personal problems or used as a coping mechanism, dependence may develop. When the individual becomes dependent on the drug, a genetically associated psychological mechanism leads to an alteration of the brain function. This is a feature of central nervous system (CNS) drugs that leads to addiction.

Genetic factors significantly contribute, approximately 50%, to the likelihood that an individual will develop an addiction. Environmental factors, cultural influences and resilient behaviors learned by the individual impact the extent to which genetic factors exert their influence.3

Other factors that may contribute to the genetic expression of addiction include: 3

  • Cognitive and affective distortions, which impair perceptions and compromise the ability to deal with feelings

  • Disruption of healthy social supports and problems in interpersonal relationships

  • Exposure to trauma or stressors that overwhelm an individual’s coping abilities

  • Distortion in meaning, purpose and values that guide attitudes, thinking and behavior

  • Distortions in a person’s connection with self, with others and with the transcendent (also referred to as God or the Higher Power)

  • The presence of co-occurring psychiatric disorders

It is important for the clinician to have tools to help identify potential oral health risks. The Caries Risk Assessment Form (Figure 1) is a form that can be utilized to identify the oral health risks for the patient who uses/abuses various substances and assist them with identifying patient education strategies to best meet their needs.

Chart to identify the oral health risks for patients who use/abuse various substances.

Figure 1. The Caries Risk Assessment Form.

In order to begin the discussion about possible substance use disorders, the use of verified screening tools may be helpful. Below are links to a variety of such tools. Some, such as the TAPS tool, screen for a number of substances including alcohol and prescription medications while others such as the MAST screen for alcohol only. While some instruments can be self- administered and others clinician-administered, all are meant to have professional discussion and follow-up.

For an overview of validated screening and assessment tools, click here.

  • TAPS for multiple substances including nicotine, alcohol and prescription medications.

  • DAST - 10 for drug use, not including nicotine or alcohol.

  • MAST screens for alcohol use only.

  • SBIRT in an early intervention and treatment tool for those with a substance use disorder.58