Prevalence of Substance Abuse Disorders in Cancer Patients

ABSTRACT: Drug abuse presents a complex set of physical and psychosocial issues that complicate cancer treatment and pain/symptom management. Most oncologists are not be well versed in either the conceptual or practical issues related to addiction. As a result, they often struggle in their attempts to effectively treat patients who are or have been substance abusers, and they find it difficult to understand issues of addiction in patients with pain who have no history of substance abuse. In the first installment of a two-part series, the authors explore the epidemiology of substance abuse. An examination of the distinctions between abuse and dependence leads to definitions of these terms appropriate for the oncology setting. Guidelines for assessing aberrant drug-taking behavior are also offered. Part 2, which will appear in the next issue of oncology, will discuss the clinical management of cancer patients with a history of substance abuse.[ONCOLOGY 12(4): 517-521, 1998]

Drug usage is surprisingly common in this country, as indicated by statistics showing that almost one-third of the US population has used illicit drugs, and an estimated 6% to 15% have a substance-use disorder of some type.[1-3] The prevalence of drug use in this country and its association with life-threatening diseases, such as AIDS, cirrhosis, and some types of cancer,[4] ensures that problems related to abuse and addiction will be encountered in oncology settings.

Drug abuse (current or even a remote history) presents a complex set of physical and psychosocial issues that complicate cancer treatment and pain/symptom management. Oncologists are generally not well versed in either the conceptual or practical issues related to addiction; thus, they struggle in their attempts to treat these patients effectively, and they find it difficult to understand issues of addiction in patients with pain who have no history of substance abuse. In this article, we will examine important conceptual and clinical aspects of addiction that can lead to better care of these challenging patients.

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