The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 3: Assessment of Physical SymptomsTable 3-4: Aberrant Drug-Related Behaviors* (continued)26 picasBehaviors more suggestiveof addiction continuedBehaviors less suggestiveof addictionRepeated dose escalations or similarnoncompliance despite multiple warningsRepeated visits to other clinicians oremergency rooms without informingprescriberDrug-related deterioration in function atwork, in family or sociallyRepeated resistance to changes in therapydespite adverse drug effectsAggressive complaints about the need formore drugsDrug-hoarding during periods of reducedsymptomsRequesting specific drugsOpenly acquiring similar drugs from othermedical sourcesOccasional unsanctioned dose escalation orother noncomplianceUnapproved use of the drug to treat anothersymptomReporting psychic effects not intended bythe clinicianResistance to a change in therapyassociated with tolerable adverse effectsIntense expressions of anxiety aboutrecurrent symptomsIII* Based on clinical experience, these behaviors can be divided into those that are relatively more or less likely to be related to addiction.Source: Passik SD, Portenoy RK. Substance abuse issues in palliative care. In Berger A, ed. Principles and Practices of SupportiveOncology. Philadelphia: Lippincott-Raven Publishers, 1998. Reproduced with permission. Copyright 1998.If aberrant behaviors are identified in a patient, the differential diagnosis of these behaviorsshould be explored (see Table 3-5). Aberrant behavior may occur in the setting of addiction. Italso seems likely that some behaviors are more suggestive of addiction than others. The differentialdiagnosis of all of these behaviors is broad and includes many diagnoses and problemsother than addiction. 48, 49 Psychiatric disorders, confusional states, pseudo-addiction and criminalintent are among the problems that should be considered. Pseudo-addiction refers to thepresence of behaviors that are suggestive of addiction in a patient whose problem is not addic-U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 59