Unhealthy alcohol users are much more likely than the general population to have concurrent tobacco and illicit drug use. This chapter gives an overview of what clinicians need to know about recognizing other drug use and its attendant comorbidities, and providing preventive care and substance use interventions. Substance use is most likely to be uncovered through routine screening, which should be followed by an assessment that determines the degree and severity of use. Medical providers should be aware of common medical and psychiatric problems among tobacco and other drug users. They should be prepared to provide focused preventive care, and to educate patients on harm reduction strategies, including use of sterile injection equipment and overdose prevention. Importantly, medical providers can intervene directly to help patients reduce or stop using tobacco and other drugs, through pharmacotherapy coupled with counseling. Addressing tobacco and other drug use among patients with unhealthy alcohol use can enhance the success of alcohol interventions, and improve overall patient care by helping the provider to identify and treat associated medical conditions, avoid potentially harmful drug interactions, understand and improve adherence to treatment, and build trust.
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