It is very important to remember that many patients who develop dependence on one substance may have a very high risk of developing dependence on another substance.
For example, your alcohol dependent patient may develop benzodiazepine dependence. This may be because both substances utilize similar neural pathways. Additionally, patients may have developed coping mechanisms centered around obtaining relief or comfort from a substance, rather than from non-chemical coping mechanisms.
Irrespective of the etiology of dual or polysubstance dependence, you must be aware of the additional risk when prescribing substances such as benzodiazepines and opioids to patients with a history of any type of substance dependence or abuse. You just might precipitate a “sideways” relapse.
Educating patients about this risk is key as well. If they know the risk of using other substances (aside from the one that they had the abuse issue with), they can become a partner in their own care. A well-informed and motivated patient will sometimes decline the dentist’s one-time hydrocodone prescription or the primary care doctor’s short-term lorazepam prescription to avoid the risk altogether.