Skip to Main Content


  1. Addiction is a very common medical illness. It is characterized by loss of control over an abusable substance, including an inability to voluntarily self-regulate drug use, compulsive preoccupation with obtaining or using a drug, and continued use despite adverse consequences.

  2. Addiction may be managed successfully as a chronic disease, and many patients respond positively to treatment with long periods of abstinence.

  3. Consultation with an addiction medicine specialist is encouraged when providing care for active or recovering alcohol or drug abusers during the perioperative period.

  4. Preoperative assessment of all patients presenting for surgery should include a routine evaluation for alcohol or drug abuse.

  5. Establishing a supportive, nonjudgmental but firm approach to the patient with active alcoholism or drug addiction is vital for successful care.

  6. Preoperative history, physical examination, and laboratory testing should be guided by the known medical consequences of alcohol and drug addiction.

  7. A blood alcohol concentration and a urine drug screen should be obtained in all active and most recovering alcohol or drug abusers.

  8. Polysubstance abuse is common among alcohol or drug users.

  9. Infectious diseases are epidemic in injection drug users.

  10. Alcohol abuse has extensive medical consequences that impact every major organ system and is a major risk factor for perioperative morbidity and mortality.

  11. Abuse of sedative–hypnotics, opioids, cocaine, amphetamines, hallucinogens, and inhalants is associated with a wide variety of drug specific medical complications.

  12. Withdrawal is commonly encountered during the perioperative period in alcohol or drug abusers, and prophylaxis against withdrawal should be instituted before surgery.

  13. Recovery involves abstinence in combination with a series of personal changes to maintain sobriety.


Addiction is a major public health problem. The lifetime prevalence of alcohol or drug addiction in the United States is estimated to be approximately 14% and 7%, respectively.1 The literature describing the evaluation and treatment of patients with addiction is exhaustive. This chapter focuses on what the anesthesiologist needs to know to effectively manage the perioperative care of the addicted patient.


Addiction is defined by loss of control over a drug or substance of abuse. The inability to voluntarily self-regulate drug use, compulsive preoccupation with obtaining or using a drug, and continued use despite adverse consequences are central features of this multifaceted disease.2 Initial drug use is usually voluntary, and most users do not develop drug dependence, but repetitive drug exposure in a susceptible individual appears to cause fundamental changes in central nervous system function that produce the disease. Evidence suggests that genetic predisposition to addiction may be related to alterations in neurocircuitry that enhance sensitivity to the reinforcing effects of drugs of abuse, thereby overwhelming cognitive control of behavior.3 Thus addiction is a chronic disease; once present, it is regarded as permanent. However, it may be managed successfully, and many patients respond positively to treatment with long periods of abstinence.4


The neurobiology of addiction has been well documented and is not discussed in detail here.3,5 Three major concepts pertain to ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.