New-Onset Wrist Drop After a Night of Drinking: A Case Report.

This case report highlights the clinical approach to evaluating a patient with substance use disorder presenting with a sudden onset of peripheral neuropathy in the left hand. Our patient had significant cardiovascular risk factors, which further broadened the differential diagnosis beyond common causes of mononeuropathy. The use of detailed and appropriate clinical history, physical examination, and careful selection of relevant laboratory and radiological tests was instrumental in ruling out multiple medical differential diagnoses, including common mononeuropathies and life-threatening ones, such as cerebrovascular accidents, which facilitated the involvement of necessary consults while also treating both the presenting medical complication and underlying severe alcohol use disorder with additional efforts at relapse prevention.

Improving Substance Use Disorder Treatment Training in Medical School.

Substance use disorder (SUD) remains a major cause of morbidity and mortality in the United States and globally. Even though a lot of proposals have been implemented to help combat the opioid epidemic and are to be applauded, there remain a lot of changes that need to be made at the level of medical school training of physicians. It will take a paradigm shift to effect a lasting change in the culture around SUD treatment. This will include a review of the curriculum, which is still skewed towards the management of established diseases rather than prevention and screening, the changing of the lingo of stigmatization of patients and the disease, which in turn affects treatment utilization. These changes should also emphasize risk stratification, the ready application of the United States Preventive Services Task Force screening recommendations for drug and alcohol screening, and the use of recommended drinking limits for men and women readily in patient evaluation, coupled with prompt intervention. There should be a concerted effort to build skills in proven evidenced-based behavioral therapy complementary to existing effective pharmacological therapies. The examinations by medical schools and the medical examining bodies should reflect these changes. Despite all our efforts in the treatment of established SUD so far, we are not going to treat our way out of the "drug epidemic" without emphasis on prevention and intervention, especially at the grassroots of medical education.