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Christopher R. Brigham
,
Stephen L. Demeter
, and
E. Ranolph Soo Hoo

Introduction Determining the factors contributing to the disease in evaluating pulmonary disease is critically important. In the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment ( AMA Guides) , Sixth Edition, Section 5.3, Environmental Exposures, Lifestyle Choices, and Pulmonary Disease (6th ed, 80), emphasizes the importance of obtaining a thorough history of tobacco use and occupational exposures. This history is mandatory in assessing impairment related to cardiopulmonary issues. It should be noted in all evaluations

in AMA Guides® Newsletter
Joseph A. Hirsch
,
Steven Mandel
,
Kurt T. Hegmann
,
Alexandra G. Stratyner
,
Stuart Gitlow
,
James B. Talmage
, and
Christopher R. Brigham

Abstract

There is an epidemic of drug overdose–related fatalities. Recent data indicate that the age-adjusted death rate from overdoses nearly quintupled over a 20-year period (2001-2021) to 32.4 per 100,000. More than 70% of these fatalities were caused by opioid overdose, especially the synthetic drug, fentanyl. Despite an increase in substance abuse and dependency treatment, mortality and morbidity associated with opioid, cocaine, psychostimulant, benzodiazepine, alcohol, and tobacco use disorders continue to rise. To better understand the factors contributing to this crisis, the multifaceted phenomenon of drug addiction is explored. The controversial chronic, relapsing “disease of the brain” model, which emphasizes the role of the neurotransmitter dopamine, the ventral tegmental area, and the nucleus accumbens, is critically considered. In addition, more expansive neurobiological models that include a host of other neurotransmitters, brain regions, and cognitive processes, as well as classical and operant conditioning and social learning theory to help better understand compulsive drug taking, tolerance, risk-taking, and relapse, were examined. For this, the roles of genetics and epigenetics vs individual agency in drug addiction were considered. The economic and occupational consequences borne both individually and societally are enormous. Ultimately, whether the presence of drug addiction satisfies the criteria for a disability remains a conundrum, especially from the perspectives of financial support (eg, Social Security, private insurance companies) vs regulation (eg, licensing agencies).

in AMA Guides® Newsletter
Christopher R. Brigham
,
Steven Feinberg
, and
Waqas A. Buttar

disease process, and comorbid conditions are coexisting medical conditions that are not necessarily compensable in a work-related injury but may affect the patient's treatment and recovery. Many comorbid conditions are also chronic health conditions that may interact with the sequelae of a compensable injury or illness or may affect the patient's health and abilities. 7 Examples of comorbid conditions are chronic illnesses (eg, diabetes, heart disease, hypertension [HTN], arthritis), obesity, aging, tobacco use, illicit drug use, personality disorders, and

in AMA Guides® Newsletter
Marcos Iglesias

frequently preventable and often managed with lifestyle changes and early interventions. Therefore, physicians should identify modifiable behaviors and recommend healthy lifestyle choices. Most chronic diseases are caused by modifiable behaviors: tobacco use and secondhand smoke exposure, poor diet, lack of physical activity, and excessive alcohol consumption. 8 The Centers for Disease Control and Prevention (CDC) estimates that “eliminating three risk factors (smoking, poor diet, and lack of activity) would prevent 80% of heart disease and stroke, 80% of type 2 diabetes

in AMA Guides® Newsletter
Christopher R. Brigham
and
James B. Talmage

. Past Surgical History: Prostate surgery November of 2005. Off-Work Activities: He had one acre of land for which he did all of the landscaping and gardening. He also bikes and walks. Currently he lives in an apartment. Social History: He has occasional wine but no tobacco use. Present Complaints He states that his hand becomes numb particularly after 15 minutes of driving as well as in the course of his work activities. He finds himself having to shake his hand to allow himself to continue to work. This progresses as the day goes on. The pain can be 7 out

in AMA Guides® Newsletter
Jay Blaisdell
,
James B. Talmage
, and
Stephen Demeter

of treatment compliance is used in some other internal medicine chapters of the Sixth Edition, it is not used in the pulmonary chapter since any burden of ongoing treatment is already incorporated into the tables. The history should be recorded in the report as it was related to the physician by the patient and should not be confused with a summary of medical records reviewed. Dyspnea, hemoptysis, sputum production, cough, wheezing, tobacco use, and occupational history should be documented in detail. Whether supplemental oxygen is used intermittently or

in AMA Guides® Newsletter