Scope note: this article covers medical conditions caused by or aggravated by long-term substance use. SimranShri is a residential addiction treatment centre — we treat the addiction and the medical consequences that substance use has produced on the body. Where medical conditions need ongoing specialist care beyond our scope, we coordinate handover to the appropriate physician. We do not treat conditions unrelated to substance use.
By the time a patient arrives in residential rehab, the body has been living with substance exposure for years — often decades. The liver is not untouched. The heart is not untouched. Sleep architecture is disrupted. Nutrition is depleted. Blood pressure, blood sugar, and electrolytes are often out of range. A serious addiction programme treats all of this alongside the addiction, because a patient who is sober but still in liver failure is not a recovered patient.
Why addiction rarely travels alone
Long-term heavy substance use is a physiological stressor. Every major organ system absorbs some of that stress, and by the time dependency is established, measurable damage has usually accumulated. The damage is often silent — liver disease, cardiac issues, and nutritional deficits can be substantial before the patient notices symptoms. Part of the admission workup is surfacing the silent damage so it can be treated rather than ignored.
The pattern of damage is substance-specific. Alcohol concentrates damage in the liver, heart, and gastrointestinal system. Opioids have different consequences — respiratory, endocrine, injection-related. Stimulants hit the cardiovascular system hard. The workup at admission is calibrated to the substance profile.
Alcohol-related medical conditions
Liver disease
The most common alcohol-related medical finding at admission. Ranges from fatty liver (reversible with abstinence) through alcoholic hepatitis (serious, requires medical management) to cirrhosis (chronic, may require specialist hepatology care). Liver function tests at admission establish where the patient is on this spectrum.
Early fatty liver and alcoholic hepatitis respond substantially to abstinence, nutritional rehabilitation, and the standard residential programme. Cirrhosis requires coordination with hepatology and the residential stay includes education on what the patient needs to manage long-term.
Cardiovascular issues
Alcohol-induced hypertension is common and often undiagnosed at admission. Alcoholic cardiomyopathy — enlarged, weakened heart — is less common but serious. ECG and blood pressure monitoring at admission detect the majority. Hypertension often improves substantially with abstinence, sometimes resolving without medication.
Gastrointestinal issues
Gastritis, reflux, and pancreatitis are common. Alcohol-induced pancreatitis can be acute or chronic and requires specific management. Upper GI symptoms usually improve within 2-4 weeks of abstinence with dietary support.
Neurological issues
Peripheral neuropathy (numbness, tingling in hands and feet), Wernicke-Korsakoff syndrome (a thiamine-deficiency complication that requires immediate B1 supplementation), and cognitive impairment that improves slowly over months of abstinence. Thiamine supplementation is routine at admission for any patient with heavy alcohol history, regardless of whether deficiency has been confirmed.
Opioid-related medical conditions
Injection-related infections
Patients with injection histories are screened for HIV, hepatitis B, and hepatitis C at admission. Any positive result triggers coordination with the appropriate specialist — we are not a hepatitis or HIV treatment centre, but we identify and hand over.
Respiratory issues
Heroin that has been smoked rather than injected produces its own respiratory consequences. Chronic cough, reduced lung function, and bronchitis-like symptoms are common. Pulmonary evaluation at admission if indicated.
Endocrine issues
Long-term opioid use suppresses testosterone in men and disrupts menstrual cycles in women. Both typically recover on their own over 3-12 months of abstinence or buprenorphine stabilisation, but evaluation at admission is standard.
Constipation and GI motility
Chronic opioid use slows GI motility. Many patients arrive with long-standing constipation that has become part of their baseline experience. Resolves with abstinence and dietary support.
Stimulant-related medical conditions
Cardiovascular issues
The most important category. Cocaine and other stimulants stress the cardiovascular system acutely (during use) and chronically. Hypertension, arrhythmias, and in some cases cardiomyopathy or previous undiagnosed cardiac events. ECG at admission is mandatory for any stimulant-history patient, and cardiology consult is arranged where any abnormality is detected.
Nasal and respiratory damage
Long-term nasal cocaine use damages the nasal septum and sinuses. Chronic sinusitis, nosebleeds, and in advanced cases septal perforation. ENT consult arranged when findings warrant.
Neurological issues
Cognitive effects of long-term stimulant use — attention, memory, executive function — often improve substantially over the first 6 months of abstinence but can take longer. Cognitive assessment at admission and again at 3 months establishes baseline and progress.
Nutritional and sleep issues across substances
Nutritional depletion is nearly universal at admission across all substance categories. Patients have been undereating, eating poorly, or using substances that suppress appetite. Specific common deficits: thiamine (alcohol), folate, B12, vitamin D, iron, magnesium. Blood workup at admission identifies deficits and supplementation begins in the first week.
Sleep architecture is profoundly disrupted across substances. Even after the acute withdrawal phase resolves, normal sleep can take weeks or months to re-establish. Sleep hygiene, structured bedtimes, physical activity, and selective short-term sleep support are all used. We avoid benzodiazepine and Z-drug prescribing for sleep given the dependency history — non-habit-forming alternatives are used where pharmacological support is needed.
Dental issues are common — particularly in long-term methamphetamine or cocaine users, but also in long-term alcohol users who have been vomiting and poorly maintaining oral hygiene. On-site dental consultation and arranged treatment.
How the admission workup handles all this
The admission medical workup at SimranShri includes:
- Full physical examination by the psychiatrist and medical officer on day 1.
- Complete blood count, liver function tests, kidney function tests, lipid profile, blood sugar, thyroid function, vitamin B12, folate, vitamin D, electrolytes.
- ECG routinely; echocardiography if any cardiac concern or stimulant history with ECG abnormality.
- Urine toxicology to confirm substance profile.
- HIV, hepatitis B, hepatitis C screening for any patient with injection history.
- Nutritional assessment by the kitchen team in coordination with the medical team.
- Dental assessment where visible issues warrant.
- Specialist referrals (hepatology, cardiology, endocrinology, ENT) arranged where findings require.
The workup is done in days 1-3 and informs both the immediate medical management and the discharge handover plan. Patients leave with a clear picture of what they need to manage medically going forward, which physicians to see, and what the timeline for improvement looks like for the conditions that will resolve with abstinence.
Families sometimes worry that their loved one is "too unwell" for rehab and needs to be in hospital first. In most cases the two are compatible — we can manage substantial medical issues in-house with coordination, and delaying rehab admission for medical stabilisation usually delays both. Our admissions team does a medical screening call that helps determine the right pathway for your specific situation.
- By the time dependency is established, measurable medical damage has usually accumulated — often silent until surfaced by admission workup.
- Alcohol concentrates damage in the liver, heart, GI system, and nervous system. Liver disease ranges from reversible fatty liver through cirrhosis requiring specialist care.
- Opioid-related conditions centre on injection-related infections (HIV, hepatitis B/C), respiratory issues, endocrine disruption, and chronic constipation.
- Stimulant-related conditions are most cardiovascularly serious — hypertension, arrhythmias, cardiomyopathy. ECG at admission is mandatory.
- Nutritional depletion (thiamine, B12, folate, vitamin D, iron, magnesium) and disrupted sleep architecture are nearly universal across substances and respond to structured care.
- Admission workup includes full bloods, ECG, toxicology, infection screening, and specialist referrals where indicated. Patients leave with a clear medical handover plan.
