# Lifestyle: substance_use archetype **Category:** [Clinical (archive)](https://discourse.openehr.org/c/clinical-archive/153) **Created:** 2006-05-10 03:54 UTC **Views:** 22 **Replies:** 9 **URL:** https://discourse.openehr.org/t/lifestyle-substance-use-archetype/14538 --- ## Post #1 by @Sam Dear All I have been working on the archetypes for lifestyle and have approached them with trepidation. I am aware that there are lots of things that a person might like to record, and a lot of preferences. So we need to have a rich model for these things. The first one I have published is substance use and as designed includes alcohol, tobacco, caffeine and others - it is possible to nominate the others and have as many as you wish. The substance archetype is on the Ocean site: [http://oceaninformatics.biz/archetypes/openEHR-EHR-OBSERVATION.substance_use.v1.html](http://oceaninformatics.biz/archetypes/openEHR-EHR-OBSERVATION.substance_use.v1.html) There is a link to the ADL on that page (second row) You will notice that I have not completed the descriptions in places, apologies. The question I have is whether it is best to deal with this as a broad archetype (deals with a number of substances although each slightly differently) or as specialisations. The current archetype is the former, but it would be possible to deal with these as three archetypes: Substance use \ _Alcohol \_Tobacco The advantage would be that you could look in the same place for the information and then see what the substance was, while the specialisation would provide the different recordings favoured for the different substances. The problem with this latter approach is that many people would probably use the unspecialised archetype for everything, and it would be difficult to get meaningful data about the most common substances leading to harm. For this reason, and the simplicity of use for software (templates mean that there could be three different templates that provided the same functionality), I favour the inclusive approach. I am interested in your thoughts, Sam --- ## Post #2 by @Bill_Walton Hi Sam, Could you say more about the need for 'substance use' archetypes? I'm not sure I understand why it would be a good idea to record alcohol consumption differently from, for example, consumption of herbal teas. Or prescription drugs for that matter. I'm sure I'm missing something. Thanks, Bill --- ## Post #3 by @Karsten_Hilbert Recording "substance use" is more intended to record a \*fact\* about the lifestyle of an individual rather than an \*intent to treat\* as with prescription drugs\. There's a fine line as always: herbal teas, OTC drugs etc may or may not have been intended to be treatment by the provider\. However, disambiguating such in a given case is at the discreetion of the provider/patient in question\. OpenEHR needs to provide facilities for both\. Karsten --- ## Post #4 by @Bill_Walton Hi Karsten, Karsten Hilbert wrote: > > Recording "substance use" is more intended to record a > \*fact\* about the lifestyle of an individual rather than an > \*intent to treat\* as with prescription drugs\. > > There's a fine line as always: herbal teas, OTC drugs etc > may or may not have been intended to be treatment by the > provider\. However, disambiguating such in a given case is at > the discreetion of the provider/patient in question\. OpenEHR > needs to provide facilities for both\. It seems to me that 1\) we want to provide a mechanism for recording \_all\_ substances used, and 2\) for each, we want to record who 'prescribed' it\. Patients "intend to treat" when they ingest herbal teas, OTC drugs, etc\.\. While I definitely see the value in recording the 'prescriber', I still don't see the value in creating a seperate archetype for 'substances' that are not provider prescribed\. In fact, it seems to me to create unnecessary complexity\. Example\.\.\. A patient is undergoing chemotherapy\. The patient finds that smoking marijuana helps control the nausea\. If the patient lives in California their physician can prescribe the use of marijuana\. It they live in Texas, its use cannot be prescribed\. Another example\.\.\. A patient wants to quit smoking cigarettes\. The physician prescribes Nicorette gum\. Then the FDA approves Nicorette for OTC sale\. What would be the information value of recording this information with different archetypes? What would seperate archetypes allow me to do that I couldn't do as easily with a single archetype with a 'prescriber' attribute that could accomodate a value of 'self'? Thanks, Bill --- ## Post #5 by @system The EHR is about recording observed facts. One of those facts is the "use of substances". This means one has to document: - What - What for - How - How much - When - Prescribed by whom, when, where - Dispensed by whom, when, where - Administered by whom, when, where - Used when - ... Irrespective of a regular drug, herbal tea, food additive, smog, self medicated, prescribed, or taken by an involuntary action one always want to record the same things. Isn't it? So why not a generic Archetypes: "Observation: Substance Use" Gerard -- -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 653 108732 --- ## Post #6 by @Karsten_Hilbert Concise, as always\. Karsten --- ## Post #7 by @chunlan.ma The fact of "use of substances" is a little more complicated than these. For example, a person started smoking in 1995. He quit smoking after receiving smoking cessation therapy for two months in 2000. For some reason, he re-started smoking in 2001. How could we record the commence date and the re-commence date using the current archetype? How could we record the fact about quitting smoking, such as the times this person attempts to quit, with/without help, the therapies he received, etc. Chunlan Gerard Freriks wrote: --- ## Post #8 by @system Yes. Life is more complex than we can imagine most of the times. What you are referring to is data and information dealing with addiction not the 'normal' use. The meaning if "Addiction to a substance" is considerably different from the "Use of a substance". Extra data and information will have to be documented. In my minds-eye I see an archetype "Observation: Addiction of a substance" and within it the use of "Observation: Use of substance". Gerard -- -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 653 108732 --- ## Post #9 by @Sam Dear All I want to move this to the Clinical list - we do not want to explain the vageries of medicine and health care as it is too time consuming. This is lifestyle data - not substance administration. Cheers, Sam Gerard Freriks wrote: --- ## Post #10 by @Sam Chunlan raised the issue of someone stopping and starting and wanting to keep a record of this. This is infact possible using the observation class, as we can have as many time events as required - and they can be interval or point in time. We can say that someone smoked from 12/3/45 to 15/4/89 - average consumption of 3 cigarettes per day, ceased on 15/4/89 We could have intervals with higher consumption.....I think this is a good way to use the Observation class in this situation. Sam Gerard Freriks wrote: --- **Canonical:** https://discourse.openehr.org/t/lifestyle-substance-use-archetype/14538 **Original content:** https://discourse.openehr.org/t/lifestyle-substance-use-archetype/14538