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PYB159 - No.2 > 13. Specialist Interventions > Flashcards

13. Specialist Interventions Flashcards

1
Q

what are some interventions targeting the drug with regards to drug information?

A

Important to provide accurate information
Particularly useful for pre-contemplators
Correct inaccurate or dangerous information

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2
Q

What information is required about drugs for intervention and where can these be obtained?

A

Effects and side effects, dosage, methods, and potential harms
E.g. Brochures/psycho-education

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3
Q

How is drug information useful for pre-contemplators?

A

Avoids confrontation and argument

Raises awareness

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4
Q

What are the interventions targeting the drug withdrawal management (detoxiication)

A

Variety of settings (related to service and severity of withdrawal)
Inpatient
outpateint
stepping stone to ongoing drug treatment
rates of relapse post withdrawal management are usually high

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5
Q

what are the varieties of settings in the interventions targeting the drug withdrawal management (detoxiication)?

A

General hospital, specialist inpatient units, outpatient clinics and home-based

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6
Q

when is inpateint interventions required in withdrawal management?

A

when physical dependence requires medical assistance

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7
Q

when is outpatient interventions required in withdrawal management?

A

Less severe or complicated

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8
Q

what is stepping stone to ongoing drug treatment an intervention?

A

Not a treatment by itself

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9
Q

what is delirium tremens?

A

Condition caused by alcohol withdrawal

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10
Q

how is delirium tremens characterised?

A

characterized by tremor, visual hallucinations, and autonomic instability

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11
Q

what did Jack Kerouac say about delirium tremens?

A

“But anybody who’s never had delirium tremens even in their early stages may not understand that it’s not so much a physical pain but a mental anguish indescribable to those ignorant people who don’t drink and accuse drinkers of irresponsibility.”

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12
Q

what did Vanessa in 17 years clean say about addiction?

A

“Once addicted, your life then becomes a dedication to your addiction…

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13
Q

what are agonists

A

drugs that occupy receptors and activate them

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14
Q

what are antagonists?

A

drugs that occupy receptors but do not activate them. they block receptor activation by aconists

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15
Q

what does agonist alone result in?

A

full activation

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16
Q

what does agonist + antagonist result in?

A

less activation

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17
Q

what does antagonist alone result in?

A

no activation

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18
Q

What is the naltrexone rapid detoxification intervention of targeting the drug?

A

Naltrexone is an Opiate Antagonist - blocks the effect of opioids
Causes a rapid withdrawal from opiates (matter of hours vs days)
Not shown to be more effective than standard methods of detoxification hence it is Not widely offered
Risks associated is Mainly overdose

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19
Q

what is the effect of naltrexone maintenance treatment?

A

Cravings reduced, and blocks effects of opiates -
Varying effectiveness – not widely supported

Prior to use - detox completely from opioids
To minimise withdrawal reaction

Tablets vs implants

Outcomes best if highly motivated, employed, with good social support, older and with prior treatment experience

Cost can be a restrictive factor

Risk of overdose

20
Q

what is the methadone maintenance treatment of interventions targeting the drug?

A

Full opiate agonist

For those unable to cease opiate use/manage withdrawal

  • Maintenance rather than abstinence
  • Often preferred choice for high levels of opiate dependence
  • Can be useful for chronic pain treatment
  • Protective treatment for released prisoners with opiate use histories

Selected GP and Alcohol and Drug Services only – highly regulated

High retention in treatment
Not as intensive

Reduces/does not eliminate heroin use for all

Reduces HIV risk behaviour, criminal behaviour, and risk of overdose

21
Q

what is the buprenophine intervention targeting the drug?

A

Partial agonist & partial antagonist

Maintenance treatment
Can be a detoxification aid
Detoxification and withdrawal from Buprenorphine better tolerated than from methadone or heroin
Less severe symptoms

Higher doses improve retention in treatment and reduce heroin use

Can be taken in one, two, or three day doses (Double/Triple dosing options)

Compared to methadone maintenance treatment:

  • Similar/slightly less retention in treatment,
  • Reduces illicit drug use to an equivalent or greater extent
22
Q

what is the theory of liquid handcuffs?

A

“Ask the same people (people on methadone) what they know about methadone itself, where it comes from or the chemistry behind it, and they shrug. “Who cares? You’re not hanging out. You’re not twitching. You can function.” And the bad part? “You put on weight. It makes you sweat. Rots your teeth. Keeps you tied to a clinic or pharmacy.””

23
Q

what are anticraving medications?

A

Campral (Acamprosate) - 3 times daily dosing

Naltrexone - Daily dosing and High cost

Both sometimes prescribed taken together

Mixed effectiveness

24
Q

what is antabuse maintenance therapy?

A

Blocks enzyme that metablises alcohol

Reacts with alcohol to make client feel very ill -
Effectively develop a severe allergic reaction to alcohol (can be fatal)

More effective if used in conjunction with ongoing support

Indications: Alcohol Use Disorder with Tolerance/Withdrawal symptoms and abstinence as a goal

Some risks including hepatitis
Regular liver function testing essential

25
Q

what are examples of nicotine replacements?

A

Patches
Once-daily application, socially acceptable, easy to use, steady and reliable dose

Gum
Best for smokers heavily dependant on Nicotine
Poor compliance

Inhalers
Plastic tube with inhalable nicotine

All are more effective with counselling

26
Q

what occurs in urine drug screening?

A

Random or intermittent urine drug screening to identify drug used recently
Timing varies between drugs – depends on pharmacokinetics

May aid in relapse prevention
Best if voluntary decision by person

Helps to demonstrate adherence?
False positives/negatives

Danger in shifting to less easily detectable drugs, masking agents etc…
Focus can become on ‘beating’ the screen rather than treatment goals

27
Q

in interventions targeting the individual, what is controlled drinking/drug use training

A

If abstinence not a goal – harm minimisation approach
Requires high motivation
Difficult for long-standing addiction
Environmental factors often key to success -
Strong social supports required

28
Q

What is the process involved in controlled drinking/drug use training?

A

Self-monitoring
Develop limits and rules around consumption
Devise strategies for high risk situations
Use rewards to maintain changes to behaviour

29
Q

what are tips to control your drinking in the controlled drinking programs?

A 
Plan drinking 
Consume drinks with less alcohol 
Avoid cocktails and punches 
Start with non-alcoholic drink 
Every second drink non-alcoholic
30
Q

what are self-help groups?

A

Non-drug using social support – usually run by peers in recovery
Widely available
Easy to set up and run – no/low cost
12 Step programs most common

31
Q

why is the 12-step program the most common self-help group?

A

Strong ‘spiritual’ based philosophy
Require abstinence as a goal
peer facilitated treatment

32
Q

what are the 12 steps in the 12-step program?

A

Step 1 - We admitted we were powerless over our addiction - that our lives had become unmanageable
Step 2 - Came to believe that a Power greater than ourselves could restore us to sanity
Step 3 - Made a decision to turn our will and our lives over to the care of God as we understood God
Step 4 - Made a searching and fearless moral inventory of ourselves
Step 5 - Admitted to God, to ourselves and to another human being the exact nature of our wrongs
Step 6 - Were entirely ready to have God remove all these defects of character
Step 7 - Humbly asked God to remove our shortcomings
Step 8 - Made a list of all persons we had harmed, and became willing to make amends to them all
Step 9 - Made direct amends to such people wherever possible, except when to do so would injure them or others
Step 10 - Continued to take personal inventory and when we were wrong promptly admitted it
Step 11 - Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out
Step 12 - Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs

33
Q

what are brief interventions?

A

1-5 sessions with follow-up and self-help material
Very focussed interventions - e.g. decision making, problem solving, goal setting, relapse prevention
Useful for pre-contemplators, less severe/complicated Substance Use Disorder, and primary care settings
Results often as good or better than longer therapy in these contexts

34
Q

what is the premise in social skills training?

A

Deficient social skills -

Leads to poor adjustment and dysfunction and thus use Substance abuse as a coping strategy

35
Q

what is the focus in social skills training

A

training in areas of deficiency - teaching new social skills
group therapy can be a good setting for this

36
Q

what is involved in social skills training?

A

Assertiveness training, anger management, relaxation training, modelling, role playing etc…

37
Q

what is involved in cognitive behavioural therapy?

A

May be a longer-term intervention
Focus on dysfunctional cognitions
Behaviours that maintain alcohol and other drug use
Skills training
In addition to treatments for any mental health comorbidities

38
Q

What are behaviours that can maintain AOD use?

A

Change to social groups, cued associations, “seemingly irrelevant decisions”

39
Q

in interventions targeting the environment, what are community developments?

A

Generates and disseminates drug-related resources to the community
Prevention and intervention strategies
Can raise awareness of drug issues
Useful if linked to the development of more comprehensive strategies for the community

40
Q

in interventions targeting the environment, what are Employment, educational and recreational opportunities?

A

Recognises role of social disadvantage in substance abuse problems
If successful, are strong protective factors against drug misuse
Opportunities to develop skills and social networks outside the drug using lifestyle
Can improve self-worth and self-esteem
Introduces alternatives and healthy lifestyle

41
Q

in interventions targeting the environment, what are family therapy?

A 
Focus on treating the ‘family’
Better treatment outcomes
Family members need to agree to be involved
Confidentiality issues
Multiple needs need to be managed
42
Q

why do family therapies have better treatment outcomes?

A

Can improve compliance with treatment and earlier engagement

Can alleviate distress for significant others

43
Q

in interventions targeting the environment, what are case managements?

A 
Single point of contact with health and social services
Client driven
Advocacy
Community based
Flexible and culturally sensitive
Link clients with appropriate services
Monitor clients’ progress in treatment
44
Q

in interventions targeting the environment, what are rehabilitation centres?

A

Medium to long-term residential programs
Public & Private options
- Private usually shorter stay – a few weeks, Public – a few months
Generally require abstinence as a goal
Facilitate access to medical services, education, employment, skills training, and community supports
Usually promote participation in daily running of program – ‘Therapeutic Community’
Tend to be group therapy based
Staged reintegration programs - Half-way and 3/4 (less structured) houses

45
Q

What is involved in matching clients to treatments?

A

No two people are the same
Different problems require different types or combinations of interventions at different levels - Although there are specific interventions that may work best for specific populations
Job of clinician/case manager is to work out which option is best for the client, in collaboration with the client

46
Q

what is usually most effective treatment?

A

combinations of treatment and intervention options. i.e. drug intervention, indivudal intervention and environment interventions
drug - maintenance therapy
individual - CBT
Environment - family therapy

47
Q

what is the goal of matching clients to treatments?

A

Goal is to place client into least intensive treatment that will most likely facilitate treatment goals

PYB159 - No.2 (5 decks)

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