22-02-23 - Drug and alcohol dependency

Question 1

Learning outcomes

Answer 1

• Contrast various historical and social models of substance misuse
• Contrast Medical and Biopsychosocial models of substance misuse
• Identify biological, psychological and social aspects of functioning from a case scenario
• Explain how these aspects of functioning may be used as the basis of a psychological formulation

Question 2

What are 3 classifications of problematic drinkers?

Answer 2

• 3 classifications of problematic drinkers:

1) Hazardous drinkers
* Drinking that increases risk of harm, in the absence of current harm.

2) Harmful drinkers
* Drinking above recommended limits with evidence of alcohol-related problems.

3) Dependent drinker
* Drinking associated with moderate / severe dependence

Question 3

What are treatment options for:
1) Prevention of drinking
2) Hazardous drinking
3) Harmful drinking
4) Moderately dependent drinking
5) Severely dependent drinking

Answer 3

• Treatment options for:

1) Prevention of drinking
* Public health programmes – primary prevention

2) Hazardous drinking
* Simple brief interventions in generalist setting

3) Harmful drinking
* Extended brief interventions in generalist settings

4) Moderately dependent drinking
* Less-intensive treatment in generalist or specialist settings

5) Severely dependent drinking
* More intensive specialist treatment

Question 4

What is the maximum number of units of alcohol that should be consumed per week?

What groups should not drink?

Answer 4

• A maximum of 14 units of alcohol per week for both women and men to keep health risks low, preferably spread over three or more days
• There should be no drinking at all during pregnancy

Question 5

What is the Alcohol Use Disorders Identification Test (AUDIT)?

What is it used for?

What does it consist of?

What are Zones 1-4 for AUDIT risk level (in picture)?

Answer 5

• The Alcohol Use Disorders Identification Test (AUDIT) is a test developed by WHO to screen for alcohol use disorders
• It consists of 10 questions scored 1-4 that take 2 minute to complete
• These scores are used to form 3 different domains
• The AUDIT score can then be placed in Zone 1-4 (in picture) that indicates the risk level of the individual and what kind of interventions should be used
• Zones 1-4 for AUDIT risk level (in picture)

Question 6

What are 6 elements of brief interventions?

Answer 6

• 6 elements of brief interventions:

1) Feedback: about risk or impairment

2) Responsibility for change

3) Advice: Cut down / abstain

4) Menu: Options; Change; Setting targets / goals

5) Empathy: Reflective listening; No confrontation

6) Self-efficacy: Enhance belief in ability to change

Question 7

What are 4 barriers to implementation?

Answer 7

• 4 barriers to implementation:
  1) “It’s too hard”
  2) Need to get them out of the door quick
  3) Can’t get any help from specialist services.
  4) “Haven’t got the time for this”

Question 8

What is the CIWA-AR? What group should CIWA-AR be used in?

What are the 10 items of CIWA-AR?

Answer 8

• The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR) is to be used by medical professionals to assess and diagnose the severity of alcohol withdrawal.
• The CIWA-Ar should used in all patients suspected of being at risk to have alcohol withdrawal.
• 10 items of CIWA-AR:
  1) Nausea and vomiting
  2) Tremor
  3) Paroxysmal sweats
  4) Anxiety
  5) Agitation
  6) Tactile disturbances
  7) Auditory disturbances
  8) Visual disturbances
  9) Headache
  10) Orientation and clouded sensorium

Question 9

How is CIWA scored (in picture)?

Answer 9

Question 10

What is Chlordiazepoxide used for in alcohol withdrawal?

How does CIWA score influence the amount Chlordiazepoxide used to treat alcohol withdrawal (in picture)?

What 2 other medications can be considered in alcohol withdrawal?

Answer 10

• Chlordiazepoxide is used to relieve anxiety and to control agitation caused by alcohol withdrawal
• How CIWA scores influence the amount Chlordiazepoxide used to treat alcohol withdrawal (in picture)
• 2 other medications can be considered in alcohol withdrawal:
  1) Pabrinex
  2) Oral vitamins (prescribe after completion of pabrinex)

Question 11

What 3 things are individuals at increased risk off when going through alcohol withdrawal?

After how long are these most likely to occur?

Answer 11

• 3 things are individuals at increased risk off when going through alcohol withdrawal and after how long they are most likely to occur:

1) Risk of seizures – after about 12 hours

2) Severed complications (medical emergency) e.g dehydration – after about 24 hours

3) Mild withdrawals e.g nausea – after about 48 hours

Question 12

What is the drug harm index?

Which drug is at the top of this index?

Answer 12

• The drug harm index is a system that scores drugs based on which ones have the greatest impact on different aspects of our life
• Alcohol is at the top of the drug harm index

Question 13

What screening tool is available for alcohol?

Answer 13

• Screening tool available for alcohol - Adapted ASSIST-Lite drug, alcohol and tobacco screening tool for health and social care settings

Question 14

How can opiate dependency be scored?

Answer 14

Question 15

Why are basic principles of assessment necessary for those with alcohol/drug problems?

What are 7 basic principles of assessment?

Answer 15

• Basic principles of assessment are necessary for those with alcohol/drug problems to ensure we develop the appropriate treatment plan
• 7 basic principles of assessment:

1) Patterns of substance use e.g using during work time

2) Withdrawal risks

3) Co-existing problems

4) Support systems

5) Motivation to change

6) Setting safety

7) External sources of stress

Question 16

What are 6 factors in assessment of dependency?

Answer 16

• 6 factors in assessment of dependency:

1) Compulsion / strong desire to use

2) Inability to control use

3) Withdrawal
* Physical withdrawals – can be fatal particularly in alcohol, seizures, death
* Psychological withdrawal state of anhedonia characterised by dysphoria, irritability, emotional distress

4) Tolerance
* Through habituation an individual develops a tolerance to the effects of a substance
* With repeated administration more of the substance is required in order to achieve the same effects

5) Preoccupation

6) Persistent use despite knowledge of harm

Question 17

What is DSM-5 criteria used for?

How is it scored (in photo)?

Answer 17

• DSM-5 criteria is used for substance use disorders

Question 18

What 5 things should we consider during assessment?

Answer 18

• 5 things should we consider during assessment:

1) Presenting (current issue)

2) Predisposing (predisposed factors to be in this situation)
* E.g adverse childhood experiences (ACEs)

3) Precipitating (factors cause (an event or situation, typically one that is undesirable) to happen suddenly, unexpectedly, or prematurely)

4) Perpetuating (factors continuing to keep this person in this situation)

5) Protective (does this person have a good social network etc

Question 19

What is formulation?

What are biological, psychological and social examples of predisposing, precipitating, and perpetuating factors (in picture)?

Answer 19

• Formulation occurs after assessment and involves gathering all the information you have on the patient in order to form a treatment plan

Question 20

What are the 3 treatment principles?

Answer 20

• 3 treatment principles:
  1) Physiological
  2) Psychological
  3) Social

Question 21

H)ow do we form a collaborate care plan (in picture)?

Answer 21

Question 22

Why is it a problem that relapse is not accepted in alcohol and drug problem treatment?

Answer 22

• It is problematic that relapse is not accepted in alcohol and drug problem treatment as it can provide worse outcomes with patients
• There can be stigma and trauma associated with drug relapse, making it difficult for patients to seek help.

Question 23

What are 6 parts of the cycle of change (in picture)?

Answer 23

Question 24

What is an addition hospital liaison service?

What is the aim of an addiction liaison service?

What are 4 roles of the addiction hospital liaison service?

Answer 24

• An addition hospital liaison service is a team of nurses that meet with people with drug and alcohol problems
• The aim of an addiction liaison service:
• To provide timely expertise to improve the safety, quality, clinical outcomes and experience of care of individuals with AOD issues presenting to ED or admitted to hospital
• 4 roles of the addiction hospital liaison service:

1) Provide effective and holistic treatment to those individuals with alcohol and other drugs (AOD) concerns, presenting to emergency departments or hospital admissions.

2) Accomplished through providing hospital clinicians, direct access to specialist addiction clinicians

3) Advice and support with assessment and management of hospital inpatients and emergency department presentations

4) Better outcomes, improved patient satisfaction and reduced healthcare costs.

Question 25

What is not having a hospital liaison service related to?

What are 4 risks of this?

What are 3 outcomes of this?

Answer 25

• Not having a hospital liaison service is related to poor clinical outcomes, reduced patient satisfaction, negative experience of treatment and increased healthcare costs
• 4 risks of this:
  1) Risks related to withdrawal, intoxication or chronic effects of AOD use;
  2) Exacerbation of other medical conditions;
  3) AOD use during period of hospitalization;
  4) Excess mortality
• 3 outcomes of this:
  1) Repeat admissions;
  2) Discharges against medical advice;
  3) Increased healthcare costs