5) Substance Misuse

Question 1

What is substance misuse?

Answer 1

Refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.

Question 2

What are some types of substance?

Answer 2

Stimulants (increase alertness, energy and confidence) ie cocaine
Hallucinogens (‘mind altering’, change perceptions, mood and senses) ie LSD
Depressants (make you feel relaxed) ie cannabis, alcohol heroin
Volatile substances and ‘designer drugs’

Question 3

What is an alternative drug offered to chronic opiate users? Why is this prescribed?

Answer 3

Methadone
Still strong enough to have severe effects on non-drug users, but can be tightly controlled and dose reduced over time to prevent withdrawal affects.

Question 4

Identify some of the harms associated with drug use

Answer 4

Social effects (lose job, lose relationships ad housing)
Psychological (thought to increase likelihood of mental illness ie Sz and cannabis use)
Physical effects (liver cirrhosis)

Question 5

What is dependence? What are the types associated with substance abuse?

Answer 5

Can be physical and/or psychological
Physical relates to experiencing symptoms related to the withdrawal of the substance.
Psychological relates to having impaired control- struggles to cope with everyday stresses without the use of the substance (to obtain a feeling of a ‘high’ or avoid negative feelings)

Question 6

How is dependence diagnosed? (ICD-10)

Answer 6

3 or more characteristics required:

• strong desire/compulsion to take the substance
• difficulties in controlling the substance taking behaviour in terms of onset, termination and levels of use
• physiological withdrawal state
• evidence of tolerance (over use, requires more of the substance to experience an affect- leads to increased problem)
• neglect of other pleasures
• continued use of the substance despite clear evidence of harmful consequences

Question 7

How is dependence diagnosed? DSM-5

Answer 7

• taking substance in larger amounts, for longer than meant to
• wanting to cut down/stop, but not managing
• spending a lot of time getting/using/recovering from sub
• cravings
• not managing school/work because of sub
• continued use despite problems in relationships/work, caused by sub misuse
• development withdrawal symptoms

Question 8

How is alcohol dependence identified?

Answer 8

Screening: Audit-C

Question 9

Identify some risk factors for drug use

Answer 9

• issues relating to family life (neglect, psychical and/or emotional abuse)
• mental health
• employment/educational attainment (unemployment associated with increased drug use)
• social groups
• previous drug use
• biology (those who report positive effects from drug misuse more likely to continue)

Question 10

Models that help us to understand drug use include?

Answer 10

-moral model
-disease model
-psycho-dynamic
-social learning
-social-cultural model
-public health
(-genetic model- amphetamine gene)

Question 11

Describe use of learning theories to explain dependence

Answer 11

Learned associations between +ve/-ve reinforcers.
Classical conditioning models:
-unconditional stimulus (falling blood alcohol levels) triggers unconditional response (craving/withdrawal symptoms). Cue/stimulus (conditioned stimulus) ie sight of needle or smell of favourite drink is paired with conditioned response of conditional withdrawal

Question 12

Outline imitation theories

Answer 12

We learn though observation and listening to others (role models)

• modelling= risk of drug use increases if observe others doing it
• expectation= positive reward makes behaviour more likely. Negative experience will promote avoidance (exploited in treatments)
• self-efficacy= how you view your ability to abstain or deal with situations (if patient believes they can quit, helped with treatment, this will increase the likelihood of maintenance of behaviour)

Question 13

What is the involvement of rational choice?

Answer 13

Dependency involves making rational choices that favours the benefits of dependence over costs. Individuals motivated by their goals.

Theory of rational addiction= economic model
People who ‘discount’ future more likely to become addicted (needs to be addressed in public health models)

Question 14

Identify the stages of the Cycle of Change (Prochaska& Diclemente)

Answer 14

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance (long term leads to lasting exit)
6. Relapse (cycle starts again)

Question 15

What are the main elements of treatment and care?

Answer 15

• substitute prescription (mostly methadone)
• psycho-social counselling ie CBT, solution focussed therapy, support groups
• detoxification
• maintenance medication (naltrexone)
• recovery capital (increase- patient has more to lose if they revert back to previous behaviour)