7: Substance Use Disorder

Question 1

what is the key indicator for substance use disorder?

Answer 1

substance use has to impair functioning in everyday life

Question 2

what are examples of direct physical harm as a result of substance abuse

Answer 2

Liver, heart & lung damage, increased cancer risk

Question 3

what are examples of indirect physical harm of substance use?

Answer 3

illness, injury, self-neglect, harm from risky behaviours (hepatitis, HIV, overdose)

Question 4

what are 4 examples of indirect social/interpersonal harm of substance use?

Answer 4

Conflict with others (e.g. disapproving family members)
Exclusion / stigma
Poor educational attainment
Homelessness

Question 5

what are examples of indirect mental health harm of substance use?

Answer 5

Transient psychosis (e.g. cannabis induced psychosis)
Depression & Anxiety (e.g. depressant effects of alcohol)
For people with established illness (e.g. psychosis)
More / worse symptoms
Poorer functioning
More relapses and hospitalisations
Increased suicidality; Aggression

Question 6

what % of adults ages 16-59 have taken drugs at some point?

Answer 6

35%

Question 7

what % of adults aged 16-59 have taken an illicit drug in the last year?

Answer 7

9%

Question 8

what % of young adults aged 16 to 24 had taken an illicit drug in the last year & how many would be classed as frequent drug uses?

Answer 8

21%, 4.3%

Question 9

what % of men and women have drunk alcohol in the past week?

Answer 9

65% of men and 50% of women

Question 10

what % of men and women drink above the safe amount of alcohol in the past week?

Answer 10

38% of men and 19% of women

Question 11

does NICE suggest getting people with mental health issues to stop using drugs completely

Answer 11

no, only reduce

Question 12

what is the timeframe for early remission?

Answer 12

at least 3 but less than 12 months without substance use disorder criteria (except craving)

Question 13

what is the timeframe for sustained remission?

Answer 13

Sustained remission is defined as at least 12 months without criteria (except craving).

Question 14

what is the role of naltrexone and which drugs is it effective for?

Answer 14

reduces craving for alcohol
blocks effects of opioids in the brain (reducing pleasure)

Question 15

what is the role of methadone?

Answer 15

reduces withdrawal symptoms

Question 16

which family of drugs is there no pharmacological aid for?

Answer 16

amphetamines (& cannabis)

Question 17

what does reducing substance use lead to in someone’s substance use journey

Answer 17

greater treatment adherence; fewer relapses & hospitalisations etc

Question 18

what are the 5 predominant psychological interventions for substance use?

Answer 18

Motivational interventions (MI) – motivational interviewing
Cognitive Behavioural Therapy (CBT)
Contingency management (CM)
Family (systemic) therapy (FT)
Psychoeducation (PE)

Question 19

what are the 5 goals of psychological assessment for substance use?

Answer 19

Patterns of use (what substances; when used; where; how much?)
History of use; previous treatment
Motives for use
Consequences (negative AND positive) – impact of use
Motivation to address problems

OVERALL: Seeks: To understand role played by substances in client’s life; identify factors maintaining substance use and obstacles to change / relapse risks

Question 20

what does motivational interviewing seek to resolve?

Answer 20

ambivalence in patients towards their substance use - helping clients to understand how their substance use keeps them from achieving their goals and help them prepare to change

Question 21

what is the theoretical underpinning of behaviour modification?

Answer 21

learning theory (positive and negative reinforcement)

Question 22

what is contingency management?

Answer 22

abstinence maintenance technique:
incentivises and reinforces abstinence with the aid of vouchers, privileges, prizes or financial incentives (clear urine screen = reward) can also be used in interventions to reduce substance use