9. Substance-related disorders Flashcards
how many Australians use substances daily?
4/10 Australians daily smokers, risky drinkers, or used illicit drugs in last 12 months
percentage of Risky alcohol use in Australians > 14 years
18% drinking > 2 SD / day
percentage of Tobacco use in Australians > 14 years
12% daily smokers
percentage of Cannabis use in Australians > 14 years
10.4% national average (use in last 12 months)
Most common illicit drug (36% of drug users report cannabis use)
percentage of Metham use in Australians > 14 years in last 12 months
Ice (80% pure metham) Speed (10-20% pure) 1.4% national average (last 12 months) 6.3% ever used Drops in NSW Higher rates in WA (2.7%), Tasmania (2.1%) and SA (1.9%)
percentage of Ecstacy use in Australians > 14 years in last 12 months
2% national average
percentage of Pain killers / opiate misuse (excl OTC) use in Australians > 14 years in last 12 months
4.8% opioids
Over the counter / prescribed codeine products most commonly misused.
Pharmas second most commonly misused illicit
drug
Highest users in their 20s and 40s
public perception of illicit drug use according to the NDSHS
Public perception – treatment/education program best for all drugs except cannabis (warning)
Most people support harm reduction for injectors
Great majority of people support medicinal cannabis (87%)
One third Australians support cannabis legalisation
Low risk drinking
– 2SDs/5 days per week, 4 SDS on a single occasion increases risk of injury
At what age does alcohol have bad affects?
under 15s, no alcohol, delay as long as possible after 15
Tobacco, alcohol and illicit drugs as a killer
Tobacco still the biggest killer (18000K per year), followed by alcohol (6000K per year), followed by illicit drugs (1800 per year))
Drug use in disadvantaged communities
2.7x smoking
1.7x alcohol abstinence
Less cocaine/ecstasy (1.2% compared to 3%)
Drug use in unemployed people
1.8x smoking
1.5x cannabis
3.1x meth/amphetamine
Drug use in Homosexual or bisexial people
5.8x use of ecstasy and meth/amphetamine
Drug use in people living in urban and regional regions
Smoking under 10% in inner city areas, around 20% in regional areas
What are the basic criteria of substance use disorder
impaired control (craving, larger amounts than intended, persistent desire to cut down, excessive time to obtain)
social impairment (failure to fulfil obligations, continued use despite problems)
risky use (use in hazardous situations)
tolerance/withdrawal
Number of symptoms present determines severity
Severity of of substance use disorder
Number of symptoms present determines severity
2-3 mild
4-5 moderate
6+ severe
Key feature of presentation: Ambivalence
Tolerance of drugs
Milder symptom, somewhat normative, varies greatly over comparatively few years
Withdrawal
Rare for adolescents
Confused with hangover
Normative aspects may mean..?
over-diagnosis -
stigmatisation
useful assessment measures of substance use disorder
Screening – AUDIT, Fagerstrom
Patterns, context, baseline - Timeline follow-back
Motivational factors - Expectancies/efficacy
What items are involved in an AUDIT as a measure of SUD
Hazardous alcohol use (3 items) Dependence symptoms (3 items) Harmful alcohol use (4 items: guilt/blackouts/injuries/others concerned about drinking) Scores and treatment (tentative) - 8-15: brief advice/education - 16-19 brief counselling and monitoring - 20+ further diagnosis
Timeline follow back as a measure for SUD
1-3 months (up to yesterday), marked in standard days, mark in personal holidays special events, best estimate, something written in each box
Last drink? How much? Where were you?
Max drink? When? (How much)? Where were you?
Least amount? When? Where were you?
Abstinence days? Where were you?
Then work back from today..
Work around anchors
Expectancies of alcohol according to the alcohol expectancy questionnaire and the drinking expectancy profile?
(Young & Knight, 1991)
- Transforms experience
- Enhances social/physical pleasure
- Sexual experience and performance
- Power and aggression
- Social assertiveness
- Reduces tension
What are the expectancies of alcohol according to the Negative alcohol expectancy questionnaire?
(McMahon & Jones, 1993)
- same day
- next day
- long term
Expectancies of cannabis according to the Marijuana Effect Expectancy Questionnaire - brief
(Torrealday et al., 2008)
- Cognitive and behavioural impairment (heavily weighted negative)
- Relaxation and tension reduction (heavily weighted positive)
- Social and sexual facilitation (very heavily weighted positive)
- Perceptual and cognitive enhancement (very heavily weighted)
- Global negative effect (heavily weighted negative expectancy)
- Craving and physical effects (modestly weighted negative)
