Alcohol And Drug Treatments Flashcards
Who has the highest rates of drugs, alcohol and mental disorders?
Young people 15-25 year olds
What is the leading cause of death in young people?
Suicide
What is the prevalence of smoking?
Down 24% in 1991 to 15% in 2010
20% 20-24 year old
12-17 year girls more likely to smoke than boys
What is the prevalence of alcohol abuse?
Drinking to get drunk rates falling but still very high in young people 60-50%
What is the prevalence of cannabis use in Australia?
Au biggest consumers in the world until us leagalised
Rates going down
Young people biggest consumers
What are 4 comorbidities that commonly occur with cannabis use?
- AOD disorders - Psychiatric symptoms caused by alcohol and drugs
- Depression
- Psychotic experiences
- Psychotic disorders
What has changed in the DSM-4 to the DSM-5 edition regarding substance use disorders?
**legal problems has been removed
Added- craving the drug
Substance abuse and disuse have been separated
What is the number 1 cause of disability and death in 15-29 year olds?
AOD disorders
Alcohol and other drug disorders
24%-32% total disability
19-36% deaths
What are the help seeking behaviours found in young people experiencing AOD related problems? Give 3 reasons why
Very few seek help
7% of males
18% females
Because:
- Social norms
- Don’t view use as problematic
- Stigma associated with AOD treatment
What is the most common drug young people seek assistance for?
Cannabis
Treatment episodes increasing
How many people globally seek help for AOD?
1 in 6
50% first time for cannabis
What are the 4 options for youth treatment for AOD?
- Regulatory- reduce risk
- Prevention- delay age of use
- Early intervention- reduce progression from regular to problematic
- Treatment of AOD dependence
What are the regulatory actions taken to reduce AOD?
- Use law policies and enforcement to reduce supply and demand
- Australian AOD policy is harm minimisation
What are the 4 regulatory approaches for tobacco?
- Cigarette tax- 12.5% increase
$1 per cigarette
1 billion less sold a year
- Media campaigns: attitudes/policies
- Package changes
- Not smoking in venues
What are the regulatory actions for alcohol?
Alcopops tax
What are the health policies around alcohol consumption?
- Amount of drinks reduced to less than 2 per day
2. For people under age of 18 no alcohol is safest
NHMRC guidelines state to reduce the risk of lifetime alcohol related disease or injuries, how many drinks per day?
Less than 2
NHMRC guidelines state to reduce the risk of injury due to alcohol, how many drinks on a single occasion?
Less than 4
Drinking more than 4 drinks doubles the risk of injury in the next 6 hours
Evidence based research
What evidence for regulation of alcohol policy has been found to be effective (Burton et al, 2017)
- Tax and price regulation
- Regulation and marketing
- Regulating availability
- Provision of information
- Managing the drinking environment
- Preventing drug/drink driving
- AOD school education (does not work)
- Brief intervention
What is the purpose of universal school based drug education?
Prevent/delay age of onset
But may not work as increased curiosity
What is Climate Schools Combined?
Online universal school based drug prevention program
- substance use - alcohol and cannabis
- mental health
Social melodrama about social relationships (cartoon)
What are the 4 methods used for Climate schools combined?
- Combined- substance use (y9) and mental health (y10)
- Mental health only (y10)
- Substance use only
- Control-hpe as normal
Which one prevents anxiety/depression and substance use best?
What do you target to delay onset?
What was it about the Climate schools combined that put kids off drinking?
Cool girl vomiting on cool guy
What were the initial results from the Climate schools course for alcohol?
After 6 Months Climate group significantly less average weekly alcohol. This difference even more significant at 12 Months
What were the initial results from the Climate schools course for cannabis?
Not significant at pre to post treatment but significantly less likely to use cannabis at 6 and 12 Months after treatment than in control group
What were the initial results from the Climate schools course for psychological distress?
Intervention group less likely to have symptoms of distress than control group
What is an evidence based approach to prevention of AOD use?
Climate schools course found to be effective
Who are early intervention courses targeted at?
At risk youth
- early onset (<14 years)
- disengaged youth
- AOD related injury/illness
- family history of AOD dependence
In early interventions for AOD, what happens in a brief intervention?
1-2 sessions (10-15 minutes to 2x1 hour sessions)
Brief assessment and feedback
Motivational interviewing
What makes it hard to commit to behaviour change?
Ambivalence is the key dilemma we all face when making a change to our behaviour
What are the 3 key dimensions needed for behaviour change?
- Readiness
- Confidence
- Importance
What is motivational interviewing?
A collaborative conversation style for strengthening a persons own motivation and commitment to change
Counselling approach
What are the 3 components of motivational interviewing?
- Strategies (commitment/motivation)
- Principles
- Spirit
What is the Spirit of motivational interviewing under a fundamental approach of MI?
Fundamental approach to MI:
- Collaboration
- Evocation
- Autonomy
- Compassion
What is motivational interviewing NOT?
Confrontation
Education
Authority
*****what are the 4 principles of motivational interviewing?
- Express empathy
- Develop discrepancy (between how things are and how the person wants to be)
- Respond to sustain (“I like smoking”) talk and discord (formerly roll with resistance)
- Support self-efficacy (support them to find their own way and make the change that they want to, however long that takes.
***roll with resistance is OUT
What evidence is there for Brief Motivational Interventions?
Well established efficacy for alcohol in meta analysis reviews
Small to moderate affects compared to Control or other interventions
What are the advantages to web based alcohol interventions?
99%young people online daily
Own smart phones
Check phone regularly
These interventions simple and effective
Rapidly increase treatment access
What is Ray’s night out?
An app developed to promote harm minimisation and controlled drinking strategies
Aims to increase safe drinking behaviours and awareness of alcohol use limits
What was found in a randomised Control trial for Rays night out?
Gave Young people who used alcohol in the last month the Rays night out app
Some had immediate access, some 1 month delay
Wanted to determine the apps impact on alcohol knowledge, use and related behaviours
Results:
Immediate access group had greater alcohol knowledge
Every ones drinking went down
Feedback:
Think about drinking goals
Helps identify stupid lines
Hints on safer drinking
What evidence is there for how do we increase the impact of motivational interventions?
A randomised Control trial of enhanced brief motivational interviewing
Methods:
Target alcohol, cannabis and psychological stress
1-3 face to face sessions
MI + brief coping skills VS assessment feedback/information
Results:
Greater reductions in alcohol, cannabis and distress
What are the 4 Personality Risk Profiles for substance use?
- Anxiety sensitivity
- Depression proneness
- Sensation seeking
- Impulsively
What evidence is there for matching personality risk targeted and coping skills for alcohol illness and injury?
CBT type interventions
Good results
Those who got the personality type targeted intervention had over 50% reductions in days they were drinking
Amount of drinks reduced
Not much reduction in alcohol related harm
What are the 4 points of evidence that has been found for all brief AOD interventions?
- All brief interventions work
- All groups improve over time
- Personality targeted coping skills training enhances motivational interviewing effects
- Is an effective early intervention model for risky alcohol use in non help seeking young people
What are 7 AOD treatment types?
- Telephone
- Outpatient care
- Outreach
- Day programs
- AOD withdrawal
- Residential rehabilitation
- Pharmacotherapy
What is the biggest problem with treatment for AOD abuse/dependence?
There is a huge gap between the current evidence base and routine practice
What model does residential rehabilitation use?
A therapeutic community model
Abstinence based
Run by residents
Self help
Mutual aid groups
Hierarchy structure
Mixed evidence
What is the goal of CBT?
Assist individuals in changing maladaptive behaviours by acquiring coping skills
What are 3 methods to prevent AOD relapse?
- Reinforce self efficacy
- Coping skills
- Planning for set backs
What is the evidence for CBT for AOD dependence in adolescents?
- CBT better substance use outcomes than insight orientated therapy and psycho education
- CBT VS CBT+FFT - both groups min lvls at post treatment but CBT+FFT only maintained
What is the evidence for CBT for depression and alcohol dependence in adolescents?
Methods:
10 sessions CBT
Results:
84% full or partial remission
Decreased anxiety and depression
More days abstinence
Decreased cannabis and other drugs
