AOD WORKSHEET Flashcards
How would you respond to the following. 4. Abstinence is the only way to manage addiction.
Think about harm minimisation, education
• Why do you think people are so reluctant to admit they have a substance-related disorder or another addiction, such as gambling?
Shame, fear of stigma, discrimination and being judged
• What do you think are some of the attitudes and skills required to work with people with addictions?
Non-judgemental, professional boundary awareness, respect, listening skills understanding addiction and recovery principles
Brief intervention / Components include? Recommended for…. Not recommended for …
Components include; assessment, feedback, listening and advising, defining treatment goals, discussing strategies. Recommended for people with relatively few problems, low to moderate dependence on alcohol and cannabis and smokers. Not recommended for high dependency.
Motivational interviewing describe the four stages
Pre-contemplation
No intention of changing
Contemplation
Is aware of problem but remains ambivalent. Thinking about changing. Therapist must acknowledge this and works on tipping the balance without a pile of should and should not do’s. Offer support but responsibility remains with client.
Preparation
Client intends to change but is confused, looking for advice and support, therapist inspires hope and choice while de-mystifying the change process
Action
Behaviour changes commence
Relapse prevention / describe
Maintenance
Change has been achieved, vigilance required to avoid relapse and may slip back and have to work their way through the cycle again. This is an expected part of this process and care must be taken to ensure the client understands this to avoid sense of guilt and failure.
Harm minimisation and harm reduction
Examples of harm-reduction strategies:
- Needle exchange programmes
- Methadone programmes (Opioid Recovery Service)
- Nicotine replacement therapy (NRT)
- AA
- NA (narcotics anonymous)
- Controlled drinking ideas (Alcohol Advisory Board)
Alcohol Withdrawal
Common symptoms:
Tremor, hypertension, restlessness, sweating, diarrhoea, headache, difficulty sleeping, decreased appetite and anxiety
Alcohol Withdrawal
Pharmacological management:
Benzodiazapines, Thiamine
Alcohol Withdrawal
Nursing management:
Reduce agitation and remain calm, observe airway and breathing, monitor vital signs, assess for head injury, keep client calm and reduce exhaustion, hydration
Alcohol Withdrawal
Substance withdrawal and detoxification (five main areas)
- Minimising progression to severe withdrawal
- Decreasing risk of injury
- Eliminating risk of dehydration, electrolyte and nutritional imbalance
- Reducing risk of seizures
- Identifying presence of concurrent or differential diagnosis,
Drug groups and give examples
Depressants (Alcohol, Benzodiazepines, Opioids, Barbiturates, Cannabis)
- Stimulants (Amphetamines, Caffeine, Cocaine, Nicotine, Ecstasy)
Hallucinogens (Cannabis, Mushrooms, ACID Ketamine, Daytura, Ecstasy) Cannabis (Cannabis and synthetic Cannabis)
List the factors that can influence the development of addiction
Genetic Social Psychological Cultural Personality Physiological
Impact of addiction of the person.The four Ls and explain each
Liver (drinking causes inflammation (hepatitis) and deposits of fat, leading to scarring and cirrhosis in 15% of heavy drinkers. Worse if co-morbid Hep C))
Lover (alcohol involved in most domestic disputes)
Livelihood
1) leading cause for mistakes and poor performance at
work
2) Central Nervous System changes such as Wernicke –
korsafoff syndrome can be permanent dementia type
changes related to vitamin B deficiency (pg 487 4th
ed Evans, Nizette and O’Brien 2016)
3) Alcohol affects serotonin binding in the brain causing
depression and anxiety
Law (alcohol a leading contributor to crime)
What is: talking to people at an early stage about their substance use
Core components are
providing feedback to the client on risk or impairments due to substance use
listening to the client’s concerns; advising about consequences of continued drug use
defining treatment goals such as reducing or ceasing drug use
discussing and implementing strategies for treatment (i.e. triggers) and strategies to manage
Stages of change model
Pre-contemplation and tasks? [interventions]
Pre-contemplation – no intention of changing behaviour in the near future (6 months approx), generally appearing unmotivated and resistant to change
Tasks: Increase awareness of need for change and concern about the current pattern of behavior; envision possibility of change
Stages of change model
Contemplation and tasks? [interventions]
Contemplation – individual state their intent to change in the near future but are ambivalent about change
Tasks: Analysis of the pros and cons of the current behavior pattern and of the costs and benefits of change. Decision-making.
Stages of change model
Preparation and tasks
Preparation – individual intend to actively change, within the next month or so, and preparation is therefore a transition from contemplation to action rather than a stable state
Tasks: Increasing commitment and creating a change plan.
Stages of change model
Action – and tasks
Action – the individual is making changes, or has done so recently
Tasks: Implementing strategies for change; revising plan as needed; sustaining commitment in face of difficulties
The DSM 5 allows clinicians to specify how severe the substance use disorder is, depending on how many symptoms are identified (out of 11). Two or three symptoms indicate a mild substance use disorder, four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder. state the DSM 5
1) Needing more of the substance to get the effect you want (tolerance)
2) Development of withdrawal symptoms, which can be relieved by taking more of the substance.
3) Taking the substance in larger amounts or for longer than the you meant to
4) Wanting to cut down or stop using the substance but not managing to
5) Spending a lot of time getting, using, or recovering from use of the substance
6) Cravings and urges to use the substance
7) Not managing to do what you should at work, home or school, because of substance use
8) Continuing to use, even when it causes problems in relationships
9) Giving up important social, occupational or recreational activities because of substance use
10) Using substances again and again, even when it puts you in danger
11) Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance
Impacts addiction have on the individual and whanau / Health wise physical
Physical: Dental neglect Lack of fitness Tiredness Hangovers vomiting Ulcers Liver disease Weight loss Weight gain Blackouts Memory Loss Injuries Premature Aging – females
Impacts addiction have on the individual and whanau / Economic
Drugs debts Poor priorities Fines Lawyers fees Selling Possessions Gambling Credit cards Car crashes No holidays No good clothes No extras/treats
Addiction is a condition where
Addiction is a condition where a person no longer has control over their alcohol or drug use. It may be non-substance addiction such as gambling. Most common in NZ = Alcohol
There are common phases/stages in addiction
Pre-contemplation Contemplation Planning Action Maintenance relapse
Brief intervention = ASEAN meaning
A = assessment (Screening (AUDIT), brief
assessment)
S = Summary (Feedback to client current
risks/harms ie: sexual activity,
work performance)
E = Education (ALAC guidelines drinking, risks
of drinking for them)
A = Advice (To reduce this risk, it is
medically advised to lower
your alcohol use)
N = Negotiate (This weekend = movie night)
a plan
Strategies for moderation
Alcohol-free days Spacers Thirst quencher Food – before and during Avoid rounds Be the designated driver?! Sipping Putting glass down Low alcohol alternatives Set budget
addiction interventions Harm minimisation (examples)
Alcohol.org drinking guidelines Needle exchange programme Opioid substitution treatment Nicotine replacement therapy Rational recovery (24/7) support groups Controlled drinking strategies
AOD Interventions can be harm minimisation or abstinence based
Abstinence (examples)
- Residential treatment programme
- AA/NA (Alcoholics/narcotics Anonymous)
- 12 step programmes
- Naltrexone implants
- Disulfiram (Antabuse)
- Ibogaine treatment
