Key ideas in treatment Flashcards
What are the 10 key ideas in the treatment of addiction?
- Who needs treatment?
- Dependence
- Harm reduction
- Motivation to change
- Maintenance and abstinence
- Organising treatment
- Failure to respond
- Coercion
- What is recovery?
- Who pays?
What does the pyramid of treatment needs suggest?
> At the bottom:
- most people
- with infrequent use and no problems
- > little/no treatment need
> At the top:
- few people
- with frequent use and multiple problems
- > large treatment need
=> graded need for treatment
What does the natural history of drug misuse tell us?
> Most problematic substance users stop using on their own
> People in treatment are stuck with their use and need help (large treatment need)
> Substance misuse is a relapse illness for some
(most still get better)
> Natural history is very variable and often not predictable
- hard to predict who. is gonna have problems and who won’t
How do most problematic substance users stop using on their own?
- Reduced drug use with age
- Most people mature with age
What makes substance misuse a relapse illness for some people?
Periods of small use, no use, or great use
What is a spontaneous recovery in drug misuse?
Some people decide to stop using sometimes in their life
- range of personal reasons
When does spontaneous recovery often occur?
At a time of change
- new job
- relationship
- newborn child
What is the valid concept on spontaneous recovery among patients?
- You need to hit rock-bottom to stop
- Readiness for treatment
How does the person’s environment and situation play a central role in helping them stop drug misuse?
Stable life helps recovery
- e.g. homeless vs. having a home and family
- However, a proper environment is not always necessary to help people stop
Why is self-detoxification common?
There’s a population that isn’t in treatment and doesn’t want to be
- they’ll go in treatment when benefits of treatment outweigh benefits of no treatment
=> aim of treatment system is to engage as much people as possible
Why do people need treatment?
- Stop drug misuse
- Reduce personal harm
- Help manage their lives
- Reduce risk to others
- Reduce risks to community
What is the division of the different drugs used?
- Small number of people using harmful drugs
- High number of people using less harmful drugs
Why is the type of drug important?
> Some drugs require particular treatment
- opiate substitution treatment specific to opiate use
> Some drugs cause harm
- any injected is harmful
> Propensity to cause dependence
> Spontaneous reduction more common with certain drugs
=> Assessment of problems is needed before treatment can be offered
In which case is spontaneous reduction of drug misuse more common?
Often in people with high social support and social capital
Why is lay people’s understanding of dependence and addiction important?
Because when you talk to people who use drugs you need to know what they think of it
Why is the propensity of dependence important?
- Treatments differ wether people are dependent on the substance they use
- Presence of dependence increases risk of severe withdrawal symptoms (varies between chemical structure of substances)
What does dependence as a continuum or a binary concept refer to?
The severity of the dependence and withdrawal symptoms
- physical or psychological dependence
What is dependence as a binary concept?
You are either addicted or not
- binary understanding
What makes the binary understanding of dependence attractive?
It provides a point in treatment when person needs to take medication to stop using
What does the evidence reflected in the DSM-5 suggest is the nature of the concept of dependence?
Dependence as a continuum:
- you’re more or less addicted depending on where you are and the dosage used
Who gave the first descriptions of dependence?
Edwards and Gross (1976):
- narrowing of repertoire
- salience of drinking
- increased tolerance to alcohol
- withdrawal symptoms
- relief or avoidance of withdrawal symptoms by further drinking
- subjective awareness of compulsion to drink
- reinstatement after abstinence
Why is defining dependence important?
- Enables correct planning of treatment
- Look at prognosis / diagnosis
- Important for research
How do the ICD-10 and DSM-5 characterise substance abuse and harmful use
> ICD-10: abuse has a single diagnostic category, dependent of harmful use
> DSM-5: combines mild harmful use AND severe dependence
How does abuse differ from harmful use?
Harmful use is less severe than dependence
What does the ICD-10 describe as the qualifications for diagnosis of dependence or abuse?
Only if 3 of more have been present together during the previous year:
- strong desire or sense of compulsion to take substance
- difficulties in controlling substance-taking behaviour
- physiological withdrawal state
- evidence of tolerance
- progressive neglect of alternative pleasures or interests because of psychoactive substance use
- persisting with substance use despite clear evidence of overly harmful consequences
How is harmful use of substances described in ICD-10?
Diagnosis requires that actual physical and mental damage have been caused
- pattern of psychoactive substances misuse that’s damaging to health
What is the most commonly used objective measure in the UK to assess service users on alcohol abuse?
Alcohol Use Disorders Identification Test (AUDIT)
- questions on people’s drinking and how often they drink
What do you need to do for service users to fill in the AUDIT?
- Explain what a unit is
- Help them understand how it will quantify how much they’re drinking
What is the AUDIT-C?
Shortened version of the AUDIT
- only contains three questions
- commonly used in screening
- part of preparing for a brief advise session
When is an objective measure of dependence useful (e.g. SADQ)?
When someone has a high AUDIT score, or is describing physical signs of withdrawal
What is the SADQ?
Severity of Alcohol Dependence Questionnaire
- objective measure of dependence
Why is the assessment of service users important?
- Helps to choose the right treatment
- Decisions on complexity can be made
- Helps evaluate prognosis
What is the idea of harm reduction?
Reducing the harm from substance misuse
- started in HIV epidemic mid 1980s
- more important than stopping people using drugs
What is harm reduction according to Newcombe (1992)?
Term that defines policies, programmes, services and actions that work to reduce the health/social/economic harms
- to individuals, communities, society
- associated with drug use
What are the steps in the hierarchy of goals in drug treatment?
- Unsafe injecting of street drugs
- Safe injecting of street drugs
- clean injecting paraphernalia - Smokable drugs
- rather than injection
- considerable step for many people - Prescribed drugs and street drugs
- Prescribed drugs alone
- Drug free
- for many these steps take years
- for many substances: similar move from unsafe using to abstinence
What are the four main harm reduction interventions?
- Needle and syringe exchange
- give out clean ones, they bring them back - Provision of injecting paraphernalia and needle cleaning equipment
- Provision of smoking paraphernalia (foils)
- Provision of condoms and other items to reduce high risk sexual behaviour
What is the success of needle and syringe exchange interventions?
- Didn’t help the most chaotic people
- Returning needles helped reduce needle waste in communities
What does injecting paraphernalia consist of?
- Cups to cook heroin in
- Heroin filters
- Citric acid
- Sterile water
What can be provided to people for safer injecting, in countries where it’s illegal to provide injecting paraphernalia?
Needle cleaning equipment
In which communities is it important to provide condoms and other items to reduce high risk sexual behaviour?
Communities associated with prostitution and sex related drug use/exchange
What did the government policy for needle and syringe exchange do in the UK?
Policy made early in HIV epidemic
-> efficient reduction of HIV prevalence