L9- Substance misuse treatment Flashcards
different treatment models
- Medical model
- Disease model
- Behavioural model
- Medical model
- Detoxification regimes
- Substitute prescribing
- Disease model
- Step facilitation
- AA/NA – ‘12 step programme’
- Behavioural model
- CBT
- Motivational interviewing
medical model
Abnormal condition that causes discomfort, dysfunction, or distress to the individual afflicted - Focus on the physical conditions: o Tolerance o Physical withdrawal symptoms o Vitamin deficiency o Pancreatitis - Pharmaceutical treatment preferred
disease model also known as
Minnesota model
disease model (Minnesota)
combines in-patient with therapy and groups
- Addiction is an illness
- Loss of control the primary symptom
- Addiction is genetic and therefore predetermined
- Abstinence/avoidance is the only viable treatment
behavioural model
Addiction doesn’t exist, excessive use is a ‘mis-learnt coping mechanism ‘
- Excessive use/misuse is a result of:
o Social
o Economic
o Familial learned experiences
- Alternative coping mechanisms can be taught and past experiences addressed
which substances are commonly misused?
- Alcohol
- Opiates
- Stimulants
- Synthetic cannabinoids
treatments
- Harm reduction
- Psychosocial
- Pharmacological
- Relapse prevention
which setting?
- community
- in patient
Most people try to change between
8-11 times, so don’t give up hope
treatment should combine
harm reduction, psychosocial and pharmacological approaches
treatment outcome best dictated by
the patient
harm reduction (most important) and alcohol
o Vitamin B
o Safety advice
harm reduction (most important) and opiates
o Naloxone
o Overdose awareness
harm reduction (most important) and injecting
o Needle exchange
o Injecting advice
o BBV screening
o Sexual health
harm reduction (most important) and other routes of administration
o Sharing advice
o BBV screening
Psychosocial interventions apply to
all interventions
examples of psychosocial interventions
- Motivational interviewing
- CBT
- Mindfulness
- Solution Focused Therapy
- Relapse prevention
- Peer support
- Mutual Aid
pharmacological interventions can be used to
- stabilise
- detoxify
- prevent relapse
example of substitute prescribing for stabilisation
- opiates: methadone (opioid addiction)
relapse prevent for alcohol
- Disulfiram (Antabuse)- Alcohol Deterrent (24h after last drink)
the right setting could be in the
community or inpatients
pros of community setting
- Access time
- Least disruptive
- Maintains social support
- Pace
- Continuous psychosocial program
pros of inpatient setting
- high supervision
- Safer
- Can handle complexity
cons of community setting
- Not suitable for everyone
- Lower supervision
- Higher risk
cons of in patients
- Access time
- Removes social support
- Cost
- Divorced from community treatment
two types of withdrawal
psychological and pohsyical
psychological
applies to all substances
physical
generally CNS depressants
opiate withdrawal (low risk)
- Heavy cold and light flu
- New experience of pain (haven’t experienced pain in 5 years)
- Very low pain tolerance- e.g. tooth ache is awful ◦Psychological (all substances)
- Won’t die
alcohol withdrawal (higher risk and most likely)
- Withdrawal seizures
- Delirium tremens
- Wernicke’s encephalopathy
- Death
delirium tremens
- Medical emergency- admit to hospital as risk of cardiovascular collapse and death
- Complicates 5% of severe untreated alcohol withdrawals
- Consists of confusion and agitation and there may be florid visual hallucinasion and delusions
complications ofd delirium tremens include
o Seizures o Hyperthermia o Dehydration o Electrolyte imbalance o Cardiovascular shock o Acute liver failure o Wernickes encephalopathy
what is used to reduce the risk of fits and delirium tremens
chlordiazepoxide or diazepam
- Duration: 7-10 days
- Dose- varies by patient:
o Age, gender and body mass
o Degree of alcohol dependence
o Other drug use and medication
o Associated physical disease
wernickes encephalopathy occurs due to
thiamine deficiency
wernickes encephalopathy
- Important cause of longer term brain damage.
- Difficult to diagnose: classical triad of confusion, ataxia and ophthalmoplegia only present in 1 in ten cases.
- Results from vitamin deficiency in chronic alcoholism from poor intake and malabsorption
- Stopping drinking precipitates it, as withdrawal state puts additional requirements on depleted body vitamin stores
prevention of wernickes encephalopathy
Vitamin D
- Lower dose regime:
oral thiamine tabs 100mg twice daily. Oral vitamin B co strong tabs, 2 tabs twice daily
- Higher dose regime:
oral thiamine and vitmaine B co strong AND Parenteral vitamins
