L9- Substance misuse treatment

Question 1

different treatment models

Answer 1

1. Medical model
2. Disease model
3. Behavioural model

Question 2

1. Medical model

Answer 2

• Detoxification regimes

- Substitute prescribing

Question 3

2. Disease model

Answer 3

• Step facilitation

- AA/NA – ‘12 step programme’

Question 4

3. Behavioural model

Answer 4

• CBT

- Motivational interviewing

Question 5

medical model

Answer 5

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

Question 6

disease model also known as

Answer 6

Minnesota model

Question 7

disease model (Minnesota)

Answer 7

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

Question 8

behavioural model

Answer 8

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

Question 9

which substances are commonly misused?

Answer 9

• Alcohol
• Opiates
• Stimulants
• Synthetic cannabinoids

Question 10

treatments

Answer 10

1. Harm reduction
2. Psychosocial
3. Pharmacological
4. Relapse prevention

Question 11

which setting?

Answer 11

• community

- in patient

Question 12

Most people try to change between

Answer 12

8-11 times, so don’t give up hope

Question 13

treatment should combine

Answer 13

harm reduction, psychosocial and pharmacological approaches

Question 14

treatment outcome best dictated by

Answer 14

the patient

Question 15

harm reduction (most important) and alcohol

Answer 15

o Vitamin B

o Safety advice

Question 16

harm reduction (most important) and opiates

Answer 16

o Naloxone

o Overdose awareness

Question 17

harm reduction (most important) and injecting

Answer 17

o Needle exchange
o Injecting advice
o BBV screening
o Sexual health

Question 18

harm reduction (most important) and other routes of administration

Answer 18

o Sharing advice

o BBV screening

Question 19

Psychosocial interventions apply to

Answer 19

all interventions

Question 20

examples of psychosocial interventions

Answer 20

• Motivational interviewing
• CBT
• Mindfulness
• Solution Focused Therapy
• Relapse prevention
• Peer support
• Mutual Aid

Question 21

pharmacological interventions can be used to

Answer 21

• stabilise
• detoxify
• prevent relapse

Question 22

example of substitute prescribing for stabilisation

Answer 22

• opiates: methadone (opioid addiction)

Question 23

relapse prevent for alcohol

Answer 23

• Disulfiram (Antabuse)- Alcohol Deterrent (24h after last drink)

Question 24

the right setting could be in the

Answer 24

community or inpatients

Question 25

pros of community setting

Answer 25

• Access time
• Least disruptive
• Maintains social support
• Pace
• Continuous psychosocial program

Question 26

pros of inpatient setting

Answer 26

• high supervision
• Safer
• Can handle complexity

Question 27

cons of community setting

Answer 27

• Not suitable for everyone
• Lower supervision
• Higher risk

Question 28

cons of in patients

Answer 28

• Access time
• Removes social support
• Cost
• Divorced from community treatment

Question 29

two types of withdrawal

Answer 29

psychological and pohsyical

Question 30

psychological

Answer 30

applies to all substances

Question 31

physical

Answer 31

generally CNS depressants

Question 32

opiate withdrawal (low risk)

Answer 32

• 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

Question 33

alcohol withdrawal (higher risk and most likely)

Answer 33

• Withdrawal seizures
• Delirium tremens
• Wernicke’s encephalopathy
• Death

Question 34

delirium tremens

Answer 34

• 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

Question 35

complications ofd delirium tremens include

Answer 35

o	Seizures
o	Hyperthermia
o	Dehydration
o	Electrolyte imbalance
o	Cardiovascular shock
o	Acute liver failure
o	Wernickes encephalopathy

Question 36

what is used to reduce the risk of fits and delirium tremens

Answer 36

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

Question 37

wernickes encephalopathy occurs due to

Answer 37

thiamine deficiency

Question 38

wernickes encephalopathy

Answer 38

• 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

Question 39

prevention of wernickes encephalopathy

Answer 39

Vitamin D

Question 40

• Lower dose regime:

Answer 40

oral thiamine tabs 100mg twice daily. Oral vitamin B co strong tabs, 2 tabs twice daily

Question 41

• Higher dose regime:

Answer 41

oral thiamine and vitmaine B co strong AND Parenteral vitamins