Lecture 6 - Substance Use and Comorbidity Flashcards
What is early remission of substance use? (DSM-5)
At least 3 months but less than 12 months without substance use
What is sustained remission of substance use?
At least 12 months without substance
What do Abstinence programmes state?
- There is no safe amount of use
- Complete cessation of use is necessary
What are examples of abstinence programmes?
- 12 step self help program (AA)
- Detoxification programs (opioid treatment)
- Pharmacological interventions
What are some examples of pharmacological interventions for SUD?
- Disulfiram = interferes with alcohol metabolism causing nausea and vomiting
- Naltrexone = reduces alcohol cravings and blocks effects of opioids in the brain
- Methadone = reduces withdrawals
What impacts the success rates of abstinence programmes?
Highly dependant on motivation to change - sometimes based on coercion and mandatory (told to by family or hospital)
What is the aim of Harm reduction?
- Treatment is at individual level - aim is to reduce the risks associated with substance use. E.G needle sharing, drink driving, morbidity, mortality
- Meet people where they are at
- Small changes better than none - reduce negative consequences, promote recovery whilst accepting relapse, improve quality of life
What do NICE guidelines suggest about dual diagnosis?
- Help healthcare professionals guide people with psychosis and substance misuse to stabilise, reduce or stop substance use
- Abstinence is not necessary - reducing and stabilising is the desired outcome
What should healthcare professionals ask adults and young people with psychosis about their alcohol / drug use?
- What they use
- The quantity, frequency and pattern of use
- The route of administration
- Duration of current level of use
What is suggested for psychosis treatment?
Antipsychotic meds, CBT, family intervention
What is suggested for substance use treatment?
Motivational interventions, CBT, family involvement, contingency management
What are psychosocial interventions?
- Integrated therapy (individual or groups):
- Motivational interviewing
- CBT
- Psychoeducation
- Family therapy
What does psychological assessment determine?
Patterns of use, history of use, motives for use, consequences, motivation to address the problem and personal strengths
What does psychological assessment seek for SUD?
To understand the role played by substances in the clients life - factors maintaining the substance use and obstacles to change
What should the treatment plan be for SUD?
- Person centred
- Address problems and goals
- Take into accounts the clients motivation to change
What are the stages of change?
Precontemplation -> Contemplation -> Preparation -> Action -> Maintenance -> Relapse
What is the precontemplation stage?
Client not thinking about changing substance abuse behaviour - do not consider it a problem
What is the contemplation stage?
Still using but begin to think about cutting back
What is the preparation stage?
Still using but intend to stop - planning for change
What is the action stage?
Chooses a strategy to stop substance use, begins to make the changes
What is the maintenance stage?
Sustaining abstinence or reduction and avoiding relapse
What is the relapse stage?
Relapse and return to an earlier stage
What method of support is beneficial for the precontemplation stage?
Motivational interviewing - persuade client to change / challenge their use / enhance motivation to change
What is motivational interviewing?
A person-centred counselling method
Collaborative conversation to strengthen motivation and commitment to change
Views ambivalence as normal
Responsibility to change is with the client
Helps client understand that their substance use is keeping them from achieving goals
How does motivational interviewing work out?
If the reason for change is stronger than the reason for staying the same - tipping the balance for change
What are some reasons for using (staying the same)?
- Substance relaxes them, stops anxieties, gets rid of voices
What is Psychoeducation?
Provides information about the impact of substance use on MH
Educate clients about substance use, behaviours, consequences
Useful if paired with another method
What is Cognitive Behavioural Therapy (CBT) for SUD?
- Identifies drug use
- Focuses on teaching substance user new and more effective skills for dealing with high risk situations (negative states, interpersonal conflict, social pressure) and cravings
- Aims to change learned behaviour by changing thinking patterns, beliefs, perceptions and assumptions
- Lifestyle changes to decrease urges and increase healthy alternatives
What are relapse prevention techniques?
- Similar to CBT: focus on coping skills in high risk situations, specific to RELAPSE
- Client taught that relapse is part of the process, encouraged to stay engaged in treatment after relapse
- Intervention is long 6-26 sessions
What do the NICE guidelines state about family therapy?
- Families should have the opportunity to be involved in decisions about treatment
- Be given info and support
- Be offered family intervention
- Be offered info about support groups
What is family therapy?
- Big psychoeducation focus- info about dual disorders
- Teaches communication skills and builds problem solving skills
- Helps family develop relapse prevention
What is integrated therapy?
- Typically starts with motivational interviewing (pre-contemp / contemplation)
- Moves onto CBT (action / plan) and relapse prevention
- Moves back and forth
- Includes psychoeducation and can involve family intervention
What is Contingency Management?
Behaviour modification (based on Skinners learning theory)
- Incentivises and reinforces abstinence with the aid of vouchers, privileges, rewards, financial incentives
- A clear urine = reward
- Recommended for substance use but no evidence for dual diagnosis
What did a Circle Trial study find about contingency management?
500+ cannabis users with psychosis - no difference in outcome between those receiving CM and control
