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Interventions to Improve Mental Health and Wellbeing > Lecture 6 - Substance Use and Comorbidity > Flashcards

Lecture 6 - Substance Use and Comorbidity Flashcards

1
Q

What is early remission of substance use? (DSM-5)

A

At least 3 months but less than 12 months without substance use

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2
Q

What is sustained remission of substance use?

A

At least 12 months without substance

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3
Q

What do Abstinence programmes state?

A
  • There is no safe amount of use
  • Complete cessation of use is necessary
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4
Q

What are examples of abstinence programmes?

A
  • 12 step self help program (AA)
  • Detoxification programs (opioid treatment)
  • Pharmacological interventions
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5
Q

What are some examples of pharmacological interventions for SUD?

A
  • Disulfiram = interferes with alcohol metabolism causing nausea and vomiting
  • Naltrexone = reduces alcohol cravings and blocks effects of opioids in the brain
  • Methadone = reduces withdrawals
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6
Q

What impacts the success rates of abstinence programmes?

A

Highly dependant on motivation to change - sometimes based on coercion and mandatory (told to by family or hospital)

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7
Q

What is the aim of Harm reduction?

A
  • 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
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8
Q

What do NICE guidelines suggest about dual diagnosis?

A
  • 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
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9
Q

What should healthcare professionals ask adults and young people with psychosis about their alcohol / drug use?

A
  • What they use
  • The quantity, frequency and pattern of use
  • The route of administration
  • Duration of current level of use
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10
Q

What is suggested for psychosis treatment?

A

Antipsychotic meds, CBT, family intervention

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11
Q

What is suggested for substance use treatment?

A

Motivational interventions, CBT, family involvement, contingency management

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12
Q

What are psychosocial interventions?

A
  • Integrated therapy (individual or groups):
  • Motivational interviewing
  • CBT
  • Psychoeducation
  • Family therapy
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13
Q

What does psychological assessment determine?

A

Patterns of use, history of use, motives for use, consequences, motivation to address the problem and personal strengths

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14
Q

What does psychological assessment seek for SUD?

A

To understand the role played by substances in the clients life - factors maintaining the substance use and obstacles to change

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15
Q

What should the treatment plan be for SUD?

A
  • Person centred
  • Address problems and goals
  • Take into accounts the clients motivation to change
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16
Q

What are the stages of change?

A

Precontemplation -> Contemplation -> Preparation -> Action -> Maintenance -> Relapse

17
Q

What is the precontemplation stage?

A

Client not thinking about changing substance abuse behaviour - do not consider it a problem

18
Q

What is the contemplation stage?

A

Still using but begin to think about cutting back

19
Q

What is the preparation stage?

A

Still using but intend to stop - planning for change

20
Q

What is the action stage?

A

Chooses a strategy to stop substance use, begins to make the changes

21
Q

What is the maintenance stage?

A

Sustaining abstinence or reduction and avoiding relapse

22
Q

What is the relapse stage?

A

Relapse and return to an earlier stage

23
Q

What method of support is beneficial for the precontemplation stage?

A

Motivational interviewing - persuade client to change / challenge their use / enhance motivation to change

24
Q

What is motivational interviewing?

A

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

25
Q

How does motivational interviewing work out?

A

If the reason for change is stronger than the reason for staying the same - tipping the balance for change

26
Q

What are some reasons for using (staying the same)?

A
  • Substance relaxes them, stops anxieties, gets rid of voices
27
Q

What is Psychoeducation?

A

Provides information about the impact of substance use on MH
Educate clients about substance use, behaviours, consequences
Useful if paired with another method

28
Q

What is Cognitive Behavioural Therapy (CBT) for SUD?

A
  • 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
29
Q

What are relapse prevention techniques?

A
  • 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
30
Q

What do the NICE guidelines state about family therapy?

A
  • 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
31
Q

What is family therapy?

A
  • Big psychoeducation focus- info about dual disorders
  • Teaches communication skills and builds problem solving skills
  • Helps family develop relapse prevention
32
Q

What is integrated therapy?

A
  • 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
33
Q

What is Contingency Management?

A

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

34
Q

What did a Circle Trial study find about contingency management?

A

500+ cannabis users with psychosis - no difference in outcome between those receiving CM and control

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