Lecture 6, SUD Flashcards
According to the DSM-5, what is remission?
At least 3 but less than 12 months without substance use disorder criteria, except for craving
What are abstinence programmes?
Based on the idea that there is no “safe” amount of use. The aim is to complete cessation of use
Name examples of abstinence programmes.
Detoxification programmes (opioid treatment programmes)
12 step self-help programmes
Pharmacological Interventions
What medications come under pharmacological interventions?
Disulfiram, which interferes with alcohol metabolism causing nausea and vomiting
Naltrexone, which reduces craving for alcohol/blocks effects of opioids in the brain
Methadone, which reduces withdrawal symptoms
What are detox/12 step approaches highly dependent on?
Motivation to change, and sometimes based on coercion/mandatory
What is the aim of treatment at an individual level?
To reduce the risks associated with substance use; to reduce or prevent excess morbidity and mortality.
What are the goals of treatment at an individual level?
- Reduce negative consequences of substance use for the individual
- Promote recovery (whilst accepting relapse)
- Improve quality of life
What are the aims of the NICE guidelines for dual diagnosis?
To help healthcare professionals guide people with psychosis and coexisting substance misuse to stabilise, reduce and stop their substance misuse.
What are the assumptions of the NICE guidelines for dual diagnosis?
- Abstinence is not necessary, simply reducing/stabilising SU is also a desirable outcome.
- Reducing substance use will lead to improved outcomes
If a person has used substances, what should healthcare professionals ask them?
- The particular substance(s) used
- The quantity, frequency and pattern of use
- The route of administration
- Duration of current level use
What are the recommended evidence-based treatment for psychosis?
Anti-psychotic medication, CBT and family intervention
What are the recommended evidence-based treatments for substance use?
Motivational interventions, CBT, contingency management, family involvement
What are the psychosocial interventions for dual disorders?
They typically involve a combination of the recommended interventions (“integrated therapy”): Motivational interviewing; CBT; psychoeducation; family therapy/systematic therapy
What are the modalities of psychosocial interventions?
Individual, group, combination - increasingly use of internet and mobile apps to deliver therapy
What does psychological assessment determine?
Patterns of use, history of use (previous treatment), motives for use, consequences, motivation to address problems, personal strengths
What does psychological assessment seek to understand?
Role played by substances; factors maintaining substance use and the obstacles to change/relapse risks
What should a treatment plan be?
Person centred; Address problems and goals identified during assessment; Consider client’s motivation to address and change; identify treatment goals and target behaviour; identify measurable outcomes
What are the stages of change in Prochaska & DiClemete’s model?
Precontemplation; Contemplation; Preparation; Action; Maintenance; Relapse
What is the precontemplation stage?
It is where clients are not thinking about changing substance behaviour and may not consider it to be a problem - MOTIVATIONAL INTERVIEWING
What is the contemplation stage?
Still using substances, but they begin to think about cutting/quitting use
What is the preparation stage?
Still using substances, but intent to stop - planning for change begins
What is the action stage?
Clients choose a strategy for discontinuing substance use and begin making changes
What is the maintenance stage?
Clients work to sustain abstinence or evade relapse
What is the relapse stage?
Many clients will relapse and return to an earlier stage, but will have hopefully gained new insights into problems
What is motivational interviewing?
A person-centred counselling method for addressing the common problem of ambivalence about change. It seeks to elicit and explore an individual’s own arguments for change
What is the emphasis of motivational interviewing?
Helping clients to understand how their substance use keeps them from achieving their goals
