Lecture 6, SUD

Question 1

According to the DSM-5, what is remission?

Answer 1

At least 3 but less than 12 months without substance use disorder criteria, except for craving

Question 2

What are abstinence programmes?

Answer 2

Based on the idea that there is no “safe” amount of use. The aim is to complete cessation of use

Question 3

Name examples of abstinence programmes.

Answer 3

Detoxification programmes (opioid treatment programmes)
12 step self-help programmes
Pharmacological Interventions

Question 4

What medications come under pharmacological interventions?

Answer 4

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

Question 5

What are detox/12 step approaches highly dependent on?

Answer 5

Motivation to change, and sometimes based on coercion/mandatory

Question 6

What is the aim of treatment at an individual level?

Answer 6

To reduce the risks associated with substance use; to reduce or prevent excess morbidity and mortality.

Question 7

What are the goals of treatment at an individual level?

Answer 7

• Reduce negative consequences of substance use for the individual
• Promote recovery (whilst accepting relapse)
• Improve quality of life

Question 8

What are the aims of the NICE guidelines for dual diagnosis?

Answer 8

To help healthcare professionals guide people with psychosis and coexisting substance misuse to stabilise, reduce and stop their substance misuse.

Question 9

What are the assumptions of the NICE guidelines for dual diagnosis?

Answer 9

1. Abstinence is not necessary, simply reducing/stabilising SU is also a desirable outcome.
2. Reducing substance use will lead to improved outcomes

Question 10

If a person has used substances, what should healthcare professionals ask them?

Answer 10

• The particular substance(s) used
• The quantity, frequency and pattern of use
• The route of administration
• Duration of current level use

Question 11

What are the recommended evidence-based treatment for psychosis?

Answer 11

Anti-psychotic medication, CBT and family intervention

Question 12

What are the recommended evidence-based treatments for substance use?

Answer 12

Motivational interventions, CBT, contingency management, family involvement

Question 13

What are the psychosocial interventions for dual disorders?

Answer 13

They typically involve a combination of the recommended interventions (“integrated therapy”): Motivational interviewing; CBT; psychoeducation; family therapy/systematic therapy

Question 14

What are the modalities of psychosocial interventions?

Answer 14

Individual, group, combination - increasingly use of internet and mobile apps to deliver therapy

Question 15

What does psychological assessment determine?

Answer 15

Patterns of use, history of use (previous treatment), motives for use, consequences, motivation to address problems, personal strengths

Question 16

What does psychological assessment seek to understand?

Answer 16

Role played by substances; factors maintaining substance use and the obstacles to change/relapse risks

Question 17

What should a treatment plan be?

Answer 17

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

Question 18

What are the stages of change in Prochaska & DiClemete’s model?

Answer 18

Precontemplation; Contemplation; Preparation; Action; Maintenance; Relapse

Question 19

What is the precontemplation stage?

Answer 19

It is where clients are not thinking about changing substance behaviour and may not consider it to be a problem - MOTIVATIONAL INTERVIEWING

Question 20

What is the contemplation stage?

Answer 20

Still using substances, but they begin to think about cutting/quitting use

Question 21

What is the preparation stage?

Answer 21

Still using substances, but intent to stop - planning for change begins

Question 22

What is the action stage?

Answer 22

Clients choose a strategy for discontinuing substance use and begin making changes

Question 23

What is the maintenance stage?

Answer 23

Clients work to sustain abstinence or evade relapse

Question 24

What is the relapse stage?

Answer 24

Many clients will relapse and return to an earlier stage, but will have hopefully gained new insights into problems

Question 25

What is motivational interviewing?

Answer 25

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

Question 26

What is the emphasis of motivational interviewing?

Answer 26

Helping clients to understand how their substance use keeps them from achieving their goals