Lecture 7 - Alcohol/Substance Use Disorders Flashcards
What does “substance use” cover?
Range of substances, both legal/illegal
Some terms interchangeable (use/misuse/abuse) or underlined (alcoholism/heavy drinker)
Definitions important (lifetime use/recent/current)
What is DSM criteria for substance use disorder?
Not to do with freq/dose
Diagnosis reflects impact of current substance use on functioning in everyday life (harm being done)
Use can be problematic/harmful without dependence criteria met, particularly for people w/ mental health problems (who may have increased sensitivity)
What are the physical consequences of drug use?
Direct: liver/heart & lung damage/increased cancer risk
Indirect: illness/injury/self-neglect/harm from risky behaviours
What are the social/interpersonal consequences of drug use?
Conflict w/ others, exclusion/stigma, poor educational attainment, homelessness
What are the mental health consequences of drug use?
Transient psychosis (eg. Cannabis nudged), depression/anxiety, people w/ established illness (more/worse symptoms, poorer functioning, relapses/hospitalisations, increased suicidality, aggression)
Increased rates of mental health problems due to substance use?
In 2019/20, 7027 hospital admissions w/ primary diagnosis of drug-related mental health/behavioural disorders
What is the prevalence of drugs in the UK (2019-2020)
35% adults (16-59) taken drugs at some point, 9% in the last year
21% young adults aged 16-24 taken, drug use fell 1995-2013 but rising again now
What is the prevalence of alcohol in the UK (2019-2020)
65% men/50% women drunk alcohol in past week, prevalence increases w/ age
38% of men and 19% of women aged 55-64 drinking ‘above safe limits’ (14 units +)
More people ‘never’ drinking increasing and binge drinking decreasing, particularly among young adults
What groups are more likely to drink problematically/use illicit substances?
Young people (esp students), people w/ mental health problems, deprived areas
What is relationship between substance use/mental health?
Highly comorbid (dually diagnosed)
eg. Drug diagnosis + bipoar disorder = 8.3%
Should we intervene in substance use?
Multiple negative consequences (physical/psychological)
Less engagement w/ services, decreased medication + treatment adherence
NICE guidance – psychotherapeutic interventions should aim to stop/reduce use in people w/ mental health problems
What is remission from disorder? (DSM-5)
At least 3 but less than 12 months w/out substance use disorder criteria (except craving)
Sustained remission = at least 12 months without criteria (except craving)
What is abstinence?
Based on idea that there’s no “safe” amount of use, aim for complete cessation of use
Eg. Detoxification programmes, pharmacological interventions (naltrexone – reduced craving for alcohol/blocks opioids in brain, methadone – reduces withdrawal symptoms)
Success rates variable (dependent on motivation, coercion, not available for all drug types)
What is harm reduction?
(enshrined in NICE guidelines for dual diagnosis)
Abstinence not necessary, reducing + stabilising substances use also desirable outcome
Reducing substance use will lead to improved outcomes
What are the 5 main psychological interventions?
Motivation interventions (MI)
Cognitive Behavioural Therapy
Contingency management (CM)
Family (systemic) therapy (FT)
Psychoeducation (PE)
Therapy may involve combination of these (integrated therapy)
What is psychological assessment?
Determines patterns/history/motives for use + positive/negative consequences + motivation to address problems
Seeks to understand role played by substances in life, identify factors maintaining substances use + obstacles to change/relapse risks
May take several session + involve significant others
How should a substance use treatment plan be?
Be person centred (individual needs/preference accounted for)
Address problems/goals identified in assessment
Consider motivation to address substance use/obstacles to change
Identify treatment goals/target behaviours
Identify measurable outcomes
What are the 6 stages of change?
Precontemplation: clients not thinking about changing substance abuse behaviour
Options: not address use, persuade client to change/challenge, enhance motivation to change
Contemplation: still using but begin to think about cutting back/quitting
Preparation: still using but intend to stop, planning for change
Action: begin make changes needed to carry out plan
Maintenance: sustain abstinence or maintain reduction
Relapse: return to earlier stage but hopefully gained insights
What is Motivational Interviewing? (MI)
Person-centred counselling method for addressing common problem of ambivalence about change, collaborative conversation to strengthen motivation for/commitment to change
Seek to elicit/explore individual’s own arguments for change
View ambivalence as normal, resolving ambivalence is key to change
Responsibility for change w/ client
Accept client’s goal unlikely to be abstinence or even reduction
Emphasis on helping clients understand how substance use keeps them from achieving goals
How does Motivational Interviewing work?
Reasons for change need to be stronger than reasons for staying same
Positive expectancies for effects of substance: “helps relax” “stops from feeling nervous” “rid of voices”
Aim of MI to enhance motivations to change, get client ready to make changes
Typical brief, standalone intervention or integrated with other (eg. CBT)
What is psychoeducation?
Typically included in MI + other individual interventions
Provision of info about impact of substance use on mental health
Psychoeducation groups designed to educate clients about substance abuse/related behaviours + consequences, identify resources, counteract denial
Not sufficient as treatment on its own
How does CBT work in alcohol/substance use disorders?
Identifies antecedents of drug use, focus on teaching user new/more effective skills for dealing w/ high-risk situations (eg. Negative emotional states/interpersonal conflict/social pressure/craving)
Aim to change learned behaviour by changing thinking patterns/beliefs/perceptions/assumptions
“I’m a failure” “I’m not strong enough to quit” etc.
Goes with relapse prevention
How does family/systemic therapy work in alcohol/substance use disorders?
NICE guidelines state:
Family/carers should having opportunity to be involved in decisions about treatment/care, given info/support, offered family intervention, etc.
Large psychoeducation component
Teach communication skills + builds problem solving skills in family members, including client
Help family develop relapse prevention strategies (increase support, reduce burden)
What is Contingency Management?
Behaviour modification (based on learning theory)
Incentivises/reinforces abstinence w/ aid of vouchers/privileges/prizes/financial incentives
Recommended by NICe for substance use interventions but evidence lacking for dual diagnosis
