Outpatient management of substance dependence

Question 1

Define Substance Dependence using the DSM-5 criteria. (4 marks)

Answer 1

Substance dependence, according to DSM-5, is defined as a Substance Use Disorder (SUD) characterized by a problematic pattern of substance use leading to significant impairment or distress. The diagnosis is based on the presence of at least two of the following criteria within a 12-month period: impaired control, social impairment, risky use, and pharmacological criteria such as tolerance and withdrawal.

Question 2

Explain the primary prevention strategies for Substance Use Disorders at both the individual and community levels. 94 marks)

Answer 2

(a) Individual-level interventions (2 marks)
Information dissemination about substances and their consequences
Affective education to enhance self-esteem and decision-making skills
Providing alternative activities
Resistance skills training, and personal and social skills development.

        (b) Community-level interventions (2 marks) Community engagement and mobilization reducing supply by restricting access to illicit substances demand reduction through prevention programs in broader social initiatives implementing national drug control policies.

Question 3

List and briefly describe four screening tools used to assess substance use disorders. (4 marks)

Answer 3

AUDIT (Alcohol Use Disorders Identification Test): Screens for hazardous and harmful alcohol consumption with 10 questions. (1 mark)

CAGE Questionnaire: Screens for alcohol dependence with 4 yes/no questions. (1 mark)

DAST (Drug Abuse Screening Test): Assesses drug use with 20 yes/no questions. (1 mark)

CRAFFT: Designed for adolescents, focusing on risky behaviors associated with substance use. (1 mark)

Question 4

Discuss the short-term goals of outpatient treatment for substance dependence. (4 marks)

Answer 4

(a) Achieving initial sobriety (2 marks)
The primary focus is to stop substance use
Manage withdrawal symptoms to stabilize the patient.

(b) Developing a treatment plan (2 marks)
Collaborate with healthcare providers to create a personalized plan that addresses specific needs and goals setting the foundation for long-term recovery.

Question 5

Explain the role of Motivational Interviewing (MI) in outpatient management of substance dependence, focusing on its key techniques. (4 marks)

Answer 5

Motivational Interviewing is a collaborative, person-centered approach that aims to strengthen a person’s motivation to change. The key techniques include open-ended questions, affirmations, reflective listening, and summarizing. MI operates on principles such as expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy.