S5 - Substance Misuse Flashcards
What is substance misuse
☞ the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs
can lead to dependence syndrome, which is a cluster of behavioural, cognitive and physiological phenomena that develop after repeated substance use
What are the different types of substances
note that sometimes drugs have mixed effects and can fit into more than one category)
stimulants
Make you feel more alert + more energy + more confidence.
☞ tobacco, cocaine, amphetamine and mephedrone
hallucinogens
Can change or impact perceptions, mood and senses. ‘Mind-altering’
☞ LSD, magic mushrooms, ecstasy
depressants
Make you feel more relaxed
☞ alcohol, heroin, tranquilisers and cannabis
designer drugs, volatile substances and others…
What is dependence
- Can be physical and/or psychological
- physical experiencing symptoms associated with withdrawal from the substance. The severity of these depend on the drug and how long they’ve bene taking them for
- psychological is the most difficult to treat. Relates to having impaired control over life
What tool is used to assess dependence
ICD-10 where 3 or more features are present
- Strong desire / compulsion to take substance
- Difficulties in controlling substance-taking behaviour
- Physiological withdrawal sate
- Evidence of tolerance (ie higher doses required to achieve effects that were originally produced by lower doses in past)
- Progressive neglect of alternative pleasures or interest
- Persisting with substance use despite clear evidence of harmful consequences
☞ can also use DSM-V diagnostic criteria
Risk/protective factors for drug use
risk
- Issues relating to family life eg neglect, abuse or drug misuse
- Mental health
- Employment and educational attainment
- Social groups eg spending time with drug users
- Adverse childhood experiences
- Previous drug use
- Biology ie those who report positive effects from drug misuse
protective
- Education
- Self control
- Positive self image and mental health
What are some policy responses to alcohol consumption
- Taxation and price regulation (making them less affordable)
- Regulating marketing (making them less desirable)
- Regulating availability
- Providing information and education
- Managing the drinking environment
- Reducing drink driving
Theories of dependence: classical conditioning
- Drug dependence arises from environmental effects + a drug effect
- Unconditional stimulus such as falling blood alcohol levels ⇢ unconditional response eg craving or withdrawal symptoms
- A cue/conditioned stimulus (eg sight of needle or smell of drink) is paired with an unconditional stimulus like falling alcohol levels
Theories of dependence: imitation theories
Social learning theory ☞ learn through observation and listening to others – our behaviours and decision making is developed through what we observe in our peers/role models
- modelling where the risk of developing drug misuse increases if you see others around who are participating in this type of behaviour
- expectation where a positive reward makes drug use more likely. Ie early connections between behaviours and perceived rewards (ie parent comes home from work and uses alcohol to relax). ▶︎ a negative experience will promote avoidance
- self efficacy where how you view your ability to abstain or deal with situations will impact on behaviour
Theories of dependence: rational choice theories
☞ dependency involves making rational choices that favours the benefits of dependence over the cost. Individuals are motivated by their wants + goals
- Applies economic concepts to addiction and dependence
- A harmful addiction has a negative effect on an individual’s resoures
- Individuals make decisions about whether or not to take a substance, taking into account how their current use impacts on the future
- People who discount the future are more likely to become addicted
- making drugs more costly (both financially and in other ways) would lead to reduced drug use
Route of drug use and their physical complications
- oral upper GI irritation, ulceration and malignancy
- intranasal rhinitis, epistaxis, ulceration, septal perforation, viral transmission
- inhalation perioral dermatitis, aspiration, asphyxiation
- smoking infection, cough, pneumothorax and cancer
- intramuscular scarring, vessel damage, pain, haematoma (at injection site)
- subcutaneous scarring, lipodystrophy and risk of infection
What are some physical effects of dependent drug misuse
- Complications of injecting (ie groin, arm, toes) where DVT and abscesses
- Blood-borne virus transmission eg Hep B, Hep C and HIV
- Effects of poverty (ie nutrition)
- Poor pregnancy outcomes
- Side effects of opiods (constipation etc)
- Side effects of cocaine (vasoconstriction + serotonin syndrome)
What are some social effects of dependent drug misuse
- Effects on relationships eg family and friends
- Second-hand effects on children
- Imprisonment
- Social exclusion
- Loss of job
What are some psychological + mental health effects of dependent drug misuse
- Fear of withdrawal
- Craving
- Guilt
☞ these may all be temporarily alleviated with drug use - Self medication
- Depression
What are the aims of drug misuse treatment
- To reduce harm to user, family, community and society
- To improve health and prevent death
- To stabilise lifestyle
- Reduce illicit drug use
- Reduce crime
- Improve prospects for rehabilitation and integration
What can primary care doctors offer to newly presenting drug users
- Health check eg blood pressure to check for complications
- Empathy + listening ear
- Screening for blood borne viruses
- Contraception
- Sexual health checks and advice
- General immunisation status
- Signposting to additional help (ie housing, counselling, injecting advice and benefits)
- Information on local drugs services including needle exchange
