S5- Substance misuse Flashcards
Define substance misuse
Refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs
- can lead to dependence syndrome
A) What is dependence syndrome?
B) Characteristics of this
A) A cluster of physiological, behavioural and cognitive phenomena in which the use of a substance or class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value
B) Desire to take psychoactive drugs, alcohol or tobacco
What are the 3 types of substances?
- Stimulants: make you feel more alert, more energy and confidence e.g. tobacco, cocaine, amphetamine (speed) and mephedrone
- Hallucinogens: mind altering: can impact your perceptions mood and senses e.g. LSD and magic mushrooms
- Depressants: make you feel relaxed e.g. alcohol, heroin, tranquillisers and cannabis
What is dependence?
- can be physical and/or psychological
- Physical: relates to experiencing symptoms associated with withdrawal from the substance
- Psychological: relates to having impaired control
Diagnostic guidelines
Xx
A) What is audit-c
A) tool used to identify alcohol dependence,
List some risk factors for drug use
- Issues relating to family life: neglect, drug misuse and/or emotional or physical abuse has taken place
- Mental health: depression, anxiety and ADD associated with drug misuse
- Unemployment and poor education attainment
- Social groups
- Previous drug use
- Biology: people who report positive effects from drug misuse
What are ACES?
Adverse childhood experiences e.g. abuse, parental separation, alcohol abuse, drug use, incarceration- increases someone’s chances of misusing substances in later life
What are the theories of dependence?
- Learning theories: something that we have learnt e.g. classical conditioning models
- Imitation theories: e.g. social learning theory
- Rational choice theories
Classical conditioning model
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A) What is the social learning theory?
B) Explain how you can apply this to patterns of substance misuse
A) An imitation theory - learning through observation and listening to others
B)
- Modelling: risk of developing drug use increases if you see others around you using drugs
- Expectation: a positive reward makes drug use more likely. E.g. seeing a parent using alcohol to relax. A negative experience will adversely promote avoidance
- Self-efficacy: how you view your ability to abstain or deal with situations impacts on behaviour
A) What is the theory of rational addiction?
B) Explain how you can apply this to patterns of substance misuse
C) How could this theory be used to reduce drug use?
A) Makes a distinction between harmful and beneficial addictions
B) Involves making rational choices that favours the benefits of dependence over the costs.
- individuals are motivated by their preferences (wants or goals)
- people who are dependent make utility maximising decisions about taking the substance and take into account their future
- discounting future—> addiction
C) Making drugs more costly, in all ways not just financial
What are the 3 different models for treatment?
- Medical model
- detoxification regimes
- substitute prescribing - Disease model
- step facilitation
- AA/NA - Behavioural model
- CBT
- Motivational interviewing
What is the medical model of treatment?
- focus on the physical condition i.e. tolerance, physical withdrawal, symptoms, vit deficiency, pancreatitis
- not good to use just on its own
What is the disease model of treatment?
- Minnesota model: combines in-patient with therapy and groups
- addiction is: an illness, with lots of control being the primary symptom
- addiction is genetic and can be predetermined
- abstinence/avoidance is the only viable treatment
What is the behavioural model of treatment?
- Addiction doesn’t exist, excessive use is a mis-learnt coping mechanism
- excessive use/misuse is a result of social, economic and familial learned experiences
- alternative coping mechanisms can be taught and past experiences addressed
The most important thing in treatment is harm reduction. Identify these in diff substances
- Alcohol: pump full of vitamin B, safety advice
- Opiates: Naloxone (opiate reversing injection), overdose awareness
- Injecting: needle exchange, Blood borne virus screening, sexual health, injecting advice
What are some of the psychosocial interventions?
- motivational interviewing
- CBT
- Mindfulness
- solution focused therapy
- relapse prevention
- peer support
- mutual aid
Substitute prescribing:
A) Opiates
B) Amphetamine
A) Substituting opiates with methadone(opioid, agonist), buprenorphine (antagonist opioid receptor modulator)
- using less of the illegal heroin, their lifestyle choices more stable
- reduces risk of infection
B) Dexamphetamine
Detoxification:
A) Alcohol
B) Opiates
C) Synthetic cannabinoids
A) Benzodiazepines—> chlordiazepoxide
B) Opiate substitutes: methadone, buprenorphine
C) Symptomatic detox: chlordiazepoxide
Relapse prevention:
X
List the pros and cons of the
A) community setting
B) In patient setting
A)
Pro’s:
- access time
- least disruptive
- maintains social support
- pace
- continuous psychosocial program
Cons:
- not suitable for everyone
- lower supervision
- higher risk
B)
Pro’s
- high supervision
- safer
- can handle complexity
Cons:
- access time
- removes social support
- cost
- divorced from community treatment
What is the most successful treatment combination for substance misuse?
- When two models are combined: pharmacotherapy with at least one psychosocial approaches —> motivational interviewing is the preferred treatment
What are the symptoms of withdrawal associated with alcohol?
- Withdrawal fits/seizures
- Delirium tremens: confusion, agitation, florid visual hallucinations and delusions —> lead to seizures, hyperthermia, dehydration, electrolyte imbalance, cardiovascular shock, acute liver failure
- Wernicke’s encephalopathy: acute brain disease associated with thiamine deficiency, cause of long term brain damage, result from vitamin deficiency
- Death
A) How can delirium tremens be treated?
B) Prevention of wernickes?
A) Using benzodiazepines (chlordiazepoxide or diazepam) for 7-10 days, dose varies by patient (age, gender, body mass, degree of alcohol dependence, other drug use and medication and associated physical disease)
B)
- Lower dose regimen; oral thiamine tablets 100 mg x2 daily, oral vitamin B x2 a day
- Higher dose regimen: oral thiamine and vitamin B and parenteral vitamins
