S6) Substance Misuse and Treatment Options Flashcards
What is substance abuse?
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs
Psychoactive substance use can lead to dependence syndrome.
What is dependence syndrome?
Dependence syndrome is a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug
Identify 5 consequences of dependence syndrome
- Difficulties in controlling drug use
- Persisting drug use despite harmful consequences
- Higher priority given to drug use than to other activities
- Increased tolerance for drug
- Withdrawal symptoms
What are the three main types of substances?
- Stimulants
- Hallucinogens
- Depressants
What are depressants?
Provide some examples
Depressants are substances that make you feel relaxed e.g. alcohol, tranquilisers, cannabis
What are stimulants?
Provide some examples
Stimulants are substances that make you feel more alert and give you more energy and confidence e.g. tobacco, cocaine, amphetamine (speed)
What are hallucinogens?
Provide some examples
Hallucinogens are mind-altering substances that can change/impact your perceptions, mood and senses e.g. LSD, magic mushrooms and ecstasy
Describe the treatment regime outlined in the Medical Model
- Detoxification regimes
- Substitute prescribing
- Focus on the physical condition i.e. tolerance, physical withdrawal symptoms, vitamin deficiency, pancreatitis
Describe the treatment regime as outlined in the Disease Model
- Addiction is an illness, with loss of control the primary symptom
- Addiction is genetic & therefore predetermined
- Abstinence/avoidance is the only viable treatment e.g. Alcoholics Anonymous / Narcotics Anonymous
Describe the treatment regime outlined in the Behavioural Model
- Addiction doesn’t exist, excessive use is merely a ‘mis-learnt coping-mechanism’ for anxiety/low self-esteem
- Excessive use/misuse is a result of social, economic & familial learned experiences
- Alternative coping mechanisms can be taught, & past experiences addressed
What treatment is offered when addicts don’t want to change?
Harm Reduction:
- Alcohol: Vitamin B
- Opiates: Naloxone
- Injecting: Needle exchange, BBV screening, sexual health
What treatment is offered when addicts don’t want to stop?
Substitute prescribing:
- Opiates: Methadone, Buprenorphine
- Amphetamine: Dexamphetamine
What treatment is offered when addicts do want to change?
Detoxification:
- Alcohol Benzodiazepines: Chlordiazepoxide
- Opiate Substitutes: Methadone, Buprenorphine
What treatment can be given when addicts want to stay changed?
Relapsed Prevention:
- Disulfiram (Antabuse): Alcohol Deterrent
- Acamprosate (Campral): Anti-craving
- Naltrexone: Opioid-receptor antagonist
What is erratic/unintentional non-adherence?
Erratic non-adherence occurs when the patient wants to follow the agree treatment but is prevented from doing so by barriers beyond their control
What is intelligent / intentional non-adherence?
Intelligent non-adherence occurs when the patient decides not to follow the treatment recommendations
How can one understand intelligent non-adherence?
This is best understood in terms of the beliefs and preferences that influence the person’s perceptions of the treatment and their motivation to start and continue with it
Identify and describe the 5 factors in the multidimensional model of adherence
- Disease factors: no, few or mild symptoms
- Healthcare factors: poor availability of services, long waiting times
- Treatment factors: complex regimens, unpleasant side effects
- Psychosocial factors: depression, poor support
- Patient factors: negative attitudes to treatment
What is concordance?
Concordance involves negotiation between patient & doctor over treatment regimes, in which patients beliefs and priorities are respected
State the 8 steps outlined in the concordance approach
⇒ Define problem
⇒ Describe treatment options & consequences of no treatment (convey equipoise)
⇒ Provide info in preferred format
⇒ Check patient understanding of options
⇒ Elicit patient’s concerns and expectations
⇒ Ascertain patient’s preferred role in decision making
⇒ Defer if necessary
⇒ Review decisions
