S6) Substance Misuse and Treatment Options

Question 1

What is substance abuse?

Answer 1

Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs

Question 2

Psychoactive substance use can lead to dependence syndrome.

What is dependence syndrome?

Answer 2

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

Question 3

Identify 5 consequences of dependence syndrome

Answer 3

• 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

Question 4

What are the three main types of substances?

Answer 4

• Stimulants
• Hallucinogens
• Depressants

Question 5

What are depressants?

Provide some examples

Answer 5

Depressants are substances that make you feel relaxed e.g. alcohol, tranquilisers, cannabis

Question 6

What are stimulants?

Provide some examples

Answer 6

Stimulants are substances that make you feel more alert and give you more energy and confidence e.g. tobacco, cocaine, amphetamine (speed)

Question 7

What are hallucinogens?

Provide some examples

Answer 7

Hallucinogens are mind-altering substances that can change/impact your perceptions, mood and senses e.g. LSD, magic mushrooms and ecstasy

Question 8

Describe the treatment regime outlined in the Medical Model

Answer 8

• Detoxification regimes
• Substitute prescribing
• Focus on the physical condition i.e. tolerance, physical withdrawal symptoms, vitamin deficiency, pancreatitis

Question 9

Describe the treatment regime as outlined in the Disease Model

Answer 9

• 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

Question 10

Describe the treatment regime outlined in the Behavioural Model

Answer 10

• 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

Question 11

What treatment is offered when addicts don’t want to change?

Answer 11

Harm Reduction:

• Alcohol: Vitamin B
• Opiates: Naloxone
• Injecting: Needle exchange, BBV screening, sexual health

Question 12

What treatment is offered when addicts don’t want to stop?

Answer 12

Substitute prescribing:

- Opiates: Methadone, Buprenorphine

• Amphetamine: Dexamphetamine

Question 13

What treatment is offered when addicts do want to change?

Answer 13

Detoxification:

• Alcohol Benzodiazepines: Chlordiazepoxide
• Opiate Substitutes: Methadone, Buprenorphine

Question 14

What treatment can be given when addicts want to stay changed?

Answer 14

Relapsed Prevention:

• Disulfiram (Antabuse): Alcohol Deterrent
• Acamprosate (Campral): Anti-craving
• Naltrexone: Opioid-receptor antagonist

Question 15

What is erratic/unintentional non-adherence?

Answer 15

Erratic non-adherence occurs when the patient wants to follow the agree treatment but is prevented from doing so by barriers beyond their control

Question 16

What is intelligent / intentional non-adherence?

Answer 16

Intelligent non-adherence occurs when the patient decides not to follow the treatment recommendations

Question 17

How can one understand intelligent non-adherence?

Answer 17

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

Question 18

Identify and describe the 5 factors in the multidimensional model of adherence

Answer 18

• 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

Question 19

What is concordance?

Answer 19

Concordance involves negotiation between patient & doctor over treatment regimes, in which patients beliefs and priorities are respected

Question 20

State the 8 steps outlined in the concordance approach

Answer 20

⇒ 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