Session 5: Addiction and substance misuse Flashcards
Define substance misuse and outline associated epidemiology
Harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.
Estimates show that 10.4M adults drink at level that increases risk of health harm. Of these 595,000 may need treatment for alcohol dependance.
Estimates show that 2.7M adults took an illicit drug in the last year. Around 301,000 people in England are opiate or crack users.
Describe mechanisms of dependance( physical /physcological), tolerance, withdrawal, addictive behaviour and models of addiction
Physical dependance: experiencing symptoms associated with withdrawal from substance
Psychological dependance: impaired control, drugs become the crutch of their life
Dependance diagnosed using: tolerance, presence of withdrawal, addictive behaviour
Tolerance: levels increase with higher dependance
Addictive behaviour: persisting with consumption despite clear evidence of overtly harmful consequences.
Describe the common treatment regimens for various types of substance misuse problems and withdrawal states
- Substitute prescribing along with treatment-methadone
- Psycho-social counselling: CBT, solution focused therapy etc
- Detoxification
- Maintenance medication-antabuse etc
- Recovery capital
- Dual diagnosis- mental health needs
- Does not have to be voluntary-sanctions by justice system still effective
- continuously monitor possible drug use during treatment period
- Screen for HIV/AIDS, Hep B,C, TB,to modify behaviour. Counsel to avoid high risk behaviour.
Describe the variety of UK treatment agencies to which patients can be reffered to
Referral: specialist drug, voluntary sector, infectious diseases, maternity care
What are some policy changes made to control drug use
Policy response: taxation, price regulation, regulate marketing( no positive association), regulate availability, provide information and education, manage drinking environment, reduce drink driving, brief interventions and treatment
Advantages of methadone based treatment
- Reduces mortality very significantly
- Reduces drug related morbidity
- Reduces crime
- Reduces risk taking behaviour and spread of blood borne viruses
- Can be achieved in primary care
- Does not increase methadone mortality
What are some risk factors for drug use?
Risk factor: predicts or increase likelihood of misuse of substances
1. Family life: neglect, drug misuse, emotional, physical abuse
2. Mental health: depression, attention deficit disorder etc
3. Employment and educational attainment: unemployment etc
4. Social groups: spending time and socialising with drug users
5. Previous drug use
6. Biology: those who have positive effects from drug use more likely to continue
However, expectation drives experience.
What are the theories of dependance?
- Classical conditioning model: conditioned stimulus falling blood alcohol level, alcohol cues from smell or sight of drink etc
- Modelling: seeing others around you participating in this behaviour
- Expectation: positive reward. Early connections between behaviours and perceived rewards. Stressed parents consuming alcohol after work etc.
- Self-efficacy: how you view your ability to abstain/ deal with behaviour
In treatment: - CBT: reduces expectation of positive reward and develops self-efficacy
- 12 step programme: positive role models and promotes coping skills
- Rational choice: adicts make utility maximising choices about substance usage. Making drugs more costly( not just $) would lead to reduced use.
What are the different routes of drug use and the physical complications associated with them?
Oral route: upper GI irritation, ulceration, malignancy
Intranasal: rhintis, nose bleeds, ulceration, septal perforation, viral transmission through straws
Inhalation: dermatitis, aspiration(enters lungs, cirrhosis), asphyxiation
Smoking: infection, cough, cancer
Intramuscular: scarring, vessel damage, haematoma( blood pooling)
Subcutaneous: scarring, risk of infection( injection to layer under skin)
What are the physical effects of drug use?
Dependance, complications o finjecting, blood borne virus transmission, poverty, pregnancy outcomes, opioids SE( constipation, low salivary flow), cocaine SE( vasoconstriction), serotonin syndrome
What are the social effects of drug use?
Families, children affected, criminality, imprisonment, social exclusion
What are the psychological and mental health effects of drug use?
Fear of withdrawal, craving, guilt- all temporarily alleviated by drug use
MH: self medicaiton, depression. Solution is to use dual diagnosis
What are the complications of intravenous drug administration routes?
- Infection: bacterial/fungal specticeamia, endocarditis, aneurysms
- Vessel damage: oedema, ulcers
- Adulterants: paracetamol mixed with drugs etc
- Direct trauma: nerve damage, fistula
- Dependance
What are the aims of treatment of addiction?
Reduce harm, improve health, stabilise life, reduce consumption of drug, reduce crime.
Solutions to achieve this: improve prospects for rehabilitation, include detoxification etc
Outline the details of the cycle of change
Pre contemplation(not thinking about changing), contemplation( thinking about changing but no action yet), preparation( preparing themselves and family), action, maintenance( 6 months or more), relapse( can happen at any stage) and pre contemplation again.
