Session 5 - Drug and alcohol dependence

Question 1

Define substance misuse

Answer 1

Substance abuse is the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs that can lead to dependence syndrome that develops after repeated substance use

Question 2

Describe the mechanism of dependence (physical and psychological) - outline the 3 theories of dependence

Answer 2

1. Learning theories
   - Classical conditioning model, learned associations between positive and negative reinforcers - so drug dependence arises from environmental effects paired with a drug effect
2. Imitation theories
   - Social learning theory, learning through observation.
   Modelling, expectation and self-efficacy
3. Rational choice theories
   - Dependency involves making rational choices that favours the benefits over the costs

Question 3

Outline the cycle of change of a drug user

Answer 3

Cycle of change:
Pre-contemplation (enter)
Contemplation 
Preparation
Action
Maintenance (hopefully leave)
Relapse?

Question 4

Describe common treatment regimes for different types of addiction and withdrawal states

Answer 4

Cognitive behavioural therapy (aimed at imitation theories) - reduces the expectation of a positive reward and develops self-efficacy
The 12 step programme - positive role models and promotes coping skills

Question 5

Describe UK agencies for referral of patients with addiction problems

Answer 5

Turning Point - for drug and alcohol addiction

Action Homeless, The Bridge Project and Berry House - wrap around services for substance misuse clients

Question 6

Which 3 methods can you use to diagnose dependence?

Answer 6

Method 1: ICD-10 diagnostic guidelines

Method 2: DSM V* diagnostic criteria

Method 3 : Audit C (used in GP surgeries)