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Alcohol and Other Drugs Final Exam > Specialist Interventions and Unit Review > Flashcards

Specialist Interventions and Unit Review Flashcards

1
Q

Interventions Targeting the Drug:Drug Information

A

Important to provide accurate information
Effects and side effects, dosage, methods, and potential harms
E.g. Brochures/psycho-education
Particularly useful for pre-contemplators
Avoids confrontation and argument
Raises awareness
Correct inaccurate or dangerous information

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2
Q

Interventions Targeting the DrugWithdrawal Management (Detoxification)

A

-Variety of settings (related to service and severity of withdrawal):
–General hospital, specialist inpatient units, outpatient clinics and home-based
Inpatient:
Physical dependence requiring medical assistance
Outpatient:
Less severe or complicated
Stepping stone to ongoing drug treatment:
Not a treatment by itself
-Rates of relapse post withdrawal management are usually high

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3
Q

Delirium Tremens

A

-Condition caused by alcohol withdrawal:
–From latin meaning “trembling delirium”
–characterized by tremor, visual hallucinations, and autonomic instability
“But anybody who’s never had delirium tremens even in their early stages may not understand that it’s not so much a physical pain but a mental anguish indescribable to those ignorant people who don’t drink and accuse drinkers of irresponsibility.”

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4
Q

Case Thing

A

“Once addicted, your life then becomes a dedication to your addiction…

The longer one takes heroin the greater one’s tolerance becomes. Eventually, the little bags weren’t enough to stave off the symptoms of withdrawal, and more and more was required just to get me to work, just to get me to sleep, just to get through this trauma, just to not feel how miserable I was …

and then that little promise you made to yourself – ‘never ever a needle’ – begins to get broken down because your tolerance is now so high, smoking the stuff just doesn’t touch the sides. ..

Now the game is in a different league, the complications and ramifications are endless but they all lead to one road, an ever increasing addiction. It’s been 17 years this year since I injected my last hit of heroin which most certainly would have been in my neck, the only veins I could use at that point in my addiction.”

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5
Q

Agonists

A

Drugs that occupy receptors and activate them

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6
Q

Antagonists

A

Drugs that occupy receptors but do not activate them. Antagonists block receptor activation by agonists.

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7
Q

Interventions Targeting the Drug:Naltrexone rapid detoxification

A
  • Naltrexone is an Opiate Antagonist
  • -blocks the effect of opioids
  • Causes a rapid withdrawal from opiates (matter of hours vs days)
  • Not shown to be more effective than standard methods of detoxification
  • -Not widely offered
  • Risks associated
  • -Mainly overdose
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8
Q

Interventions Targeting the Drug:Naltrexone Maintenance Treatment

A
  • Cravings reduced, and blocks effects of opiates
  • -Varying effectiveness – not widely supported
  • Prior to use - detox completely from opioids
  • -To minimise withdrawal reaction
  • Tablets vs implants
  • Outcomes best if highly motivated, employed, with good social support, older and with prior treatment experience
  • Cost can be a restrictive factor
  • Risk of overdose
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9
Q

Interventions Targeting the Drug:Methadone Maintenance Treatment

A
  • Full opiate agonist
  • For those unable to cease opiate use/manage withdrawal
  • -Maintenance rather than abstinence
  • -Often preferred choice for high levels of opiate dependence
  • -Can be useful for chronic pain treatment
  • -Protective treatment for released prisoners with opiate use histories
  • Selected GP and Alcohol and Drug Services only – highly regulated
  • High retention in treatment
  • -Not as intensive
  • Reduces/does not eliminate heroin use for all
  • Reduces HIV risk behaviour, criminal behaviour, and risk of overdose
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10
Q

Interventions Targeting the Drug:Buprenorphine

A
  • Partial agonist & partial antagonist
  • Maintenance treatment
  • Can be a detoxification aid
  • -Detoxification and withdrawal from Buprenorphine better tolerated than from methadone or heroin
  • -Less severe symptoms
  • Higher doses improve retention in treatment and reduce heroin use
  • Can be taken in one, two, or three day doses (Double/Triple dosing options)
  • Compared to methadone maintenance treatment:
  • -Similar/slightly less retention in treatment,
  • -Reduces illicit drug use to an equivalent or greater extent
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11
Q

Liquid Handcuffs?

A

“Ask the same people (people on methadone) what they know about methadone itself, where it comes from or the chemistry behind it, and they shrug. “Who cares? You’re not hanging out. You’re not twitching. You can function.” And the bad part? “You put on weight. It makes you sweat. Rots your teeth. Keeps you tied to a clinic or pharmacy.””

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12
Q

Interventions Targeting the Drug:Pharmacotherapy for Alcohol abuse

A

Anti-craving Medications

  • Campral (Acamprosate)
  • -3 times daily dosing
  • Naltrexone
  • -Daily dosing
  • -High cost
  • Both sometimes prescribed taken together
  • Mixed effectiveness
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13
Q

Interventions Targeting the Drug:Pharmacotherapy for Alcohol abuse

A

Antabuse Maintenance Therapy

  • Blocks enzyme that metablises alcohol
  • Reacts with alcohol to make client feel very ill
  • -Effectively develop a severe allergic reaction to alcohol (can be fatal)
  • More effective if used in conjunction with ongoing support
  • Indications: Alcohol Use Disorder with Tolerance/Withdrawal symptoms and abstinence as a goal
  • Some risks including hepatitis
  • -Regular liver function testing essential
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14
Q

Interventions Targeting the Drug:Nicotine Replacement

A 
Patches:
Once-daily application, socially acceptable, easy to use, steady and reliable dose
Gum:
Best for smokers heavily dependant on Nicotine
Poor compliance
Inhalers:
Plastic tube with inhalable nicotine
All are more effective with counselling
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15
Q

Interventions Targeting the Drug:Urine Drug Screening

A
  • Random or intermittent urine drug screening to identify drug used recently
  • -Timing varies between drugs – depends on pharmacokinetics
  • May aid in relapse prevention
  • -Best if voluntary decision by person
  • Helps to demonstrate adherence?
  • -False positives/negatives
  • Danger in shifting to less easily detectable drugs, masking agents etc…
  • -Focus can become on ‘beating’ the screen rather than treatment goals
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16
Q

Interventions Targeting the Individual:Controlled Drinking/Drug Use Training

A
  • If abstinence not a goal – harm minimisation approach
  • Requires high motivation
  • Difficult for long-standing addiction
  • Environmental factors often key to success
  • -Strong social supports required
  • Process involves:
  • -Self-monitoring
  • -Develop limits and rules around consumption
  • -Devise strategies for high risk situations
  • -Use rewards to maintain changes to behaviour
17
Q

Controlled Drinking ProgramsTips to Control Your Drinking

A
  • Plan drinking
  • Consume drinks with less alcohol
  • Avoid cocktails and punches
  • Start with non-alcoholic drink
  • Every second drink non-alcoholic
18
Q

Interventions Targeting the Individual:Self Help Groups

A
  • Non-drug using social support – usually run by peers in recovery
  • Widely available
  • Easy to set up and run – no/low cost
  • 12 Step programs most common
  • -Strong ‘spiritual’ based philosophy
  • -Require abstinence as a goal
19
Q

The 12 Steps

A

Step 1 - We admitted we were powerless over our addiction - that our lives had become unmanageable
Step 2 - Came to believe that a Power greater than ourselves could restore us to sanity
Step 3 - Made a decision to turn our will and our lives over to the care of God as we understood God
Step 4 - Made a searching and fearless moral inventory of ourselves
Step 5 - Admitted to God, to ourselves and to another human being the exact nature of our wrongs
Step 6 - Were entirely ready to have God remove all these defects of character
Step 7 - Humbly asked God to remove our shortcomings
Step 8 - Made a list of all persons we had harmed, and became willing to make amends to them all
Step 9 - Made direct amends to such people wherever possible, except when to do so would injure them or others
Step 10 - Continued to take personal inventory and when we were wrong promptly admitted it
Step 11 - Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out
Step 12 - Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs

20
Q

Interventions Targeting the Individual:Brief interventions

A
  • 1-5 sessions with follow-up and self-help material
  • Very focussed interventions
  • -e.g. decision making, problem solving, goal setting, relapse prevention
  • Useful for pre-contemplators, less severe/complicated Substance Use Disorder, and primary care settings
  • Results often as good or better than longer therapy in these contexts
21
Q

Interventions Targeting the Individual:Social Skills Training

A

Premise:
Deficient social skills
–Leads to poor adjustment and dysfunction
—Substance abuse as a coping strategy
-Focus is training in areas of deficiency
–Teaching new social skills
—Group therapy can be a good setting for this
-Assertiveness training, anger management, relaxation training, modelling, role playing etc

22
Q

Interventions Targeting the Individual:Cognitive Behavioural Therapy: CBT

A
  • May be a longer-term intervention
  • Focus on dysfunctional cognitions
  • -E.g. Permission giving thoughts
  • –“One drink/shot/use won’t hurt”, or “I need this to cope”, etc…
  • Behaviours that maintain alcohol and other drug use:
  • -Change to social groups, cued associations, “seemingly irrelevant decisions”
  • Skills training:
  • -E.g. dealing with cravings, monitoring use patterns and thoughts, high risk situations, relapse prevention, alternative activities, setting goals and problem solving
  • In addition to treatments for any mental health comorbidities
  • -E.g. PTSD, Depression, Anxiety, Personality Disorders, Psychosis, etc…
23
Q

Interventions Targeting the Environment: Community Development

A
  • Generates and disseminates drug-related resources to the community
  • Prevention and intervention strategies
  • Can raise awareness of drug issues
  • Useful if linked to the development of more comprehensive strategies for the community
  • -e.g. liquor licensing interventions, support groups, school-based interventions
24
Q

Interventions Targeting the Environment: Employment, educational and recreational opportunities

A
  • Recognises role of social disadvantage in substance abuse problems
  • If successful, are strong protective factors against drug misuse
  • Opportunities to develop skills and social networks outside the drug using lifestyle
  • Can improve self-worth and self-esteem
  • Introduces alternatives and healthy lifestyle
25
Q

Interventions Targeting the Environment: Family Therapy

A
  • Focus on treating the ‘family’
  • Better treatment outcomes
  • -Can improve compliance with treatment and earlier engagement
  • -Can alleviate distress for significant others
  • Family members need to agree to be involved
  • Confidentiality issues
  • Multiple needs need to be managed
  • -Individuals may need own counselling
26
Q

Interventions Targeting the Environment: Case Management

A
  • Single point of contact with health and social services
  • Client driven
  • Advocacy
  • Community based
  • Flexible and culturally sensitive
  • Link clients with appropriate services
  • Monitor clients’ progress in treatment
27
Q

Interventions Targeting the Environment: Rehabilitation Centres

A
  • Medium to long-term residential programs
  • Public & Private options
  • -Private usually shorter stay – a few weeks, Public – a few months
  • Generally require abstinence as a goal
  • Facilitate access to medical services, education, employment, skills training, and community supports
  • Usually promote participation in daily running of program – ‘Therapeutic Community’
  • Tend to be group therapy based
  • Staged reintegration programs
  • -Half-way and 3/4 (less structured) houses
28
Q

Matching clients to treatments

A
  • No two people are the same
  • Different problems require different types or combinations of interventions at different levels
  • -Although there are specific interventions that may work best for specific populations
  • Job of clinician/case manager is to work out which option is best for the client, in collaboration with the client
  • Combinations of treatment options usually most effective I.E.:
                  DRUG                 INDIVIDUAL               ENVIRONMENT
       Maintenance therapy,            CBT,                         and Family therapy

-Goal is to place client into least intensive treatment that will most likely facilitate treatment goals

Alcohol and Other Drugs Final Exam (5 decks)

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