Substance use Disorder

Question 1

List some intoxicating or addictive substances below

Answer 1

• Alcohol
• Cannabis
• Opiates
• Amphetamines
• Benzodiazepines

Question 2

Why do you think people are reluctant to admit they have a substance-related disorder

Answer 2

shame

fear of stigma, judgement or discrimination

Question 3

Brief Intervention

Answer 3

Components include: assessment, feedback, listening and advising, strategies, defining treatment goals, discussing strategies

Question 4

Motivational interviewing

Answer 4

Precontemplation - no intent of changing
Contemplation- is aware of problem but reaims ambivalent thinking about changing. therapist must acknowledge this works on tipping, offers support/ client responsibility
Preparation- client intends to change but is confused, looking for advice and support, therapist inspires hope and choice while demystifying the change process
Action- behaviour changes commence
Maintenance- Change has been achieved, vigilance required to avoid relapse and may slip back and have to work their way back through the cycle.

Question 5

Relapse prevention

Answer 5

Relapse - this is an expected part of this process and care must be taken to ensure the client understands this to avoid a sense of guilt of failure

Question 6

Harm minimisation and harm reduction

Answer 6

Needle exchange programmes
Methadone programmes (opioid recovery service)
Nicotine replacement therapy (NRT)
AA (alcoholic anonymous)
NA (narcotics anonymous)
Controlled drinkings ideas

Question 7

Alcohol withdrawal

Answer 7

Common symptoms- temor, hypertension ,restlessness, sweating diarrhoea, readachem difficulty breathing, decreased, appetite, anxiety
nursing management- reduce agitation, remain calm, observe airways and breathing, monitoring vital signs and assess for head injury, keep client calm and reduce exhaustion and increase hydration

Question 8

substance withdrawal and detoxification (five main areas)

Answer 8

• minimise progression to severe withdrawal
• decrease risk of injury
• elimination risk of dehydration, electrolyte and nutrition imbalance
• reduce risk of seizure
• identify presence of concurrent of different diagnosis

Question 9

What is a substance

Answer 9

Any chemical entity that is used non-medically and is generally self-administered, through any route of administration for its positive psychoactive effect
Psychoactive (mind altering) compound with the potential to cause potential health and social problems (including addiction)

Question 10

Nicotine

Answer 10

cigarettes, vapor-cigarettes, cigars, chewing tobacco

Question 11

Alcohol

Answer 11

beer, wine, liquors

Question 12

Cannabinoids

Answer 12

marijuana, hashish, hash oil, edibles

Question 13

Opioids

Answer 13

heroin, methadone, buprenorphine, oxycodone

Question 14

Depressants

Answer 14

benzodiazepine (valium), barbiturates (seconal)

Question 15

Stimulants

Answer 15

amphetamine, methamphetamine, methylphenidate (ritalin)

Question 16

Hallucinogens

Answer 16

LSD, mescaline and MDMA (ecstasy)

Question 17

First screening

Answer 17

all patients should be screened for substance use disorders especially within all health care settings and when there is concern
screening tools
- AUDIT
- CAGE
- ASSIST V3
- SACCS (young people)

Question 18

Drug use continuum

Answer 18

• no use/safe use
• hazardous use: use while not causing problems, but does not meet DSM 5 criteria for a diagnosis of dependence
• problem use: use which is currently causing problems, but does not meet DSM 5 criteria for a diagnosis of dependence
• substance dependence or addiction
• dyscontrol: substance used more times than not
• sailence: much time is spent in substance use
• compulsion of use: continued use despite knowledge of problems
• physiological features

Question 19

Examination

Answer 19

1. general appearance (checking obvious mental and physical disorder)
2. readiness to change ( establishing stage of change– precontemplation, contemplation, determination, action)
3. risk assessment- utilise your services risk assessmenr tool and undertake a current risk assessment

Question 20

Brief assessment : four L’s

Answer 20

Liver- current physical health and functioning issues
Lover- current relationship issues
Livelihood- current employment
Law- legal issues related to current substance use or misuse

Question 21

Stages of change

Answer 21

• pre-contemplation
• contemplation
• preparation
• action
• maintenance
• relapse

Question 22

What does an BI look like? - ASEAN

Answer 22

A= assessment: (brief assessment)
S= summary: (feedback to current client, risk/harm i.e. sexual activity, work, performance)
E= education (ALAC guidelines drinking, risks of drinking for them)
A= advice (to reduce this risk, it is medically advised to lower/ reduce your substance use)
N= negotiate (a plan)

Question 23

Key features of a brief assessment

Answer 23

• time limited
• teachable moment
• need to be considered in the context of ongoing relationships with patient and family
• enhance self efficacy
• increases self management skills/ resilience

Question 24

Tips for communication

Answer 24

• stay calm and reasonable

- ask the person

Question 25

person not willing to change

Answer 25

• don’t be discouraged - the person may become willing to work on this in the future.
• Communicate your concern and willingness to help
• continue to monitor use and recommend change at future visits

Question 26

The process

Answer 26

• screening
• brief assessment, continuum, stages of change model
• brief intervention, FRAMES, motivational interviewing skills