Week 1 epidemiology and harms

Question 1

what is addiction?

Answer 1

Broadly speaking, addiction is a persistent, compulsive dependence on a behaviour or substance despite an awareness of the associated harms to self and others. Addiction is characterised by physiological tolerance to a substance as well as the experience of withdrawal symptoms and craving (Hart & Ksir, 2013). Tolerance to a behaviour or substance occurs when the initial response cannot be achieved without increasing the exposure. Signs of withdrawal are generally the opposite of those observed when affected by the substance or behaviour and, according to Ruiz and Strain (2014)

Question 2

what is the three diagnostic criteria associated with substance withdrawal?

Answer 2

• Development of a substance specific syndrome as a consequence of cessation of (or reduction in) substance use that has been heavy or prolonged;
• The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
• The symptoms are not a result of a general medical condition and are not better accounted for by another medical or mental disorder.

Question 3

What is the DSM-5 criteria for substance use disorder (SUD)? And what classifies as mind, moderate and severe?

Answer 3

The severity of an SUD is defined as Mild when 2-3 criteria are present, Moderate when 4-5 criteria are present, and Severe when 6 or more criteria are present (American Psychiatric Association, 2013).

1. The substance is often taken in larger amounts or over a longer period than intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
3. A great deal of time is spent in activities necessary to obtain the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home.
6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
8. Recurrent substance use in situations in which it is physically hazardous.
9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
    a. A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
    b. A markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, as manifested by either of the following:
    a. The characteristic withdrawal syndrome for the substance
    b. The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.

Question 4

What is the DSM-5 criteria for Gambling Disorder? and what classifies as Mild, moderate and Severe.

Answer 4

A. Persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period:

1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
2. Is restless or irritable when attempting to cut down or stop gambling.
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

B. The gambling behaviour is not better explained by a manic episode.

Question 5

what is the diagnostic criteria for SUD using the International Classification of Disease, 10th revision (ICD-10)? what does it focus on in comparison to the DSM-5?

Answer 5

The focus of the ICD-10 is on harmful use or “substance use that results in actual physical or mental damage” (Lowinson et al., p561). To be diagnosed with an SUD using the ICD-10, at least three of the following criteria must be present in the previous 12 months (World Health Organization, 1992):

1. A strong desire or sense of compulsion to take the substance.
2. Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use.
3. A physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms.
4. Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses.
5. Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects.
6. Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to heavy substance use, or substance-related impairment of cognitive functioning. Efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

Question 6

what is the correct terminology for people that have addictive behaviours?

Answer 6

called consumers.

Not addicts anymore because it describes them as though they are just addicts.

Question 7

why is alcohol different to drunks?

Answer 7

alcohol is apart of our history as it has had a huge impact on society and the industrial revolution It is apart our our culture, whereas drugs have not had this impact on society.

Question 8

what percentage of Australians consumed alcohol in in 2016, aged 14 and over? what is the difference between men and women? what was the average age of first consumption?

Answer 8

In 2016, 77.5% indicated they had consumed alcohol in the previous 12 months with a greater proportion of men (79.9%) than women (75.1%) consuming (AIHW, 2017). A significant proportion of young Australians aged 12-17 years (81.2%) have not used alcohol, and the average age at which alcohol is first consumed was 16.1 years in 2016, an increase from 14.4 years in 1998.

Question 9

What are some of the main findings from alcohol research? in relation to average consumption and binge drinking?

Answer 9

on the surface it appears like those trends are moving in a positive direction but what we have also seen is that this is very different when you talk about state-by-state, by age groups and by consumption trends. So we know, for example that much of this drop in consumption is driven by the Northern Territory, which has seen massive declines in the last five years. Similarly, even though average consumption has gone down what we are finding is that levels of binge drinking particularly in youth (ages 18-25 years) has increased.

Question 10

what age group is most likely to consume levels of alcohol considered high risk?

Answer 10

While 15.0% of all drinkers in 2016 reported drinking at very high risk levels, this pattern of drinking is most prevalent among those aged 18 to 29 years. Specifically, 29% of drinkers aged 18-24 and 27% of those aged 25-29 had engaged in very high risk drinking at least once during 2016 (AIHW, 2017).

Question 11

How is alcohol used worldwide?

Answer 11

it is important to note that almost half the world’s population does not drink; in 2016, 55.5% of the global population aged 15 years or older had ever consumed alcohol. There is wide variability in consumption levels across countries, however, with developed countries reporting greater consumption levels (WHO, 2018a). A minority of the total population (18.2%) engaged in monthly heavy episodic drinking. Heavy episodic drinking was more prevalent among young individuals aged 15-19 years (13.6% of all young people) and among male (29.2%) compared to female (7.2%) drinkers.

Question 12

What is tobacco uses trend over time?

Answer 12

As shown in Table 2, tobacco use in Australia has steadily declined since 1993. In 2016, 14.9% of individuals aged 14 or older were a current smoker, while 62% of individuals surveyed reported that they had never smoked, which constitutes a statistically significant increase since 2013.

Question 13

what is the tobacco trend worldwide? and what trends are there between ages, sex and countries?

Answer 13

The global trend in tobacco use mirrors that found in Australia. Between 2000 and 2015 the worldwide prevalence of daily tobacco smoking has decreased (see Figure 4 below). Rates of tobacco use differ across age groups, sex, and countries. Tobacco use is higher among men than women, and in developing compared to developed countries. Countries with the highest prevalence of daily smoking in 2016 included Indonesia, Timor-Leste, Russia and Tunisia for men, and Montenegro and Serbia for women (WHO, 2018b).

Question 14

what is Australia’s drug use trends and statistics in 2016? what are the sex differences? as what is the most commonly used illicit drug?

Answer 14

The proportion of Australians reporting use of illicit drugs in the past 12 months has remained fairly stable over time. Table 3 indicates that, in 2016, 43% of individuals reported they had ever used an illicit drug. During 2016, 15.6% of individuals surveyed indicated illicit drug use in the past 12 months. Past 12 month illicit drug use was more common among males compared to females and among individuals aged 20 – 29 years compared to other age groups. Marijuana/cannabis is the most frequently used illicit drug in Australia, with 10.4% of individuals reporting use in 2016. The use of methamphetamines, hallucinogens and synthetic cannabinoids decreased from 2013 to 2016.

Question 15

illicit drug usage worldwide. what did the World Drug report and Global Drug Survey find in 2017?

Answer 15

In 2017, an estimated 4.1-6.9% of individuals aged 15-64 worldwide had used an illicit drug in the past 12 months (UN, 2019). Table 4 below shows the global estimate of use of the six most commonly used illicit drugs. As in Australia, cannabis is the most commonly used illicit drug worldwide. Men are two to three times more likely than women to report use of an illicit drug.

Question 16

what example in the US, shows how things can change over time? Drug usage.

Answer 16

For the last decade, there has been an epidemic of pharmaceutical opiate use. Recent law changes, however, have made it much harder to get these pharmaceutical opiates. Due to this law change, there has been an increase in the illicit heroin market, which has led a marked increase in heroin-related deaths in the US.

Question 17

how/why might prescription medication be misused?

Answer 17

Some individuals may unintentionally misuse pharmaceutical drugs because they have received inappropriate advice or prescription from a health professional. Other individuals may, either intentionally or unintentionally, misuse prescription medicines by using a greater quantity of a drug or using a drug more frequently than has been prescribed. Other individuals may obtain and use pharmaceutical drugs which have not been prescribed.

Question 18

what is the trend in Australia for prescription drug misuse? has it increased or decreased? what were the most commonly misused drugs? and were there sex differences?

Answer 18

The non-medical use of prescription medicines has increased in Australia. In 2016, 12.8% of Australians reported they had ever misused a pharmaceutical drug, and 4.8% had misused a pharmaceutical drug in the past 12 months. While these rates are relatively stable compared to the 2013 rates (increase of 1.4% and 0.1%, respectively), they represent an increase from 7.4% lifetime use and 4.2% past 12 month use in 2010. Pain killers/ analgesics and opioids were the most commonly misused pharmaceutical drug in 2016, with over-the-counter analgesics more often misused than prescription drugs. In 2016, males and females tended to report misuse of pharmaceutical drugs in the past 12 months at similar rates.

Question 19

what changes were made to opioid drugs in 2018? what did the statistics show?

Answer 19

Prescription opioid drugs are used to manage pain associated with injury, surgery, and palliative care (National Pharmaceutical Drug Misuse Framework for Action: NPDMFA, 2011). Over the period 1991-2010 there has been an increase in the supply of prescription opioid drugs including methadone, morphine, codeine, and oxycodone in Australia. This increased supply has been associated with an increase in the number of drug poisoning events involving prescription opioids and a corresponding decrease in heroin-related drug poisonings.

On the 1st of February 2018, the Therapeutic Goods Administration decided that over-the-counter medicines containing codeine become prescription-only medicines. This indicates that at the time of the 2016 NDSHS products such as Nurofen Plus could be purchased on the counter at a pharmacy, which is reflected in the statistics presented above. In fact, in 2016, 75% of recent painkiller/opioid misusers indicated misusing an over-the-counter codeine product in the previous 12 months (AIHW, 2017).

Question 20

what drugs were found to be commonly associated with injecting? and what are the risks of this?

Answer 20

Injecting morphine is common among illicit drug users; one study reported that heroin was the most frequently injected drug at the Sydney Medically Supervised Injection Centre up until 2006 when pharmaceutical opioids such as morphine and oxycodone took over. The injection of oral medications such as morphine and oxycodone is associated with health risks including infection and the deposit of drug materials in blood vessels (NPDMFA, 2011).

Question 21

what is Benzodiazepines prescribed for? what are some found side effects of misuse?

Answer 21

Benzodiazepines, prescribed to manage anxiety, sleep disorders, and alcohol withdrawal, are one of the most commonly prescribed drugs (Albrecht et al., 2014). Misuse of pharmaceutical benzodiazepines is associated with problems with memory and concentration, chaotic behaviour, aggression, and disorganisation. The benzodiazepine drug alprazolam is used to treat anxiety and panic disorders. Misuse of this drug however is associated with significant harms including overdose-related death, seizures, extreme aggression, traffic accidents, and crime (NPDMFA, 2011; Oldenhof, Anderson-Wurf, Hall & Staiger, 2019). An estimated range of 1% to 20% of benzodiazepine users report experiencing increased anger or aggression as a side effect (Lader, 2011). In a recent systematic review of 46 studies (Albrecht et al., 2014), we found benzodiazepine use to have a moderate association with subsequent aggressive behaviour. Due to this, prescription monitoring programs, which centralise prescribing and dispensing data, have been implemented in Australia (Oldenhof, Anderson-Wurf, Hall & Staiger, 2019). Such programs aim to stop inappropriate prescribing, such as multiple prescribers, high-doses, and risky drug combinations, in order to decrease rising mortality rates.

Question 22

does it mean by “Dependence on one drug is often associated with use and/or dependence on other drugs”

Answer 22

Comorbid substance use. For example, the prevalence of tobacco use among those who use alcohol and/or illicit drugs is estimated at 75% (Ruiz & Strain, 2014). Comorbid substance use is particularly common among those with a cannabis use disorder. Furthermore, cannabis is the most commonly used illicit substance among those with other substance use disorders. Ruiz and Strain (2014), for example, report that up to 35% of those with a cocaine use problem, 28% of those with an alcohol use problem, and 16% of those with a heroin use problem also report cannabis dependency. Alcohol use is common among individuals who use cocaine; up to 60% of individuals with a cocaine use disorder also have an alcohol dependence issue (Ruiz & Strain, 2014).

Question 23

what is the association between substance use and mental disorders?

Answer 23

There is a strong association between substance use and mental health disorders. According to the NDSHS, in 2016, Australians who smoked cigarettes daily were twice as likely (29%) to have a diagnosed mental health disorder than those who never smoked (12%) (AIHW, 2017). Similarly, 29% of individuals who reported using an illicit drug in the past month had a diagnosed mental health disorder compared with 13.9% of non-drug using individuals.

Comorbidity, or the co-occurrence of more than one disorder, of mental health and substance use disorders is common and is associated with complex needs and poor outcomes.

Question 24

what are some unique patterns of comorbidity found?

Answer 24

Unique patterns of comorbidity have been found. For example, alcohol use disorder is often associated with anxiety, depressive, and antisocial disorders. Cannabis use disorder has been associated with higher rates of depression, anxiety disorder, and conduct disorder. Individuals with a history of cannabis use disorder have high rates of alcohol use disorder (> 50%) and tobacco use disorder (53%) (APA, 2013). Opioid dependence is commonly associated with other substance use disorders, such as tobacco, alcohol, cannabis, stimulants, and benzodiazepines.

Question 25

why might the associated between mental health and drug misuse be?

Answer 25

Ultimately, to put it colloquially, people use drugs to feel differently; because they don’t like the way they feel, and in many ways this can be related to a mental health problem at many different points in the spectrum.

Question 26

what are some other addictions other than substances? and why are they considered an addiction? and what is the alternative view?

Answer 26

There is some debate as to whether excessive behavioural tendencies such as pathological gambling, excessive internet browsing, or binge eating disorders, should be classified as addictions in the same way substance use is (e.g., Alavi et al., 2012; Jaffe, 1990). One view asserts that any stimulating source can become addictive, and when an individual engages in seemingly ordinary behaviours, such as browsing the internet, because they feel obligated rather than for leisure they can be considered addicted (Peele & Brodsky, 1979). In contrast Jaffe (1990) argues that adopting a broad inclusive definition of addiction has the potential to take the focus away from investigating the causes and correlates of individual addictions, and minimises the differences between substance use and behavioural addictions.

Question 27

what is the estimated percentage of people experiencing gambling disorders worldwide?

Answer 27

Gambling is a significant public health problem in many countries, with an estimated 0.5% to 7.6% of the adult population experiencing gambling disorders worldwide (with an average rate across all countries being 2.3%) (Williams, Volberg, & Stevens, 2012).

Question 28

what percentage of people gambling in australia yearly and weekly? and what percentage are problem gamblers?

Answer 28

Gambling is common among Australians, with some 64% of the adult population gambling at least once per year (Dowling et al., 2015; Gainsbury et al., 2014 ), and approximately 15% of individuals gambling at least weekly (Productivity Commission, 2010). Problem gamblers constitute a small proportion of all gamblers, with between 0.4% and 0.6% of Australian adults experiencing significant problems and between 3.0% and 7.7% at risk of experiencing any problems as a result of gambling (Dowling et al., 2015; Gainsbury et al., 2014).

Question 29

what are the characteristics of problematic internet use?

Answer 29

- Excessive and prolonged Internet use (typically 8-10 hours per day at least 30 hours a week), to the neglect of other activities and obligations; - Withdrawal (e.g., anger and frustration if prevented from gaming and/or computer use); - Tolerance (need for better equipment, software or hours of use); and - Adverse consequences (Spada, 2013).

Question 30

what is the social cost of Alcohol, tobacco and illicit drugs?

Answer 30

Alcohol- 14.35 billion Tobacco- 136.9 billion illicit drugs- 5 billion also; Alcohol-related harm is estimated to cost Australian individuals around $20 billion in lost wages and productivity, hospital and child protection costs, and intangible costs (Laslett et al., 2010).1includes costs related to healthcare, fires, lost productivity, road accidents; 2includes costs related to pain and suffering.

Question 31

what are the 5 categories of harm resulting from substance use?

Answer 31

overall harm: to uses- -physical (drug specific mortality drug-related mortality, drug specific damage, drug related damage) -psychological (dependence, drug specific impairment of mental functioning, drug related impairment of mental functioning) -social ( loss of tangibles, loss of relationships) to others- - physical and psychological (injury) - Social (crime, environmental damage, family adversities, international damage, economic cost, community)

Question 32

what are some of the negative effects associated with alcohol

Answer 32

here are a range of harms associated with the problematic use of alcohol, including individual acute and chronic health issues, lower life expectancy, reduced workplace productivity and absenteeism, accidents, violence, alcohol-related offences, and drink driving. Short term excessive binge drinking episodes are a major cause of road and other accidents, injury, violence, and crime. A pattern of long-term heavy episodic drinking is associated with an increased risk of chronic disease, including liver cirrhosis and brain damage, family breakdown, and broader social dysfunction.

Question 33

what are the harms associated with tobacco usage?

Answer 33

Tobacco is the single most preventable cause of ill health and death, responsible for 9.3% of the total burden of disease and injury in 2015 (AIHW, 2019). Compared to non-smokers, smokers are more likely to rate their health as poor, are twice as likely to have been diagnosed or treated with a mental illness and more likely to report high or very high levels of psychological distress. According to Ruiz and Strain (2014), the impact of tobacco can be measured by smoking attributable mortality, years of potential life lost, and productivity losses from smoking and health related absences. In the US it is estimated that 443,000 premature deaths, 5.1 million years of potential life, and $96.8 billion of productivity are lost annually due to tobacco consumption or second-hand exposure.

Question 34

what are harms associated with illicit drugs?

Answer 34

Illicit drug use contributes to acute and chronic health issues, road accidents, violence, family breakdown, and social dysfunction (NDS, 2009). Unsafe drug injecting practices are also a significant cause of blood-borne virus infections including hepatitis C and HIV/AIDs. In 2015, opioid use was responsible for the highest burden of disease and injuries of any illicit drug (1.0%), followed by amphetamine use (0.6%) and cannabis use (0.2%) (AIHW, 2019). Poly-drug use exacerbates the number and nature of drug-related harms experienced. Mixing drugs can multiply the effects of each drug, increase adverse reactions and potentially increase the risk of overdose (NDS, 2009).

Question 35

what are the 7 main harms associated with gambling?

Answer 35

Harms specifically relating to gambling are generally viewed across 7 main areas (Langham et al., 2016): - emotional or psychological distress - relationship disruption, conflict or breakdown - financial - reduced performance at work or study - decrements to health - cultural harm - illegal activities Family and interpersonal problems stemming from gambling include not having enough time for family, relationship breakdown, loss of contact with children, violence, and general arguments with family (Dowling, 2014).

Question 36

what is the prevention paradox?

Answer 36

In other words, while addicts experience far more harm on an individual level, ‘normal drinkers’ make up a lot of the numbers in terms of harm experienced and cost to society. The ‘Prevention Paradox’ was a term coined by the epidemiologist Geoffrey Rose to describe how often it is the lower risk individuals who collectively contribute the bulk of preventable illness in the community due to their greater numbers. It demonstrates that to prevent the most amount of harm, it may be necessary to focus (through universal interventions) on the majority who are not as seriously involved in harmful drug use as are the smaller proportion of high risk users.

Question 37

what are some things to consider about taking the clients perspective?

Answer 37

As we discussed in the comorbidity section, there are many factors which lead people to develop substance use and behavioural addiction problems; Rebekah's story, below, is a good example of how these factors can compound. Understanding their stories and how long it takes them to become ‘addicted’ can often be far more important than deciding whether they need motivational interviewing or cognitive behavioural therapy. The reality that many people who develop such problems have life histories of trauma, deprivation, and/or stigma always needs to be considered when considering how best to help a particular individual in their journey. Often the problems they are presenting with are simply the tip of the iceberg and keeping them alive may be far more important than getting them abstinent. Much of this is reflected in the harm reduction philosophy - an approach which we will discuss later. Such a philosophy does not come from a laze-faire ideology, but the bitter experience of clinicians working with people over many years who see incremental change, but ultimately people re-joining society after decades of support and treatment. Many examples abound of such stories, and often these can be more powerful than simple statistics. However the statistics are compelling. For example, studies typically find over 70% of female and 50% of male drug users have been sexually abused as children and over 40% have been physically abused. While in a cursory discussion with an addict in treatment, you will be told that ‘I had one hit and was hooked for life’, if you go on to ask about their drug using history they will talk about starting smoking at age 10, drinking at age 12, using cannabis at age 15, and ecstasy at age 16 before becoming miraculously hooked to heroin or methamphetamines when they were 18 or 20 (Miller, 2000, 2002). Remember, the genetic literature suggests that somewhere between 50% and 80% of all people with substance use problems come from a family that had substance use problems. In general, people in addiction treatment require many sessions across many years and different types of treatment to achieve some form of success. Many, even most, do not achieve abstinence for extended periods of time. Many heavy drinkers and illicit drug users die before the age of 50. On the other hand, some can and do move on with their lives and make extraordinary contributions, often because they can convey the experience of long-term adversity and provide us with important lessons about how people deal with complex problems, often caused by things they had no power over.

Question 38

what are some important aspects to consider when forming an attitude about substance use disorder?

Answer 38

We end this opening topic, and frame our course, with a question about how you conceptualise substance use and addiction and a recommendation to critically consider the evidence and engage in self-reflection. Dealing with people who have addictions and substance use problems is demanding and challenging work. One of the key predictors of success, and even more importantly burnout, is the attitudes which the professional brings to the interaction. This applies equally for health professionals, social workers, and law enforcement personnel. Understanding why the patient/client/offender is sitting across from you and then acknowledging that a simple set of psychological interventions is unlikely to make a substantial difference on their path is important for both parties. Certainly, we’ve known for a very long time that putting people in jail when they are young does not scare them off offending, it just ensures a downward pathway in their life. In the different professional roles you may play, it is important to understand the behaviour you are dealing with within the context of a person’s history and also the likelihood that the course of action you are recommending will have an impact. Generally, recovering from addiction is defined by making small positive steps which can undo a lifetime of negative risk factors. Being a part of a positive journey and identifying what the person in front of you needs most now to survive and take the next step forward can often be the most important task you can do. We hope in this course, to provide you with much of the evidence to enable you to assist this process.

Question 39

What is the biosocial model?

Answer 39

Individual treatments-cognitive behavioural, relapse prevention, counselling social focused treatements-family therapy, couple therapy, peer support (AA,NA), therapeutic communities, group therapy Pharmacotherapy residential treatment Psychological - learning - emotions - thinking - attitudes - memories - perceptions - beliefs - stress - stress management stratergies social - social support - family background - interpersonal relationships - cultural traditions - medical care - socio-economic - poverty - physical exercise - biofeedback ``` biological -genetic predisposition -neurochemistry -effect of -medications -immune response -HPA axis flight and fight response phycological response ```

Question 40

what are the public health approached and why are they created?

Answer 40

almost 75% of people who struggle with addiction dont seek help. interventions include: -demand reduction (educate the public to reduce consumption), mostly just illict. supply reduction: -illegal law enforcement to stop the importation of illegal drugs supply reduction of legal substances involves regulating access and investigating and interrupting illegal marketing harm reduction/minimization how do we acknowledge people use drugs and are going to use them, the stricked Harm minimisation and policy in Australia• Harm minimisation or harm reduction refers to policies, programmes and practices that aim to reduce the harms associated with the use of drugs or addictive behaviours in people unable or unwilling to stop. •The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself, and the focus on people who continue to use drugs or engage in addictive behaviours

Question 41

What are the advantages and disadvantages of harm minimization approach?

Answer 41

Major advantages of harm minimisation 1. a value-neutral view of drug use 2. a value-neutral view of users 3. a focus on problems or harmful consequences resulting from use 4. an acceptance that abstinence is irrelevant 5. a belief that the user has and should continue to have an active role in making choices and taking action about their drug us reducing crime prevent needle sharing less burden on health services prevent overdoses allows safely to those who are not ready to seek treatment on average it takes 8 treatment episodes to manage drug use disadvantages -may increase overall use of drug BUT may degrease harm to themselves or others.

Question 42

How to address personal bias? stigma around addiction? How do we manage this?

Answer 42

* Step 1: Gain insight into your personally held beliefs about addiction * Step 2: Observe your personally held views as they arise. Know your bias. * Step 3: Stop and pause when your personal bias is triggered * Step 4: Respond professionally, not personally * Step 5: Reflect

Question 43

what is the intake, screening and assessment process

Answer 43

Step 1: Intake Administer intake took, including questions on demographics, reason for call/visit, AOD use and risk. Decide if a comprehensive assessment is needed or if not, continue The intake, screening, and assessment process Step 1: Intake Administer intake took, including questions on demographics, reason for call/visit, AOD use and risk. Decide if a comprehensive assessment is needed or if not, complete preliminary summary sheet After step 1 might not need screening process, might just need education, family support, councelling If not then: Step 2: Screening Check and clarify information gathered in intake Client completes self-complete form: ATOP, AUDIT, DUDIT, K10Clinician to check, score, and add to case summary sheet these do not diagnose, they indicate if the person needs further assessment. Step 3: Assessment Complete the core component of the assessment: AOD, mental health, medical history, psychosocial, and risk Complete optional modules Score and complete final case summary sheet, fill out care plan Step 4: Review After 4 weeks, complete ATOP and K10Compare with past information to see if progress has been made Inform client of any progress Review and modify care plan accordingly AOD seminar week 1.

Question 44

what are some screening tools for addiction?

Answer 44

ATOP-The Australian Treatment Outcomes Profile (ATOP) is an outcome monitoring tool, providing a measurement of client progress. Administered at intake and then again after 4 weeks. 26 items. 1. Substance use (including injecting behaviours) 2. Health and Wellbeing (Bio/Psycho/Social model) –Global ratings 0 –10 –Housing, employment & study, violence, legal issues, child protection AUDIT -The AUDIT (Alcohol Use Disorders Identification Test) was developed by the World Health Organisation (WHO) as a simple method of screening for excessive drinking.10 items. 1.Amount and frequency of drinking (3 questions) 2.Alcohol dependence (3 questions) 3.Problems caused by alcohol (3 questions) DUDIT -The DUDIT (Drug Use Disorders Identification Test) was developed as a parallel instrument to the AUDIT for identification of individuals with drug-related problems. 11 items.1.Level of drug use2.Selected criteria for substance abuse /harmful use and dependence according to the ICD-10 and DSM-4 diagnostic systems K10-The Kessler 10 (K10) is a measure of psychological distress, whatever the cause. The K10 is predominantly used in the identification of depression and anxiety disorders.10 items .1.Frequency of symptoms of generalized psychological dis