Workshop 2

Question 1

What are three drugs that have physical withdrawal?

Answer 1

Alcohol
Benzodiazepines
Opiates

Question 2

What are the serious withdrawal symptoms?

Answer 2

Seizures -> high risk of death.
Agitation, confusion (alcohol).
Tremors, vomiting, abdominal pain, flu-like symptoms etc.

Question 3

How risky is opiate withdrawal?

Answer 3

If the patient is otherwise well, the risk of death is small. If in older patients there is a higher risk of CV complications: MI.

Question 4

Why does withdrawal sometimes last a long time?

Answer 4

It can take a very long time to restore the neurotransmitter imbalance.
Also some changes (receptor plasticity) might last longer.

Question 5

Why can opiate withdrawal be particularly painful?

Answer 5

Opiate use/withdrawal causes changes in the pain pathway - heightened perceptions of pain and craving.

Question 6

What % of people in drug and alcohol misue have a mental health disorder?

Answer 6

75%, what comes first?

Question 7

Cannabis and alcohol withdrawal can cause acute ________ and ________ respectively.

Answer 7

Cannabis and alcohol withdrawal can cause acute psychosis and anxiety respectively.

Question 8

What does substitution therapy for opiates consist of?

Answer 8

Methadone and buprenorphine licensed for SL/wafer although a lot can be lost via first pass.

Question 9

What is HAT?

Answer 9

Heroin associated injection therapy. Diamorphine injections.

Question 10

What is chlordiazepoxide?

Answer 10

BZ used in alcohol withdrawal; substitution and then withdrawal.

Question 11

Long term high dose BZ use causes

Answer 11

Can cause cognitive impairment (>30mg OD for diazepam).

Question 12

Why must patients sign up and agree to the risks of BZ substitution therapy?

Answer 12

Known to cause cognitive impairment if >30mg OD for diazepam.

Question 13

Aversion therapy for alcohol consists of

Answer 13

Disulfiram

Question 14

Mechanism of action of disulfiram

Answer 14

Inhibitor of acetaldehyde dehydrogenase enzyme which causes the effects of a hangover to be felt immediately.

Question 15

What is the cycle of change?

Answer 15

1. Pre-contemplation
2. Contemplation
3. Planning/preparation
4. Action
5. Maintenance

Question 16

What is the first step of the cycle of change?

Answer 16

Pre-contemplation - no intention to change in the forseeable future.

Awareness/contemplation of risk is minimal.

Question 17

What is the second step of the cycle of change?

Answer 17

Contemplation - aware of the risk, know it is something they should do at some point. Not really ready to change.

Question 18

What is the third step of the cycle of change?

Answer 18

Planning/ preparation: very aware of the risk. Ready to change e.g. signing up for a treatment service. Picking a date and making a plan. Most difficult step for some people.

Question 19

What is the fourth step of the cycle of change?

Answer 19

Action - actively engaging in modifying behaviour. Signing up for a behavioural change programme. Starting treatment programme for example.

Question 20

What is the fifth and final step of the cycle of change?

Answer 20

Maintenance - The effort required to prevent relapse is high. Hard to stay motivated; the risk is very high or recent. This is an important stage not to be forgotten, due to receptor plasticity etc. the risk of relapse is very high. In the example of smoking, people go around the cycle 5-6x before they quit.

Question 21

What is a lapse?

Answer 21

A lapse is not the same as a relapse but it’s a step towards a relapse. One off or short-term goes back to the behaviour that was originally changed. Can be a single episode or can trigger a relapse.

Question 22

What can repeated relapse of alcohol abuse cause?

Answer 22

Evidence that alcohol withdrawal can cause cognitive impairment due to constant detox followed by relapse.

Question 23

What is mindfulness?

Answer 23

Putting something to the front of someones mind and consciously considering it as someones behaviour. Often behaviours are unconscious and not much active thought is given to the behaviour.

Question 24

Where does taking part in a needle exchange fit in the cycle of change?

Answer 24

Pre-contemplation, step 1.

Question 25

What is resilience?

Answer 25

Term that psychologists use for people who, in the face of all this are resilient to the loss of control and dependence and substance misuse.

Question 26

What is attachment theory?

Answer 26

Normally refers to the attachment between parent and child. Child learns that if they need something, there is someone will help with that. As the needs become more complex, the attachment strengthens. If this impairs normal function, then this is when it is a problem and dependence can often be a result of this.

Question 27

What does the term ‘recovery’ refer to?

Answer 27

The recovery from substance misuse which allows integration into society. E.g. housing, avoidance of criminal justice system. Recovery must be individual and evidence based.

Question 28

What is Maslows heirarchy of needs?

Answer 28

Basic human needs to be met are food, shelter, warmth etc before complex needs can be met. Many people recovering from addiction are unable to meet their basic needs and this makes recovery very difficult - link to homelessness.

Question 29

Needle and syringe exhange programmes are a harm reduction strategy, what does this mean?

Answer 29

It means that we are trying to reduce the harm to things that we do in life: seatbelts etc. We are accepting that the person does not want to quit their addiction and also that there are risks associated with them continuing to ‘use’ which we can alleviate as they do not want any other help. Help wider community.