drug addiction joint tutorial 12/06/08. dsm iv stage i – preoccupation/anticipation stage i –...

Drug AddictionDrug Addiction

Joint Tutorial 12/06/08Joint Tutorial 12/06/08

DSM IVDSM IV

Stage I – Preoccupation/anticipationStage I – Preoccupation/anticipation

Stage II – Binge/intoxicationStage II – Binge/intoxication

Stage III – Withdrawal/negative affectStage III – Withdrawal/negative affect

Most Harmful Drugs of abuseMost Harmful Drugs of abuse

Arguably Alcohol and NicotineArguably Alcohol and Nicotine

Drugs of abuse Drugs of abuse

Cocaine/Crack CocaineCocaine/Crack Cocaine AmphetaminesAmphetamines HeroinHeroin

(“Chasing the Dragon”)(“Chasing the Dragon”) CannabisCannabis LSDLSD EctasyEctasy

Morbidity and MortalityMorbidity and Mortality

Heroin addicts have 12 times greater Heroin addicts have 12 times greater mortalitymortality

Injectors 22times more likely to die Injectors 22times more likely to die than non injecting peersthan non injecting peers

Blood borne infectionsBlood borne infections

Hep B Hep B

Hep C Hep C

HIVHIV

Ethical Principles Ethical Principles

Drug users have the same Drug users have the same entitlement as other users to NHS entitlement as other users to NHS servicesservices

Focus for treatment is the patient Focus for treatment is the patient themselves but impact on others themselves but impact on others (especially dependent children) must (especially dependent children) must be taken into accountbe taken into account

Drug treatmentDrug treatment

Drug treatment works (at least Drug treatment works (at least methadone does –no good evidence methadone does –no good evidence for benzos)for benzos)

For stimulants mainstay is For stimulants mainstay is psychosocial therapypsychosocial therapy

Detection times in urineDetection times in urine

Amphetamines - 2 daysAmphetamines - 2 days Benzos – 12hrs to 7daysBenzos – 12hrs to 7days Buprenorphine – 8 daysBuprenorphine – 8 days Cocaine – 2-3 daysCocaine – 2-3 days Methadone 7-9 daysMethadone 7-9 days Opiates (including heroin) – 48hrsOpiates (including heroin) – 48hrs Cannabis 4-45 daysCannabis 4-45 days

Guide PrinciplesGuide Principles

Local drug treatment tailored to local Local drug treatment tailored to local needsneeds

Effective MDT working (joined up Effective MDT working (joined up thinking)thinking)

Fully involve patientsFully involve patients Involve carersInvolve carers

GP trainingGP training

RCGPRCGP Certificate in the Management of Certificate in the Management of

Drug Misuse (parts 1 and 2)Drug Misuse (parts 1 and 2)

NICE psychosocial interventionsNICE psychosocial interventions

Opportunistic (1-2 sessions)Opportunistic (1-2 sessions) Brief – lasting 10-45minsBrief – lasting 10-45mins Explore ambivalence about drug useExplore ambivalence about drug use Aim to increase motivation to change Aim to increase motivation to change

drug misuse behaviourdrug misuse behaviour

12 Step principle 12 Step principle

HonestyHonesty HumilityHumility FaithFaith WillingnessWillingness SurrenderSurrender ForgivenessForgiveness Soul searchingSoul searching MaintenanceMaintenance IntegrityIntegrity Making contactMaking contact AcceptanceAcceptance ServiceService

DETOXDETOX

CommunityCommunity In patientIn patient

Useful referenceUseful reference

Drug misuse and dependence Drug misuse and dependence UK UK guidelines on clinical management guidelines on clinical management 20072007