drug use and misuse

Question 1

why do people use pcychoactive substances?

Answer 1

peer pressure
depression - to ease mental distress
dependence
experimenting

Question 2

why is it difficult to know hoe many people use opiates?

Answer 2

not all of them access treatment services

Question 3

give examples of reasons for the high cost of drug use

Answer 3

death 
crime 
health problems 
benefit system
the cost is over £16 bln/year

Question 4

what are the most common illegal drugs used?

Answer 4

cannabis
ecstasy
new psychoactive substances = legal highs

Question 5

which national system do drug and alcohol agencies have to report to?

Answer 5

national drug treatment monitoring system

Question 6

why are such a high number of people in treatment struggling with opiate use?

Answer 6

as they are prescribes methadone as a substitute and this can be an incentive to come for treatment as they are given an alternative - for non-opiates there is no alternative given so less people seek treatment

Question 7

how does methadone work?

Answer 7

μ-opioid receptor agonist with a lower affinity than morphine

Question 8

what are the commonest types of drug addiction that people seek treatment for?

Answer 8

opiates - most common

alcohol

Question 9

how can we define the substances used for non-therapeutic use?

Answer 9

ingestion of a substance affecting the CNS which leads to behavioural and psychological changes

Question 10

give examples of categories of substances that can be misused in terms of their effect on the CNS

Answer 10

opiates
depressants
stimulants
hallucinogens

Question 11

give examples of opiates

Answer 11

heroin

morphine

Question 12

what effect do opiates have on users?

Answer 12

euphoria

pain relief

Question 13

what effect do depressants have on users?

Answer 13

sedation
relaxation
slow down thinking and acting

Question 14

give examples of depressants

Answer 14

alcohol

benzodiazepines eg valium

Question 15

what effect do stimulants have on their users?

Answer 15

increase alertness and activity

elevate mood

Question 16

give examples of stimulants

Answer 16

caffeine
nicotine
cocaine
khat

Question 17

give examples of hallucinogens

Answer 17

ecstasy
ketamine
magic mushrooms

Question 18

how do hallucinogens affect their users?

Answer 18

alter sensory perception
alter thinking patterns
loss of sense of reality

Question 19

name some new psychoactive substances

Answer 19

spice and black mamba
Benzo fury
Eizolam
Bromo-dragonfly

Question 20

when did new psychoactive substances become illegal?

Answer 20

2016

Question 21

how do new psychoactive substances work?

Answer 21

mimic the effects of other substances but less predictably

Question 22

what are the different types of new psychoactive substances?

Answer 22

synthetic cannabinoids
stimulant type drugs which mimic amphetamines, cocaine and ecstasy
tranquliser-type drugs - mimic the anxiolytics eg benzodiazepine
hallucinogens that mimic substances like LSD

Question 23

what harm can new psychoactive substances?

Answer 23

addiction within a few weeks
people lose touch with reality even with small amounts, which are panic inducing and scary and have physiological and psychological effects
people were being sold them and they could be mixed with other substances, so may not be pure
overdose
temporary psychotic states
unpreditcable behaviour
A+E and hosp admissions
sudden increase in body temperature and heart rate
coma and risk to internal organs
hallucinations
vomiting
confusion leading to aggression and violence
intense comedown which can cause users to feel suicidal
may cause mental health problems eg paranoia, psychosis, anxiety

Question 24

what factors will have an impact on the level of risk associated with drugs?

Answer 24

1. the type of substance
2. the route of administration - eg IV is more dangerous because of blood bourne infections
3. quantity and frequency of use - daily or occasional
   knowledge of what they are using - strength, purity, knowledge of how to use them
4. what else are they using - alcohol, opiates, ITC drugs or meds
5. propensity for risky behaviour
6. co-existing problems eg mental or physical health, support, friends

Question 25

what are the different theories about how we should treat drug addicts? disease models are written in capitals

Answer 25

1. addiction is a disease so we should treat it with medication DISEASE 2. addiction is influenced by genes - genetic therapies DISEASE 3. addiction is a bad habit - increase punishments to make the behaviour less attractive BEHAVIOURAL 4. a failure of will - increase people's self efficacy and education on the consequences VOLITIONAL 5. social problem - target poverty, social exclusion, housing and mental health SOCIO-CULTURAL

Question 26

what are the different treatment models called?

Answer 26

disease model behaviour model volitional model socio-cultural model

Question 27

how do we prevent substance misuse?

Answer 27

reduce risk factors | increase protective factors

Question 28

what influences risk and protective factors?

Answer 28

``` individual family school environmental community ```

Question 29

what are the family risk factors for substance misuse?

Answer 29

family history of substance misuse poor parenting - lack of boundaries family conflict including domestic abuse being in care

Question 30

what are the school and community risk factors for drug misuse?

Answer 30

1. low academic attainment and committment 2. not in education, employment or training 3. availability of drugs -eg if friends are using them 4. community norms are favourable to drug use 5. community disorganisation 6. transitions 7. low neighbourhood attachment - no sense of belonging 8. gang culture

Question 31

what are the individual and peer risk factors?

Answer 31

1. sensation seeking/risk taking 2. rebelliousness 3. peer pressure 4. favourable attitudes to anti-social behaviour - ie seen as 'cool' 5. experience of trauma eg abuse, loss, poor parenting

Question 32

what are the protective factors?

Answer 32

family attachment academic achievement or extra-curricular have opportunities to feel that they can make a difference reward for positive involvement opportunities to develop self-confidence, self worth and resilience

Question 33

what is physical dependence?

Answer 33

the body adapts to the presence of the substance and over time needs more for the same effect (tolerance) stopping the drug leads to withdrawal symptoms - runny nose, stomach cramps, muscle aches

Question 34

what is psychological dependence?

Answer 34

feeling that life is impossible/challenges cannot be faced without the drug - emotional effect eg feelings of fear, pain, shame, guilt if not on drug

Question 35

how is dependence syndrome defined in the ICD 10?

Answer 35

3 or more in the past 12 months: 1. Strong desire or compulsion to use 2. Difficulties in controlling substance-taking behaviour (onset, termination, or level) 3. Physiological withdrawal state when reduce use (or substitution to avoid withdrawal ) 4. Tolerance (more for same effect) 5. Progressive neglect of pleasures/interests, increased time spent using 6. Persistent use despite evidence of harmful consequences (physical health, mood, cognition)

Question 36

give examples of withdrawal symptoms?

Answer 36

``` anxiety irritability fatigue nausea hand tremor seizure ```

Question 37

what is the National Drug Strategy for dealing with drugs?

Answer 37

reducing demand restricting supply building recovery in communities involving the family for support

Question 38

what does the support given depend on?

Answer 38

1. the drugs they are using 2. the level and pattern of use - are they dependent or not 3. the pt's preferences for support 4. what support they have tried before 5. mental and physical health 6. other issues eg housing, employment , support from family and friends

Question 39

what drug use services are available locally?

Answer 39

1. GPs 2. harm reduction services eg needle exchange 3. open access services 4. talking treatments eg CBT 5. prescribing services eg for people using opiates 6. detox - community or in patient 7. mutual aid - eg alcoholics anonymous, cocaine anonymous etc 8. residential rehabilitation

Question 40

how can talking treatments help patients?

Answer 40

1. motivational interventions - for people who cannot imagine giving up illegal drug use 2. psychological support during substitution treatment or detoxification 3. relapse prevention - planning strategies to deal with any lapse and support abstinence

Question 41

how can community prescribing ie by GPs or specialist services help?

Answer 41

1. substitution treatment - help the pt come off drugs gradually or long tern replacement for heroin ie methadone 2. opioid antagonists eg Naltrexone which help to reduce desire for opioids other help: 3. counselling and advise 4. community detoxification 5. referral to housing 6. help with criminal justice issues 7. blood borne virus testing and vaccination

Question 42

what is detoxification

Answer 42

can be inpatient or outpatient - a pt gradually reduces the amount of drug they are using and they are given medication to ease withdrawal symptoms use of Naltrexone or Naloxone which are opioid antagonists are given AFTER DETOX

Question 43

what are the features of residential rehabilitation?

Answer 43

treatment for those who wish to attain/maintain abstinence done for 3-12 months works on solving underlying issues and they each use different philosophies

Question 44

what other problems may a drug abuser have?

Answer 44

``` mental health medical problems education status legal issues - crime financial issues family child care housing BBVs ```

Question 45

how is recovery defined?

Answer 45

voluntary sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society

Question 46

how might recovered drug addicts spend their time?

Answer 46

peer support groups hobbies volunteering job