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YEAR 2 Mental Health > Substance use disorders > Flashcards

Substance use disorders Flashcards

1
Q

What type of disorder criteria is not to do with frequency/dose?

A

Substance Use Disorders

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2
Q

True or False?

Substance Use Disorders (SUD) criteria is not to do with frequency/dose

A

True

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3
Q

Substance Use Disorders (SUD) criteria is not to do with frequency/dose

What is the diagnosis based on?

A

It reflects the IMPACT of current substance use on functioning in everyday life

simply = the harm that is being done

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4
Q

What type of disorder has a diagnosis that reflects the IMPACT of current substance use on functioning in everyday life?

simply = the harm that is being done

A

Substance Use Disorders (SUD)

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5
Q

True or False?

Substance use can never be problematic/harmful without dependence criteria being met

A

False

Substance use can be problematic/harmful without dependence criteria being met

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6
Q

Substance use can be problematic/harmful without dependence criteria being met

What group of people is particularly affected by this?

A

People with mental health problems (who may have increased sensitivity to the effects of a substance)

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7
Q

What are the 3 direct consequences of substance use on physical health?

A
  1. Liver damage
  2. Heart and lung damage
  3. Increased risk of cancer
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8
Q

What are the 4 indirect consequences of substance use on physical health?

A
  1. Illness
  2. Injury
  3. Self-neglect
  4. Harm from risky behaviours (hepatitis, HIV, overdose)
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9
Q

What are the 4 consequences of substance use on social and interpersonal life?

A
  1. Conflict with others (e.g. disapproving family members)
  2. Exclusion / stigma
  3. Poor educational attainment
  4. Homelessness
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10
Q

What are the 3 consequences of substance use on mental health?

A
  1. Transient psychosis (e.g. cannabis induced psychosis)
  2. Depression & Anxiety (e.g. depressant effects of alcohol)
  3. Worsens conditions for people with established illness (e.g. psychosis)
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11
Q

Substance abuse worsens conditions for people with established illness (e.g. psychosis)

List 4 ways substance abuse does this

A
  1. More / worse symptoms
  2. Poorer functioning
  3. More relapses and hospitalisations
  4. Increased suicidality; Aggression
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12
Q

True or False?

There is not evidence for increased rates of mental health problems (e.g. psychosis) due to substance use

A

False

There is evidence for increased rates of mental health problems (e.g. psychosis) due to substance use

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13
Q

What is the evidence for increased rates of mental health problems (e.g. psychosis) due to substance use?

A

In 2019/20 there were 7,027 hospital admissions with a primary diagnosis of drug-related mental health and behavioural disorders (135 people per week)

This was 21% higher than 2009-10

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14
Q

In 2019/20 there were 7,027 hospital admissions with a primary diagnosis of drug-related mental health and behavioural disorders

How many people were diagnosed per week and how much higher is the number compared to 2009-2010?

A

135 people per week

This was 21% higher than 2009-10

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15
Q

What % of adults aged 16 to 59 had taken drugs at some point during their
lifetime in the UK?

A

35%

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16
Q

How many adults aged 16 to 59 had taken an illicit drug in the last year (3.2 million people) in the UK?

A

1 in 11 (9%)

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17
Q

How many young adults aged 16 to 24 had taken an illicit drug in the last year in the UK?

A

1 in 5 (21%)

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18
Q

What % of young adults aged 16 to 24 are classed as ‘frequent” drug users (at least monthly use) in the UK?

A

4.3%

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19
Q

Define “frequent” drug users

A

People who use drugs at least monthly

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20
Q

At what time frame did drug use fall in the UK?

A

1995-2013

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21
Q

True or False?

Drug use fell 1995-2013 but is now rising again

A

True

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22
Q

Drug use fell 1995-2013 but is now rising again

A large portion of the increase resulted from the increased use of…?

A

Class A drugs in 16–24-year-olds (largely MDMA/ecstasy and powdered cocaine)

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23
Q

What is the main contributor of drug use increase in the UK?

A

Increased use of class A drugs in 16–24-year-olds (largely MDMA/ecstasy and powdered cocaine)

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24
Q

There has been an increase in the use of class A drugs in 16–24-year-olds in the UK

What are the 2 types of drugs young adults consume?

A
  1. MDMA/ecstasy
  2. Powdered cocaine
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25
Q

What % of men had drunk alcohol in past week, according to NHS’s (2020) statistics on alcohol?

A

65%

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26
Q

What % of women had drunk alcohol in past week, according to NHS’s (2020) statistics on alcohol?

A

50%

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27
Q

According to NHS’s (2020) statistics on alcohol, alcohol prevalence increases with…?

A

Age (up to 75 years)

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28
Q

What % of men aged 55-64 drink ‘above safe limits’
(14 units +), according to NHS’s (2020) statistics on alcohol?

A

38%

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29
Q

What % of women aged 55-64 drink ‘above safe limits’
(14 units +), according to NHS’s (2020) statistics on alcohol?

A

19%

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30
Q

What are the safe limits of alcohol consumption?

A

14 units and below

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31
Q

According to NHS’s (2020) statistics on alcohol, what statistics did they find on never drinking and binge drinking in young adults?

A

Increase in people ‘never’ drinking and decrease in binge drinking, particularly among young adults

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32
Q

True or False?

Decrease in people ‘never’ drinking and increase in binge drinking, particularly among young adults

A

False

Increase in people ‘never’ drinking and decrease in binge drinking, particularly among young adults

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33
Q

True or False?

Some groups are more likely to drink problematically/ use illicit substances than other

A

True

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34
Q

Some groups are more likely to drink problematically/ use illicit substances than other

Who are these groups of people? List 2 points

A
  1. Young people, especially students
  2. People with mental health problems
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35
Q

Drug-related hospital admissions are five times more likely in the most deprived areas

What is this evidence for?

A

Evidence that some groups are more likely to drink problematically/ use illicit substances than other

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36
Q

Drug-related hospital admissions are ___ times more likely in the most deprived areas

a. five
b. three
c. ten
d. seven

A

a. five

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37
Q

Substance use and mental health problems are highly comorbid

What does this mean?

A

Substance use and mental health problems frequently occur together

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38
Q

True or False?

Substance use and mental health problems are not significantly comorbid

A

False

Substance use and mental health problems are highly comorbid

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39
Q

Define Comorbidity

A

When two disorders or illnesses occur simultaneously in the same person

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40
Q

When two disorders or illnesses occur simultaneously in the same person

This is known as…?

A

Comorbidity

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41
Q

Sometimes people with mental illness and comorbid substance use are referred to as being …?

A

“Dually diagnosed”

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42
Q

True or False?

There is lifetime prevalence of Substance Use Disorder (SUD) for people with mental health disorders

A

True

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43
Q

There is lifetime prevalence of Substance Use Disorder (SUD) for people with mental health disorders

This is especially true for people with…?

A
  1. Schizophrenia
  2. Bipolar Disorder
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44
Q

True or False?

There are multiple positive consequences (physical, psychological) of not intervening substance abuse, particularly for people with comorbid mental illness

A

False

There are multiple negative consequences (physical, psychological) of not intervening substance abuse, particularly for people with comorbid mental illness

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45
Q

Which group of people experience poorer outcomes of not intervening substance abuse?

A

People with comorbid mental illness

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46
Q

Interventions in substance use leads to less engagement with ___ and decreased ___ adherence

A
  1. Services
  2. Medication and treatment
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47
Q

What did NICE guidelines recommend for interventions in substance use?

A

Psychotherapeutic interventions should aim to stop /reduce substance use in people with mental health problems

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48
Q

Give 3 reasons why we should intervene in substance use

A
  1. Multiple negative consequences (physical, psychological) particularly for people with comorbid mental illness for whom outcomes are poorer
  2. Less engagement with services; decreased medication and treatment adherence
  3. NICE guidance: psychotherapeutic interventions should aim to stop /reduce use in people with mental health problems
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49
Q

What should the goal of substance use treatment be?

List 3 goals

A
  1. Remission
  2. Abstinence
  3. Harm reduction
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50
Q

Define early remission of substance use, according to the DSM-5

A

Early remission is defined as at least 3 but less than 12 months without substance use disorder criteria (except craving)

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51
Q

Defined as at least 3 but less than 12 months without substance use disorder criteria (except craving)

This is known as…?

A

Early remission of substance us

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52
Q

Define sustained remission of substance use, according to the DSM-5

A

At least 12 months without substance use disorder criteria (except craving)

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53
Q

At least 12 months without substance use disorder criteria (except craving)

This is known as…?

A

Sustained remission of substance use

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54
Q

Define abstinence of substance use

A

Based on the idea that there is no “safe” amount of use.

Aim = complete cessation of use

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55
Q

Based on the idea that there is no “safe” amount of use.

Aim = complete cessation of use

This is known as…?

A

Abstinence of substance use

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56
Q

Give 2 examples of how we can achieve abstinence of substance use

A
  1. Detoxification programmes (opioid treatment programmes)
  2. Pharmacological interventions
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57
Q
  1. Detoxification programmes (opioid treatment programmes)
  2. Pharmacological interventions

These can be used to achieve:

a. Harm reduction
b. Depression relief
c. Abstinence
d. Remission

A

c. Abstinence

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58
Q

Give 2 types of pharmacological interventions/medications used to achieve abstinence of substance abuse

A
  1. Naltrexone – reduces craving for alcohol / blocks effects of opiods in the brain (reducing pleasure)
  2. Methadone – reduces withdrawal symptoms
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59
Q

What medication reduces craving for alcohol / blocks effects of opiods in the brain (reducing pleasure)?

A

Naltrexone

60
Q

What medication reduces withdrawal symptoms of substances?

A

Methadone

61
Q

How can Methadone help people achieve abstinence in substance use?

A

It reduces withdrawal symptoms of substances

62
Q

How can Naltrexone help people achieve abstinence in substance use?

A

Reduces craving for alcohol / blocks effects of opiods in the brain (reducing pleasure)

63
Q

What are the success rates of interventions to achieve abstinence of substance use dependent on?

List 3 points

A
  1. Highly dependent on motivation to change
  2. Coercion or making the interventions mandatory
  3. Pharmacological aids are not available for all drug types (e.g. cannabis, amphetamine)
64
Q

Pharmacological aids are not available for all drug types

Give 2 examples of these drugs

A
  1. Cannabis
  2. Amphetamine
65
Q

Define harm reduction in substance use

A

Quitting entire is not necessary — What’s important is reducing substance use

66
Q

Quitting entire is not necessary — What’s important is reducing substance use

This is known as…?

A

Harm reduction in substance use

67
Q

What do the NICE guidelines for dual diagnosis assume about harm reduction of substance use?

List 2 points

A
  1. Abstinence is not necessary - reducing and stabilising substance use also a desirable outcome
  2. Reducing substance use will lead to improved outcomes (greater treatment adherence; fewer relapses & hospitalisations etc.)
68
Q

According to the NICE guidelines, abstinence is not necessary

Instead, what 2 things are considered desirable for harm reduction of substance use?

A
  1. Reducing substance use
  2. Stabilising substance use
69
Q

According to the NICE guidelines, reducing substance use will lead to improved outcomes such as…?

Give 3 examples

A
  1. Greater treatment adherence
  2. Fewer relapses
  3. Fewer hospitalisations
70
Q

What are 5 main psychological interventions?

A
  1. Motivational interventions (MI) – motivational interviewing
  2. Cognitive Behavioural Therapy (CBT)
  3. Contingency management (CM)
  4. Family (systemic) therapy (FT)
  5. Psychoeducation (PE)
71
Q

Therapy may involve a combination of psychological interventions e.g. MI + CBT + FT + PE

This is known as…?

A

Integrated therapy

72
Q

What 5 things do psychological assessments determine?

A
  1. Patterns of use (what substances; when used; where; how much?)
  2. History of use; previous treatment
  3. Motives for use
  4. Consequences (negative AND positive) – impact of use
  5. Motivation to address problems
73
Q

What 2 things do psychological assessments seek to understand?

A
  1. The role played by substances in client’s life
  2. Identify factors
    maintaining substance use and obstacles to change / relapse risks
74
Q

True or False?

Psychological assessments only takes a few sessions and involve significant others (e.g. family members)

A

False

Psychological assessments may take several sessions and involve significant others (e.g. family members)

75
Q

Treatment plan for substance use should consider 5 things

What are they?

A
  1. Be person centred: take individual’s needs and
    preferences into account
  2. Address problems and goals identified during assessment
  3. Consider client’s motivation to address substance use and obstacles to change
  4. Identify treatment goals and target behaviours (abstinence?)
  5. Identify measurable outcomes
76
Q

Most psychological approaches take account of stage of change and target treatment accordingly

What does this mean?

A

Stage of change dictate which methods are appropriate at a particular time

77
Q

Most psychological approaches take account of stage of change and target treatment accordingly

What are the 6 stages of change (Prochaska & DiClemete, 1983)?

A
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse
78
Q

Precontemplation is the first stage of change (Prochaska & DiClemete, 1983)

Define precontemplation

A

Clients are not thinking about changing substance abuse behaviour and may not consider their substance abuse to be a problem

79
Q

Contemplation is the second stage of change (Prochaska & DiClemete, 1983)

Define contemplation

A

Clients are still using substances, but they begin to think about cutting back or quitting substance use

80
Q

Preparation is the third stage of change (Prochaska & DiClemete, 1983)

Define preparation

A

Clients are still using substances, but intend to stop. Planning for change begins

81
Q

Action is the fourth stage of change (Prochaska & DiClemete, 1983)

Define action

A

Clients choose a strategy for discontinuing substance use and begin to make the changes needed to carry out their plan

82
Q

Maintenance is the fifth stage of change (Prochaska & DiClemete, 1983)

Define maintenance

A

Clients work to sustain abstinence (or maintain reduction) and evade relapse

83
Q

Relapse is the sixth stage of change (Prochaska & DiClemete, 1983)

Define relapse

A

Many clients will relapse and return to an earlier stage, but they will hopefully have gained new insights into problems (e.g. unrealistic goals or frequenting places that trigger relapse)

84
Q

Which stage of change (Prochaska & DiClemete, 1983) does this apply to?

Still using substances, but intend to stop. Planning for change begins

a. Action
b. Relapse
c. Precontemplation
d. Maintenance
e. Preparation
f. Contemplation

A

e. Preparation

85
Q

Which stage of change (Prochaska & DiClemete, 1983) does this apply to?

Clients work to sustain abstinence (or maintain reduction) and evade relapse

a. Action
b. Relapse
c. Precontemplation
d. Maintenance
e. Preparation
f. Contemplation

A

d. Maintenance

86
Q

Which stage of change (Prochaska & DiClemete, 1983) does this apply to?

Many clients will relapse and return to an earlier stage, but they will hopefully have gained new insights into problems (e.g. unrealistic goals or frequenting places that trigger relapse)

a. Action
b. Relapse
c. Precontemplation
d. Maintenance
e. Preparation
f. Contemplation

A

b. Relapse

87
Q

Which stage of change (Prochaska & DiClemete, 1983) does this apply to?

Clients choose a strategy for discontinuing substance use and begin to make the changes needed to carry out their plan

a. Action
b. Relapse
c. Precontemplation
d. Maintenance
e. Preparation
f. Contemplation

A

a. Action

88
Q

Which stage of change (Prochaska & DiClemete, 1983) does this apply to?

Clients are not thinking about changing substance abuse behaviour and may not consider their substance abuse to be a problem

a. Action
b. Relapse
c. Precontemplation
d. Maintenance
e. Preparation
f. Contemplation

A

c. Precontemplation

89
Q

Which stage of change (Prochaska & DiClemete, 1983) does this apply to?

Still using substances, but they begin to think about cutting back or quitting substance use

a. Action
b. Relapse
c. Precontemplation
d. Maintenance
e. Preparation
f. Contemplation

A

f. Contemplation

90
Q

What are the 3 options we have when the client is not considering change and may deny substance use as a problem during precontemplation?

A
  1. To not address substance use
  2. To persuade the client to change / challenge their position
  3. To enhance motivation to change
91
Q

What interviewing method is the most useful when the client is not considering change and may deny substance use as a problem during precontemplation?

A

Motivational Interviewing

92
Q

Motivational Interviewing is most useful when…?

A

The client is not considering change and may deny substance use as a problem during precontemplation

93
Q

What is Motivational Interviewing (MI)?

A

A person-centred, conversational counselling method for addressing the common problem of ambivalence about change

94
Q

A person-centred, conversational counselling method for addressing the common problem of ambivalence about change

This is known as….?

A

Motivational Interviewing (MI)

95
Q

What does Motivational Interviewing (MI) seek to elicit and explore?

A

An individual’s own arguments for change

To strengthen a person’s motivation to change, review pros and cons of their behaviour

96
Q

A collaborative conversation to strengthen a person’s own motivation for and commitment to change

This is known as…?

A

Motivational Interviewing (MI)

97
Q

Motivational Interviewing (MI) is a collaborative conversation aimed to ___ ?

A

Strengthen a person’s own motivation for and commitment to change

98
Q

Motivational Interviewing (MI) views ambivalence as …?

A

Normal

99
Q

What does Motivational Interviewing (MI) believe is key to change?

A

Resolving ambivalence

100
Q

Who is responsible for change, according to Motivational Interviewing (MI)?

A

Responsibility for change is with the client

101
Q

Motivational Interviewing (MI) accepts that client’s goal is unlikely to be…?

A

Abstinence (or even reduction)

102
Q

What is the main emphasis of Motivational Interviewing (MI)?

A

Helping clients to understand how their substance use keeps them from achieving their goals

103
Q

Views ambivalence as normal

This is known as…?

A

Motivational Interviewing (MI)

104
Q

Resolving ambivalence key to change

This is known as…?

A

Motivational Interviewing (MI)

105
Q

Responsibility for change is with the client

This is known as…?

A

Motivational Interviewing (MI)

106
Q

Accepts that client’s goal unlikely to be abstinence (or even reduction)

This is known as…?

A

Motivational Interviewing (MI)

107
Q

Emphasis: helping clients to understand how their substance use keeps them from achieving their goals

This is known as…?

A

Motivational Interviewing (MI)

108
Q

According to Motivational Interviewing (MI), the clients’ reasons for change need to be stronger than the reasons for…?

A

Staying the same in order to “tip the balance” for change

109
Q

Reasons for change (reducing / stopping substance use) need to be stronger than the reasons for staying the same in order to “tip the balance” for change

What type of intervention method does this apply to?

A

Motivational Interviewing (MI)

110
Q

What are the 3 possible reasons for using substances (reasons for staying the same and not changing)?

A
  1. “It helps me relax” (I can’t relax without it)
  2. “It stops me feeling nervous in a crowd”
    (I can’t socialise without it; don’t enjoy socialising)
  3. “It gets rid of the voices” (the voices will be too much if I stop)
111
Q

What is the aim of Motivational Interviewing (MI) in tackling reasons for using substances (staying the same and not changing)?

A

To enhance motivation to change; get client ready to make changes

112
Q

True or False?

Motivational Interviewing (MI) is a long process/type of intervention because it takes into account every detail

A

False

Motivational Interviewing (MI) is typically brief

It can be delivered as a stand-alone intervention or can be integrated with another (e.g. CBT)

113
Q

True or False?

Motivational Interviewing (MI) can be delivered as a stand-alone intervention only

A

False

Motivational Interviewing (MI) can be delivered as a stand-alone intervention or can be integrated with another (e.g. CBT)

114
Q

Define Psychoeducation

A

Provision of information about the impact of substance use on mental health

(Prevalence; How does your substance use compare? Withdrawal symptoms)

115
Q

Provision of information about the impact of substance use on mental health

(Prevalence; How does your substance use compare? Withdrawal symptoms)

This is known as…?

A

Psychoeducation

116
Q

How can we provide psychoeducation?

List 3 ways

A
  1. Info sheets
  2. Leaflets
  3. Info films
117
Q

True or False?

Psychoeducation is typically included in MI and other individual interventions

A

True

118
Q

What are Psychoeducation groups designed for?

A

For educating clients about substance abuse, and related behaviours and consequences

119
Q

Psychoeducation groups designed to educate clients about substance abuse, and related behaviours and consequences

What can they help clients do? List 2 points

A
  1. Identify resources
  2. Counteract denial
120
Q

True or False?

Psychoeducation is sufficient as a treatment in its own right

A

False

Psychoeducation is a useful adjunct but not sufficient as a treatment in its own right

121
Q

What does Cognitive Behavioural Therapy (CBT) identify in substance use?

A

Identifies antecedents of drug use (‘high risk situations’)

122
Q

What does Cognitive Behavioural Therapy (CBT) focus on?

A

Focuses on teaching substance users new / more effective skills for dealing with high-risk situations such as negative emotional states, interpersonal conflict, and social pressure and craving

(e.g. activity planning when boredom = a high-risk situation)

123
Q

Focuses on teaching substance users new / more effective skills for dealing with high-risk situations such as negative emotional states, interpersonal conflict, and social pressure and craving

(e.g. activity planning when boredom = a high-risk situation)

This is known as…?

A

Cognitive Behavioural Therapy (CBT)

124
Q

What is the aim of Cognitive Behavioural Therapy (CBT) in addressing substance use?

A

Aims to change learned behaviour by changing thinking patterns, beliefs, and perceptions and assumptions

e.g.
- “I’m a failure.”
- “I’m not strong enough to quit.”
- “My illness will be worse if I stop”
- “Drinking gets rid of the voices”

125
Q

Aims to change learned behaviour by changing thinking patterns, beliefs, and perceptions and assumptions

This is known as…?

A

Cognitive Behavioural Therapy (CBT)

126
Q

Identifies antecedents of drug use (‘high risk situations’)

This is known as…?

A

Cognitive Behavioural Therapy (CBT)

127
Q

What does relapse prevention mainly focus on?

A

Coping skills in high-risk situations but specific to relapse (avoiding temptation in the threatening situation)

128
Q

What are clients taught to do in relapse prevention of substance use?

List 4 points

A
  1. Understand relapse as a process
  2. Implement damage control procedures during a lapse to minimise negative consequences/chances of relapse
  3. Stay engaged in treatment even after a relapse
  4. Longer term intervention, 6-26 sessions
129
Q

Longer term intervention of substance use, 6-26 sessions

This is known as…?

A

Relapse prevention

130
Q

According to NICE guidelines, what should family and carers do in family/systemic therapy?

List 4 points

A
  1. Have the opportunity to be involved in decisions about treatment and care
  2. Be given information and support
  3. Be offered family intervention
  4. Be offered information about local family or carer support groups and voluntary organisations
131
Q

Family therapy is also known as…?

A

Systemic therapy

132
Q

What intervention to substance use has a large psychoeducation component?

A

Family / systemic therapy

133
Q

What does family / systemic therapy teach clients and family members?

A

Teaches communication skills and builds problem solving skills in family members, including the client

134
Q

Teaches communication skills and builds problem solving skills in family members, including the client

Which intervention to substance use does this apply to?

A

Family / systemic therapy

135
Q

Helps family develop relapse prevention strategies

Which intervention to substance use does this apply to?

A

Family / systemic therapy

136
Q

How can family / systemic therapy help family develop relapse prevention strategies?

List 3 ways

A
  1. By increasing support
  2. By reducing burden
  3. By decreasing conflict
137
Q

Define Contingency Management (CM)

A

Incentivises and reinforces abstinence with the aid of vouchers, privileges, prizes or financial incentives (clear urine screen = reward) to reduce substance use

138
Q

Incentivises and reinforces abstinence with the aid of vouchers, privileges, prizes or financial incentives (clear urine screen = reward) to reduce substance use

This is known as…?

A

Contingency Management (CM)

139
Q

What is Contingency Management (CM) based on?

A

Behaviour Modification (Based on learning theory, Skinner, 1953)

140
Q

Behaviour Modification (Based on learning theory, Skinner, 1953)

Which intervention to substance use does this apply to?

A

Contingency Management (CM)

141
Q

Reinforcing abstinence using rewards

Which intervention to substance use does this apply to?

A

Contingency Management (CM)

142
Q

What intervention is recommended by NICE for substance use but evidence is currently lacking for dual diagnosis?

A

Contingency Management (CM)

143
Q

Contingency Management (CM) is recommended by NICE for substance use but evidence is currently lacking for …?

A

Dual diagnosis

144
Q

How can we enhance existing interventions to substance use?

List 2 ways

A
  1. Better targeting? (only those who are ready to
    change?)
  2. Include technological advances

e.g. personalised ‘in the moment’ feedback

145
Q

How can we develop new approaches to combating substance use?

List 2 ways

A
  1. Enhance existing interventions
  2. Develop new models and approaches? e.g. VR
146
Q

This group of people have higher rates of substance use

A

People with mental illness

147
Q

Substance use can result in worse outcomes for which group of people?

A

People with mental illness

YEAR 2 Mental Health (11 decks)

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