Substance use disorders Flashcards
1
Q
What type of disorder criteria is not to do with frequency/dose?
A
Substance Use Disorders
2
Q
True or False?
Substance Use Disorders (SUD) criteria is not to do with frequency/dose
A
True
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
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)
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
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)
7
Q
What are the 3 direct consequences of substance use on physical health?
A
- Liver damage
- Heart and lung damage
- Increased risk of cancer
8
Q
What are the 4 indirect consequences of substance use on physical health?
A
- Illness
- Injury
- Self-neglect
- Harm from risky behaviours (hepatitis, HIV, overdose)
9
Q
What are the 4 consequences of substance use on social and interpersonal life?
A
- Conflict with others (e.g. disapproving family members)
- Exclusion / stigma
- Poor educational attainment
- Homelessness
10
Q
What are the 3 consequences of substance use on mental health?
A
- Transient psychosis (e.g. cannabis induced psychosis)
- Depression & Anxiety (e.g. depressant effects of alcohol)
- Worsens conditions for people with established illness (e.g. psychosis)
11
Q
Substance abuse worsens conditions for people with established illness (e.g. psychosis)
List 4 ways substance abuse does this
A
- More / worse symptoms
- Poorer functioning
- More relapses and hospitalisations
- Increased suicidality; Aggression
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
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
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
15
Q
What % of adults aged 16 to 59 had taken drugs at some point during their
lifetime in the UK?
A
35%
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%)
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%)
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%
19
Q
Define “frequent” drug users
A
People who use drugs at least monthly
20
Q
At what time frame did drug use fall in the UK?
A
1995-2013
21
Q
True or False?
Drug use fell 1995-2013 but is now rising again
A
True
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)
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)
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
- MDMA/ecstasy
- Powdered cocaine
25
What % of men had drunk alcohol in past week, according to NHS's (2020) statistics on alcohol?
65%
26
What % of women had drunk alcohol in past week, according to NHS's (2020) statistics on alcohol?
50%
27
According to NHS's (2020) statistics on alcohol, alcohol prevalence increases with...?
Age (up to 75 years)
28
What % of men aged 55-64 drink ‘above safe limits’
(14 units +), according to NHS's (2020) statistics on alcohol?
38%
29
What % of women aged 55-64 drink ‘above safe limits’
(14 units +), according to NHS's (2020) statistics on alcohol?
19%
30
What are the safe limits of alcohol consumption?
14 units and below
31
According to NHS's (2020) statistics on alcohol, what statistics did they find on never drinking and binge drinking in young adults?
Increase in people ‘never’ drinking and decrease in binge drinking, particularly among young adults
32
True or False?
Decrease in people ‘never’ drinking and increase in binge drinking, particularly among young adults
False
Increase in people ‘never’ drinking and decrease in binge drinking, particularly among young adults
33
True or False?
Some groups are more likely to drink problematically/ use illicit substances than other
True
34
Some groups are more likely to drink problematically/ use illicit substances than other
Who are these groups of people? List 2 points
1. Young people, especially students
2. People with mental health problems
35
Drug-related hospital admissions are five times more likely in the most deprived areas
What is this evidence for?
Evidence that some groups are more likely to drink problematically/ use illicit substances than other
36
Drug-related hospital admissions are ___ times more likely in the most deprived areas
a. five
b. three
c. ten
d. seven
a. five
37
Substance use and mental health problems are highly comorbid
What does this mean?
Substance use and mental health problems frequently occur together
38
True or False?
Substance use and mental health problems are not significantly comorbid
False
Substance use and mental health problems are highly comorbid
39
Define Comorbidity
When two disorders or illnesses occur simultaneously in the same person
40
When two disorders or illnesses occur simultaneously in the same person
This is known as...?
Comorbidity
41
Sometimes people with mental illness and comorbid substance use are referred to as being ...?
“Dually diagnosed”
42
True or False?
There is lifetime prevalence of Substance Use Disorder (SUD) for people with mental health disorders
True
43
There is lifetime prevalence of Substance Use Disorder (SUD) for people with mental health disorders
This is especially true for people with...?
1. Schizophrenia
2. Bipolar Disorder
44
True or False?
There are multiple positive consequences (physical, psychological) of not intervening substance abuse, particularly for people with comorbid mental illness
False
There are multiple negative consequences (physical, psychological) of not intervening substance abuse, particularly for people with comorbid mental illness
45
Which group of people experience poorer outcomes of not intervening substance abuse?
People with comorbid mental illness
46
Interventions in substance use leads to less engagement with ___ and decreased ___ adherence
1. Services
2. Medication and treatment
47
What did NICE guidelines recommend for interventions in substance use?
Psychotherapeutic interventions should aim to stop /reduce substance use in people with mental health problems
48
Give 3 reasons why we should intervene in substance use
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
49
What should the goal of substance use treatment be?
List 3 goals
1. Remission
2. Abstinence
3. Harm reduction
50
Define early remission of substance use, according to the DSM-5
Early remission is defined as at least 3 but less than 12 months without substance use disorder criteria (except craving)
51
Defined as at least 3 but less than 12 months without substance use disorder criteria (except craving)
This is known as...?
Early remission of substance us
52
Define sustained remission of substance use, according to the DSM-5
At least 12 months without substance use disorder criteria (except craving)
53
At least 12 months without substance use disorder criteria (except craving)
This is known as...?
Sustained remission of substance use
54
Define abstinence of substance use
Based on the idea that there is no “safe” amount of use.
Aim = complete cessation of use
55
Based on the idea that there is no “safe” amount of use.
Aim = complete cessation of use
This is known as...?
Abstinence of substance use
56
Give 2 examples of how we can achieve abstinence of substance use
1. Detoxification programmes (opioid treatment programmes)
2. Pharmacological interventions
57
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
c. Abstinence
58
Give 2 types of pharmacological interventions/medications used to achieve abstinence of substance abuse
1. Naltrexone – reduces craving for alcohol / blocks effects of opiods in the brain (reducing pleasure)
2. Methadone – reduces withdrawal symptoms
59
What medication reduces craving for alcohol / blocks effects of opiods in the brain (reducing pleasure)?
Naltrexone
60
What medication reduces withdrawal symptoms of substances?
Methadone
61
How can Methadone help people achieve abstinence in substance use?
It reduces withdrawal symptoms of substances
62
How can Naltrexone help people achieve abstinence in substance use?
Reduces craving for alcohol / blocks effects of opiods in the brain (reducing pleasure)
63
What are the success rates of interventions to achieve abstinence of substance use dependent on?
List 3 points
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
Pharmacological aids are not available for all drug types
Give 2 examples of these drugs
1. Cannabis
2. Amphetamine
65
Define harm reduction in substance use
Quitting entire is not necessary — What’s important is reducing substance use
66
Quitting entire is not necessary — What’s important is reducing substance use
This is known as...?
Harm reduction in substance use
67
What do the NICE guidelines for dual diagnosis assume about harm reduction of substance use?
List 2 points
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
According to the NICE guidelines, abstinence is not necessary
Instead, what 2 things are considered desirable for harm reduction of substance use?
1. Reducing substance use
2. Stabilising substance use
69
According to the NICE guidelines, reducing substance use will lead to improved outcomes such as...?
Give 3 examples
1. Greater treatment adherence
2. Fewer relapses
3. Fewer hospitalisations
70
What are 5 main psychological interventions?
1. Motivational interventions (MI) – motivational interviewing
2. Cognitive Behavioural Therapy (CBT)
3. Contingency management (CM)
4. Family (systemic) therapy (FT)
5. Psychoeducation (PE)
71
Therapy may involve a combination of psychological interventions e.g. MI + CBT + FT + PE
This is known as...?
Integrated therapy
72
What 5 things do psychological assessments determine?
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
What 2 things do psychological assessments seek to understand?
1. The role played by substances in client’s life
2. Identify factors
maintaining substance use and obstacles to change / relapse risks
74
True or False?
Psychological assessments only takes a few sessions and involve significant others (e.g. family members)
False
Psychological assessments may take several sessions and involve significant others (e.g. family members)
75
Treatment plan for substance use should consider 5 things
What are they?
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
Most psychological approaches take account of stage of change and target treatment accordingly
What does this mean?
Stage of change dictate which methods are appropriate at a particular time
77
Most psychological approaches take account of stage of change and target treatment accordingly
What are the 6 stages of change (Prochaska & DiClemete, 1983)?
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Relapse
78
Precontemplation is the first stage of change (Prochaska & DiClemete, 1983)
Define precontemplation
Clients are not thinking about changing substance abuse behaviour and may not consider their substance abuse to be a problem
79
Contemplation is the second stage of change (Prochaska & DiClemete, 1983)
Define contemplation
Clients are still using substances, but they begin to think about cutting back or quitting substance use
80
Preparation is the third stage of change (Prochaska & DiClemete, 1983)
Define preparation
Clients are still using substances, but intend to stop. Planning for change begins
81
Action is the fourth stage of change (Prochaska & DiClemete, 1983)
Define action
Clients choose a strategy for discontinuing substance use and begin to make the changes needed to carry out their plan
82
Maintenance is the fifth stage of change (Prochaska & DiClemete, 1983)
Define maintenance
Clients work to sustain abstinence (or maintain reduction) and evade relapse
83
Relapse is the sixth stage of change (Prochaska & DiClemete, 1983)
Define relapse
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
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
e. Preparation
85
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
d. Maintenance
86
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
b. Relapse
87
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. Action
88
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
c. Precontemplation
89
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
f. Contemplation
90
What are the 3 options we have when the client is not considering change and may deny substance use as a problem during precontemplation?
1. To not address substance use
2. To persuade the client to change / challenge their position
3. To enhance motivation to change
91
What interviewing method is the most useful when the client is not considering change and may deny substance use as a problem during precontemplation?
Motivational Interviewing
92
Motivational Interviewing is most useful when...?
The client is not considering change and may deny substance use as a problem during precontemplation
93
What is Motivational Interviewing (MI)?
A person-centred, conversational counselling method for addressing the common problem of ambivalence about change
94
A person-centred, conversational counselling method for addressing the common problem of ambivalence about change
This is known as....?
Motivational Interviewing (MI)
95
What does Motivational Interviewing (MI) seek to elicit and explore?
An individual’s own arguments for change
To strengthen a person’s motivation to change, review pros and cons of their behaviour
96
A collaborative conversation to strengthen a person’s own motivation for and commitment to change
This is known as...?
Motivational Interviewing (MI)
97
Motivational Interviewing (MI) is a collaborative conversation aimed to ___ ?
Strengthen a person’s own motivation for and commitment to change
98
Motivational Interviewing (MI) views ambivalence as ...?
Normal
99
What does Motivational Interviewing (MI) believe is key to change?
Resolving ambivalence
100
Who is responsible for change, according to Motivational Interviewing (MI)?
Responsibility for change is with the client
101
Motivational Interviewing (MI) accepts that client's goal is unlikely to be...?
Abstinence (or even reduction)
102
What is the main emphasis of Motivational Interviewing (MI)?
Helping clients to understand how their substance use keeps them from achieving their goals
103
Views ambivalence as normal
This is known as...?
Motivational Interviewing (MI)
104
Resolving ambivalence key to change
This is known as...?
Motivational Interviewing (MI)
105
Responsibility for change is with the client
This is known as...?
Motivational Interviewing (MI)
106
Accepts that client's goal unlikely to be abstinence (or even reduction)
This is known as...?
Motivational Interviewing (MI)
107
Emphasis: helping clients to understand how their substance use keeps them from achieving their goals
This is known as...?
Motivational Interviewing (MI)
108
According to Motivational Interviewing (MI), the clients' reasons for change need to be stronger than the reasons for...?
Staying the same in order to “tip the balance” for change
109
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?
Motivational Interviewing (MI)
110
What are the 3 possible reasons for using substances (reasons for staying the same and not changing)?
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
What is the aim of Motivational Interviewing (MI) in tackling reasons for using substances (staying the same and not changing)?
To enhance motivation to change; get client ready to make changes
112
True or False?
Motivational Interviewing (MI) is a long process/type of intervention because it takes into account every detail
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
True or False?
Motivational Interviewing (MI) can be delivered as a stand-alone intervention only
False
Motivational Interviewing (MI) can be delivered as a stand-alone intervention or can be integrated with another (e.g. CBT)
114
Define Psychoeducation
Provision of information about the impact of substance use on mental health
(Prevalence; How does your substance use compare? Withdrawal symptoms)
115
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...?
Psychoeducation
116
How can we provide psychoeducation?
List 3 ways
1. Info sheets
2. Leaflets
3. Info films
117
True or False?
Psychoeducation is typically included in MI and other individual interventions
True
118
What are Psychoeducation groups designed for?
For educating clients about substance abuse, and related behaviours and consequences
119
Psychoeducation groups designed to educate clients about substance abuse, and related behaviours and consequences
What can they help clients do? List 2 points
1. Identify resources
2. Counteract denial
120
True or False?
Psychoeducation is sufficient as a treatment in its own right
False
Psychoeducation is a useful adjunct but not sufficient as a treatment in its own right
121
What does Cognitive Behavioural Therapy (CBT) identify in substance use?
Identifies antecedents of drug use (‘high risk situations’)
122
What does Cognitive Behavioural Therapy (CBT) focus on?
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
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...?
Cognitive Behavioural Therapy (CBT)
124
What is the aim of Cognitive Behavioural Therapy (CBT) in addressing substance use?
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
Aims to change learned behaviour by changing thinking patterns, beliefs, and perceptions and assumptions
This is known as...?
Cognitive Behavioural Therapy (CBT)
126
Identifies antecedents of drug use (‘high risk situations’)
This is known as...?
Cognitive Behavioural Therapy (CBT)
127
What does relapse prevention mainly focus on?
Coping skills in high-risk situations but specific to relapse (avoiding temptation in the threatening situation)
128
What are clients taught to do in relapse prevention of substance use?
List 4 points
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
Longer term intervention of substance use, 6-26 sessions
This is known as...?
Relapse prevention
130
According to NICE guidelines, what should family and carers do in family/systemic therapy?
List 4 points
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
Family therapy is also known as...?
Systemic therapy
132
What intervention to substance use has a large psychoeducation component?
Family / systemic therapy
133
What does family / systemic therapy teach clients and family members?
Teaches communication skills and builds problem solving skills in family members, including the client
134
Teaches communication skills and builds problem solving skills in family members, including the client
Which intervention to substance use does this apply to?
Family / systemic therapy
135
Helps family develop relapse prevention strategies
Which intervention to substance use does this apply to?
Family / systemic therapy
136
How can family / systemic therapy help family develop relapse prevention strategies?
List 3 ways
1. By increasing support
2. By reducing burden
3. By decreasing conflict
137
Define Contingency Management (CM)
Incentivises and reinforces abstinence with the aid of vouchers, privileges, prizes or financial incentives (clear urine screen = reward) to reduce substance use
138
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...?
Contingency Management (CM)
139
What is Contingency Management (CM) based on?
Behaviour Modification (Based on learning theory, Skinner, 1953)
140
Behaviour Modification (Based on learning theory, Skinner, 1953)
Which intervention to substance use does this apply to?
Contingency Management (CM)
141
Reinforcing abstinence using rewards
Which intervention to substance use does this apply to?
Contingency Management (CM)
142
What intervention is recommended by NICE for substance use but evidence is currently lacking for dual diagnosis?
Contingency Management (CM)
143
Contingency Management (CM) is recommended by NICE for substance use but evidence is currently lacking for ...?
Dual diagnosis
144
How can we enhance existing interventions to substance use?
List 2 ways
1. Better targeting? (only those who are ready to
change?)
2. Include technological advances
e.g. personalised ‘in the moment’ feedback
145
How can we develop new approaches to combating substance use?
List 2 ways
1. Enhance existing interventions
2. Develop new models and approaches? e.g. VR
146
This group of people have higher rates of substance use
People with mental illness
147
Substance use can result in worse outcomes for which group of people?
People with mental illness
