Week 13 - Specialist Interventions Flashcards
(54 cards)
1
Q
Interventions targeting the drug
A
- psychoeducation/drug information
- Withdrawal management
- Pharmocotherapy
- Drug Screening
2
Q
Psychoeducation/drug information
A
Brief process of information provision focused on the communication of varied aspects of disease and treatment related information
Aim:
– To help understand their disorder,
– Understand the meaning of symptoms and what’s known about cause
– Harm minimisation / safety information
– Explore treatment options
– Early identify relapse risks
3
Q
What is the important information that needs to be shared?
A
– Effects and side effects, dosage, methods, and potential harms
– Correct inaccurate or dangerous information
– Explore treatment options
4
Q
why is it useful for the pre-contemplation stage
A
– Avoids confrontation and argument
– Raises awareness
5
Q
what works about this method?
A
- Strong evidence base in clinical trials and community settings, particularly when delivered by clinicians
- involves assessing consumption as well
as substance-related behaviour, and providing normative feedback and information on the impact of use. - Educating individuals on the impact of hazardous alcohol use on both mental and physical health may facilitate motivation to change behaviour
6
Q
Withdrawal Management
A
- the medical and psychological care of a person experiencing withdrawal symptoms as a result of ceasing or reducing substance use
- Common ‘entry point’ into AOD treatment. In/out patient
- Generally speaking, withdrawal feels like the opposite of the drug. For example when withdrawing from a depressant like alcohol a person may feel restless and agitated, or have
tremors
7
Q
Symptoms during with withdrawal
A
can be mild or severe depending on:
* Duration of use
* Substance
* Age
* Physical health
* Psychological characteristics
* Method of withdrawal
8
Q
Outcome of withdrawal management
A
- Withdrawal management can be a stand alone treatment – with limited effectiveness
- Treatment outcomes enhanced when people engage in further treatment such as counselling or rehabilitation services
9
Q
Pharmocotherapy
A
- the use of prescribed medication to
assist in the treatment of addiction. - Replacing a prescribed drug to treat a drug of dependence is used when:
- to reduce the intensity of withdrawal symptoms,
- to manage cravings, and
- to reduce the likelihood of a lapse or relapse by blocking a drug or addictive behaviour’s effect
10
Q
Aims of pharmocotherapy
A
- preventing physical withdrawal
- helps to stabilise the lives of people who are substance dependent
- to reduce the harms related to substance use.
11
Q
Agnoists and Antagonists
A
agonists - drugs that occupy receptors and activate them
antagonists - drugs that occupy receptors but do not activate them Antagonists block receptor activation by agonists
12
Q
Naltrexone Maintenance Treatment
A
- Naltrexone is a long-lasting opioid antagonist.
- Naltrexone reduces both the rewarding effects of opioids / alcohol and craving for it.
13
Q
Outcomes of Naltrexone
A
– Safe treatment
– For alcohol, 54% completed the 12 weeks of the treatment study: 39% abstained; 86% were consuming less alcohol by final visit than at baseline
* Outcomes best if highly motivated, employed, with good social support, older and with prior treatment experience
* Risk of overdose – removes tolerance
14
Q
Methadone Maintenance Treatment
A
- Full opiate agonist
- For those unable to cease opiate use/manage withdrawal
– Maintenance rather than abstinence
– Often preferred choice for high levels of opiate dependence
– Can be useful for chronic pain treatment
– Protective treatment for released prisoners with opiate use histories - Selected GP and Alcohol and Drug Services only
- High retention in treatment
– Not as intensive - Reduces/does not eliminate heroin use for all
- Reduces HIV risk behaviour, criminal behaviour, and risk of overdose
15
Q
Buprenorphine
A
- Partial agonist & partial antagonist
- Maintenance treatment
- Can be a detoxification aid
– Detoxification and withdrawal from Buprenorphine better tolerated than from methadone or heroin
– Less severe symptoms - Higher doses improve retention in treatment and reduce heroin use
- Can be taken in one, two, or three day doses (Double/Triple dosing options); long acting injectables
- compared to methadone theres slightly less retention in treatment and reduces illicit drug use to an equivalent or greater extent
16
Q
Interventions for alcohol
A
- Naltrexone
- Acamprosate
- Antabuse
17
Q
Acamprosate (Campral)
A
– Decreases cravings for alcohol in people who have been dependent on alcohol and are trying to abstain.
– Agonist and antagonist
– Maintenance: Does not prevent withdrawal symptoms
– Acamprosate significantly reduced the risk of returning to any drinking by 86% and increased the cumulative duration of abstinence by 11%
18
Q
Antabuse (Disulfiram)
A
- Maintenance Therapy - with abstinence as a goal
- Blocks enzyme that metablises alcohol - Reacts with alcohol to make client feel very ill
- Designed as a deterrent to drinking - Unpleasant side effects and sensitivity to alcohol
- Disulfiram is a safe and effective treatment. Produced an abstinence rate of more than 50%. Individuals who have taken Disulfiram for an average of 20
months have showed the highest rates of abstinence - More effective if used in conjunction with counselling and ongoing support
19
Q
Interventions for nicotine
A
- Nicotine replacement therapy
- Varenicline (Champix)
20
Q
Nicotine replacement therapy (NRT)
A
- partial agonist
- temporarily replaces nicotine from tobcco to reduce motivation to consume and withdrawal symptoms, eases transition from smoking to abstinence
- increases of successfully stopping by 50-70%
- supports the reduction of use by people not wanting to completely stop
- most effective with counselling
21
Q
Varenicline (Champix)
A
- Antagonist and partial agonist. Stimulates dopamine receptors whilst blocking nicotine receptors.
– Reduces cravings
– Lowers effects - the most efficacious smoking cessation medicine at up to 12 months
- Best with counselling and support
- Not recommended for young people
- Can be used with NRT
22
Q
interventions for Methamphetamines: Tina trial
A
- There are currently no approved medications for treating methamphetamine dependence.
- Australian trial on the use of Mirtazapine
– Two small trials conducted in the USA found mirtazapine reduced
methamphetamine use and reduced symptoms of depression in people who use methamphetamine
23
Q
Intervention for Cannabis
A
There are currently no approved pharmacotherapies approved for
treatment of cannabis use disorders
– Some medications appeared to show promise for treating individual
aspects of CUD.
– Psychosocial interventions should remain the first line
24
Q
A
25
Drug Screening
* Urinary drug screening and hair follicle testing detects over-the-counter, prescription drugs, alcohol and illicit substances.
* Simple point-of-care tests; laboratory screens
* Can often provide evidence of previous drug consumption – ‘parent drug’ and metabolites
* Screening is useful in monitoring abstinence from drug use, the use of drugs in the workplace and in legal disputes. May aid in relapse prevention.
26
Issues with drug screening
– Timing
– False positives/negatives
– Masking agents. Focus can become on ‘beating’ the screen rather than treatment goals
– Impact on therapeutic relationships / family relationships
27
Interventions targeting the individual
1. Controlled drinking/drug use training
2. self help groups
3. Brief interventions
4. Psychological therapies
28
Controlled drinking/drug use training
- an approach to alcohol consumption that focuses on moderation, or setting limits on consumption, as opposed to abstinence, or refraining from consuming alcohol altogether.
- controlled drinking is more appropriate with lower levels of dependence
- controlled drinking can be attemped after 3-6 months of abstinence
- Challenges for long-standing addiction; Environmental factors often key to success; Strong social supports required
29
Controlled drinking process
– Self-monitoring
– Develop limits and rules around consumption
– Devise strategies for high-risk situations
– Use rewards to maintain changes to behaviour
30
Self-help groups
- brings people together who are dealing with similar challenges to help build support and community around shared life experiences
- include a variety of programs with 12-step programs and self-management and recovery training (SMART recovery being most common)
- 12 step programs think abstinence is the only goal
- widely available
- easy to set up and run at no/low cost
- 12 step programs most common
31
Project matching for self help programs
12 step programs resulted in equivalent improvements compared to CBT and motivational interventions
32
SMART recovery
- CBT and MI based group program
- trained facilitators
- 4-point program
33
4-point program of SMART recovery
1. build and maintain motivation
2. cope with urges
3. learn problem solving techniques
4. achieve lifestyle balance
34
Peer workers
- community support, harm reduction and treatment
- clinicians and support workers have lived experience
- consumer advocacy
- support others to engage with services and attain goals
- authentic connection with users
- evidence on improved outcomes in limited
35
Brief interventions
- time-limited efforts to provide info or advice, increase motivation or teach behavioural change skills
- aim is to help patient understand substance use puts them at risk
- range from 5 min to 15-30 min of counselling
- delivered opportunistically in primary care, general hospital, inpatient and outpatient settings
- more intensive treatment is indicated if behaviour occurs
36
key features of brief intervention
* Focused on reduced substance use
* Address motivation
* Remain individualised
* Have the features of:
– Give feedback of risk
– Encourage responsibility for change
– Give options
– Demonstrate empathy
– Enhance self efficacy
37
What are the 6 key aspects of brief intervention?
Frames:
- Feedback of personal risk or impairment
- responsibility for change
- advice to change
- menu of alternative change options
- empathy on behalf of the practitioner
- self-efficacy or optimism in client facilitated by practitioner
38
Brief intervention outcomes
* They do not work with dependent drinkers who are seeking help for
alcohol problems
* They generally result in a 20-30% reduction in excessive drinking.
* Highly cost-effective.
* Evidence for cannabis and amphetamine use
* BIs can be an effective first level of treatment offered due to cost-effectiveness and fit with public health treatment approach
39
Psychological therapies
- effective
- CBT, MI and relapse prevention effective across many drugs
- more effective with medication particularly with opiate users
- efforts should be made to integrate these interventions in all treatment programs
40
Cognitive behavioural therapy (CBT)
- based on the premise that cognitions
influence feelings and behaviours, and that subsequent behaviours and
emotions can influence cognitions. The clinician works with individuals to identify unhelpful thoughts, emotions, and behaviours
- rated as the most effective approach to treatment with drug and alcohol population
41
Acceptance and Commitment Therapy (ACT)
- focuses on context and function of psychological experiences as the target of intervention rather than the form of freuqency of symptoms
- strong evidence for ACT as monotherapy or combination with treatment
42
Dialetic behaviour therapy (DBT)
- designed to serve five functions: enhance capabilities, increase motivation, enhance generalisation to
the natural environment, structure the environment, and improve clinician capabilities and motivation to treat
effectively
- key areas: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness
- strong evidence for treatment of substance use disorders and addiction
43
Relapse prevention
- developing skills to identify high-risk situations and triggers for cravings how to manage cravings and emotions, coping with lapes and attaining life-style balance
- effective treatment can be enhanced with CBT, MI or pharmacotherapy
44
Contingency management
- Aimed at encouraging positive behaviour by providing positive reinforcement when a client progresses toward treatment goals
- strong evidence for treatment of SUD esp opioids, tobacco and poly-use and medication adhearance however is rarely used due to high cost
45
Social skills training
- premise is that individual is deficient in social skills leading to poor adjustment and dysfunction with SUD as coping strategy
- focuses on training areas of deficiency (group therapy is a good setting for this)
- assertiveness training, anger management, modelling etc
46
Interventions targeting the environment
1. Community development
2. employment, educational and recreational opportunities
3. family therapy
4. case management
5. residential rehabilitation
47
Community development
- engaging local community in the design and implementation of prevention programs
- generates and disseminates drug-related resources
- prevention and intervention strategies
- raise awearness of drug issues
- useful if linked to development of comprehensive strategies e.g. support groups, liquor licensing, school-based interventions
48
employment, educational and recreational opportunities
* Recognises role of social disadvantage in substance abuse problems
* If successful, strong protective factors against drug misuse
* Opportunities to develop skills and social networks outside the drug using lifestyle
* Can improve self-worth and self-esteem
* Introduces alternatives and healthy lifestyle
49
family therapy
* Focus on treating the ‘family’
* Family inclusive practice
* Better treatment outcomes
– Can improve compliance with treatment and earlier engagement
– Can alleviate distress for significant others
* Family members need to agree to be involved
* Confidentiality issues
* Multiple needs need to be managed
– Individuals may need own counselling
50
Case management
* Single point of contact with health and social services
* Client driven
* Advocacy
* Community based
* Flexible and culturally sensitive
* Link clients with appropriate services
* Monitor clients’ progress in treatment
51
Residential rehabilitation
- long term program (1-12 months) living in a community of substance users, ex users and staff
- help develop skills and attitudes to make long-term changes
- includes counselling, employment, education and skills training, group work, relapse preventions and reintergration to community
- best for moderate to severe dependence
- abstinence is goal
52
outcomes of residential rehab
moderate quality evidence of improvement across substance use, mental health and social outcomes
53
challenges of residential rehab
- treatment drop out
- high relapse risk on leaving residential
- expensive
- impact on relationships, family, employment
54
matching clients to treatment
- therapeutic relationship and what happens outside of the session
- relationship has modest but consistent impact on treatment
- client ratings of therapeutic alliance are better predictors of outcomes than therapist therpaeutic alliance
- matching appropriate therapy to client affects therapeutic alliance
- drug, individual and environment require different combinations of interventions
- goal is to place client into least intensive treatment likely to facilitate treatment goals
