Transcript Drug Addiction

Drug Addiction
Joint Tutorial 12/06/08
DSM IV
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Stage I – Preoccupation/anticipation
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Stage II – Binge/intoxication
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Stage III – Withdrawal/negative affect
Most Harmful Drugs of abuse
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Arguably Alcohol and Nicotine
Drugs of abuse
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Cocaine/Crack Cocaine
Amphetamines
Heroin
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(“Chasing the Dragon”)
Cannabis
LSD
Ectasy
Morbidity and Mortality
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Heroin addicts have 12 times greater
mortality
Injectors 22times more likely to die than
non injecting peers
Blood borne infections
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Hep B
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Hep C
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HIV
Ethical Principles
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Drug users have the same entitlement as
other users to NHS services
Focus for treatment is the patient
themselves but impact on others
(especially dependent children) must be
taken into account
Drug treatment
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Drug treatment works (at least methadone
does –no good evidence for benzos)
For stimulants mainstay is psychosocial
therapy
Detection times in urine
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Amphetamines - 2 days
Benzos – 12hrs to 7days
Buprenorphine – 8 days
Cocaine – 2-3 days
Methadone 7-9 days
Opiates (including heroin) – 48hrs
Cannabis 4-45 days
Guide Principles
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Local drug treatment tailored to local
needs
Effective MDT working (joined up thinking)
Fully involve patients
Involve carers
GP training
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RCGP
Certificate in the Management of Drug
Misuse (parts 1 and 2)
NICE psychosocial interventions
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Opportunistic (1-2 sessions)
Brief – lasting 10-45mins
Explore ambivalence about drug use
Aim to increase motivation to change drug
misuse behaviour
12 Step principle
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Honesty
Faith
Surrender
Soul searching
Integrity
Acceptance
Humility
Willingness
Forgiveness
Maintenance
Making contact
Service
DETOX
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Community
In patient
Useful reference
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Drug misuse and dependence UK
guidelines on clinical management 2007