Transcript Drugs

Drugs, dependence and
medicine
D B Double
Outcome
To discuss the importance of promoting
independence, empowering patients
and allowing them to take control of
their lives, particularly in long-term
conditions
To appreciate that people can become
dependent on substances, both
physically and psychologically
The problem of long-term
conditions
Seventeen and a half million
people in this country report
a long term condition (such
as diabetes, asthma or
arthritis).
The problem of long-term
conditions
Seventeen and a half million
people in this country report
a long term condition (such
as diabetes, asthma or
arthritis).
For some people, especially
older people and those with
more than one condition,
discomfort and stress is an
everyday reality.
The problem of long-term
conditions
The impact on the NHS and
social care for supporting
people with long term
conditions is significant.
The problem of long-term
conditions
The impact on the NHS and
social care for supporting
people with long term
conditions is significant.
Care for many people with
long term conditions has
traditionally been reactive,
unplanned and episodic.
This has resulted in heavy
use of secondary care
services
The problem of long-term
conditions
The impact on the NHS and
social care for supporting
people with long term
conditions is significant.
Care for many people with
long term conditions has
traditionally been reactive,
unplanned and episodic.
This has resulted in heavy
use of secondary care
services
Just 5% of inpatients, many
with long term conditions,
account for 42% of all acute
bed days.
Long-term Medical Conditions
Alliance
Umbrella body in the UK for
over 100 national voluntary
organisations
Long-term Medical Conditions
Alliance
Umbrella body in the UK for
over 100 national voluntary
organisations
Mission to ensure people
affected by long-term
conditions have access to
the services and support
they need and can be active
participants in determining
their care.
Long-term Medical Conditions
Alliance
Patients working in
partnership with healthcare
professionals
Long-term Medical Conditions
Alliance
Patients working in
partnership with healthcare
professionals
Persons with a particular
condition can play an
important, and sometimes
leading part in their own care
and in the management of
their disease
Persons with a particular condition can
play an important, and sometimes leading
part in their own care and in the
management of their disease
Most patients' organisations believe that
this ideal has not yet been generally
accepted.
Why not?
Patient autonomy
Adversely curbed or
restrained within
contemporary healthcare
Patient autonomy
Adversely curbed or
restrained within
contemporary healthcare
Patients are often envisaged
as more or less passive
recipients rather than active
contributors
Patient autonomy
Adversely curbed or
restrained within
contemporary healthcare
Patients are often envisaged
as more or less passive
recipients rather than active
contributors
Powerful position of many
doctors
Patient autonomy
Patriarchal attitudes continue
to exist among healthcare
professionals
Patient autonomy
Patriarchal attitudes continue
to exist among healthcare
professionals
Lack of appropriate training
in how to work in partnership
with patients still prevents
the appropriate use of
patients' expertise and
wisdom
Patient autonomy
Lack of political
commitment?
- in practice, involvement of
users has been confused
with public participation
Patient autonomy
Lack of political
commitment?
- in practice, involvement of
users has been confused
with public participation
- health professionals have
been given the authority to
define users' needs for them
Patient autonomy
Lack of political
commitment?
- in practice, involvement of
users has been confused
with public participation
- health professionals have
been given the authority to
define users' needs for them
Lack of time available to
clinicians to invest in forming
partnerships with patients?
New Hippocratic Oath?
Hippocratic oath,
which granted
physicians the right
to practice in the
patient's best
interest, may conflict
with modern trend
toward patient rights
Do doctors promote the
independence of patients?
What is dependence?
Living with drugs
Legal vs illicit drugs
Living with drugs
Legal vs illicit drugs
Individual freedom
vs. state control
Living with drugs
Legal vs illicit drugs
Individual freedom
vs. state control
Cultural factors eg
alcohol
Units of alcohol
Unit of alcohol is 10mls
of pure ethanol
Units of alcohol
Unit of alcohol is 10mls
of pure ethanol
One pint (568mls) of
3.7% ABV beer is
therefore 568 x 3.7 /
1000 = 2.1 units
Units of alcohol
Unit of alcohol is 10mls
of pure ethanol
One pint (568mls) of
3.7% ABV beer is
therefore 568 x 3.7 /
1000 = 2.1 units
Small pub measure
(25ml) of spirits (40%
ABV) = 1 unit
Units of alcohol
Unit of alcohol is 10mls
of pure ethanol
One pint (568mls) of
3.7% ABV beer is
therefore 568 x 3.7 /
1000 = 2.1 units
Small pub measure
(25ml) of spirits (40%
ABV) = 1 unit
750ml bottle of wine
(12% ABV) = 9 units
Alcohol safety
Sensible drinking (DoH
1995)
Alcohol safety
Sensible drinking (DoH
1995)
No significant risk to
health - men 3-4,
women 2-3 units/day
Alcohol safety
Sensible drinking (DoH
1995)
No significant risk to
health - men 3-4,
women 2-3 units/day
Increasing risk to health
- men > 4, women >3
units/day regularly
Alcohol safety
Royal College of
Physicians
Alcohol safety
Royal College of
Physicians
Low risk: men <21,
women <14 units per
week
Alcohol safety
Royal College of
Physicians
Low risk: men <21,
women <14 units per
week
Increasing risk: men 2250, women 15-35 units
per week
Alcohol safety
Royal College of
Physicians
Low risk: men <21,
women <14 units per
week
Increasing risk: men 2250, women 15-35 units
per week
Harmful: men >50,
women >35 units per
week
Prevalence of alcohol use
In 2002, average
weekly alcohol
consumption in England
was 17.0 units for men
and 7.6 units for women
Prevalence of alcohol use
In 2002, average
weekly alcohol
consumption in England
was 17.0 units for men
and 7.6 units for women
Increasing slightly for
men and much more
markedly for women,
especially 16-24 year
olds
Syndromal concept of
dependence
(i)
a narrowing in the
repertoire of drug use
behaviour
Syndromal concept of
dependence
(i) a narrowing in the
repertoire of drug use
behaviour
(ii) increased salience in
drug-seeking behaviour
Syndromal concept of
dependence
(i) a narrowing in the
repertoire of drug use
behaviour
(ii) increased salience in
drug-seeking behaviour
(iii) increased tolerance to
the drug
Syndromal concept of
dependence
(i)
a narrowing in the
repertoire of drug use
behaviour
(ii) increased salience in
drug-seeking behaviour
(iii) increased tolerance to
the drug
(iv) repeated withdrawal
symptoms
Syndromal concept of
dependence
(v) repeated relief or
avoidance of withdrawal
symptoms by further drug
use
Syndromal concept of
dependence
(v) repeated relief or
avoidance of withdrawal
symptoms by further drug
use
(vi) subjective awareness
of a compulsion to use
the drug
Syndromal concept of
dependence
(v) repeated relief or
avoidance of withdrawal
symptoms by further drug
use
(vi) subjective awareness
of a compulsion to use
the drug
(vii) rapid reinstatement of
the syndrome after
relapse.
Psychological dependence
Reliance on medication
Psychological dependence
Reliance on medication
Negative affect
experienced in absence
of drug
Psychological dependence
Reliance on medication
Negative affect
experienced in absence
of drug
People may form
attachments to their
medication more
because of what they
mean to them than what
they do
Conclusions
Promoting independence and
empowering patients is important
Dependence can be psychological as
well as physical