Drug AddictionDrug Addiction
Joint Tutorial 12/06/08Joint Tutorial 12/06/08
DSM IVDSM IV
Stage I – Preoccupation/anticipationStage I – Preoccupation/anticipation
Stage II – Binge/intoxicationStage II – Binge/intoxication
Stage III – Withdrawal/negative affectStage III – Withdrawal/negative affect
Most Harmful Drugs of abuseMost Harmful Drugs of abuse
Arguably Alcohol and NicotineArguably Alcohol and Nicotine
Drugs of abuse Drugs of abuse
Cocaine/Crack CocaineCocaine/Crack Cocaine AmphetaminesAmphetamines HeroinHeroin
(“Chasing the Dragon”)(“Chasing the Dragon”) CannabisCannabis LSDLSD EctasyEctasy
Morbidity and MortalityMorbidity and Mortality
Heroin addicts have 12 times greater Heroin addicts have 12 times greater mortalitymortality
Injectors 22times more likely to die Injectors 22times more likely to die than non injecting peersthan non injecting peers
Blood borne infectionsBlood borne infections
Hep B Hep B
Hep C Hep C
HIVHIV
Ethical Principles Ethical Principles
Drug users have the same Drug users have the same entitlement as other users to NHS entitlement as other users to NHS servicesservices
Focus for treatment is the patient Focus for treatment is the patient themselves but impact on others themselves but impact on others (especially dependent children) must (especially dependent children) must be taken into accountbe taken into account
Drug treatmentDrug treatment
Drug treatment works (at least Drug treatment works (at least methadone does –no good evidence methadone does –no good evidence for benzos)for benzos)
For stimulants mainstay is For stimulants mainstay is psychosocial therapypsychosocial therapy
Detection times in urineDetection times in urine
Amphetamines - 2 daysAmphetamines - 2 days Benzos – 12hrs to 7daysBenzos – 12hrs to 7days Buprenorphine – 8 daysBuprenorphine – 8 days Cocaine – 2-3 daysCocaine – 2-3 days Methadone 7-9 daysMethadone 7-9 days Opiates (including heroin) – 48hrsOpiates (including heroin) – 48hrs Cannabis 4-45 daysCannabis 4-45 days
Guide PrinciplesGuide Principles
Local drug treatment tailored to local Local drug treatment tailored to local needsneeds
Effective MDT working (joined up Effective MDT working (joined up thinking)thinking)
Fully involve patientsFully involve patients Involve carersInvolve carers
GP trainingGP training
RCGPRCGP Certificate in the Management of Certificate in the Management of
Drug Misuse (parts 1 and 2)Drug Misuse (parts 1 and 2)
NICE psychosocial interventionsNICE psychosocial interventions
Opportunistic (1-2 sessions)Opportunistic (1-2 sessions) Brief – lasting 10-45minsBrief – lasting 10-45mins Explore ambivalence about drug useExplore ambivalence about drug use Aim to increase motivation to change Aim to increase motivation to change
drug misuse behaviourdrug misuse behaviour
12 Step principle 12 Step principle
HonestyHonesty HumilityHumility FaithFaith WillingnessWillingness SurrenderSurrender ForgivenessForgiveness Soul searchingSoul searching MaintenanceMaintenance IntegrityIntegrity Making contactMaking contact AcceptanceAcceptance ServiceService
DETOXDETOX
CommunityCommunity In patientIn patient
Useful referenceUseful reference
Drug misuse and dependence Drug misuse and dependence UK UK guidelines on clinical management guidelines on clinical management 20072007