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Chapter: Medicine Study Notes : Psychological Medicine

Treatment of Substance Abuse

Treatment must be for underlying addictive disorder, not just detoxification and withdrawal

Treatment of Substance Abuse


Treatment Rationale


·        Treatment must be for underlying addictive disorder, not just detoxification and withdrawal 

·        Addiction is a chronic not acute illness. Requires long term follow-up and behaviour modification (as with diabetes and hypertension) 

·        Often unsympathetic response because addiction is perceived as self-afflicted: but there are numerous involuntary components in the addictive process. Loss of voluntary control turns a drug misuser into drug addicted. There is a compulsive, often overwhelming, involuntary component 

·        Involves genetic, biological, behavioural and environmental components

·        Success rate for treatment depends on type of drug and variables inherent in the population being treated (e.g. better for professionals than for poorly educated). Nicotine has the poorest success rate. Success rates are comparable with other chronic diseases 

·        Treatment is cost-effective


 Issues In Treatment


·        Compliance with treatment. Those who comply with treatment have best prognosis – as with other chronic diseases

·        Who should be involved: multidisciplinary approach 

·        Managing the environment: peer pressure, money, job, supports, triggers to former behaviour, family relationships (can they be helped, education about illness) 

·        The most significant predictor of treatment success is an empathic, hopeful, continuous treatment relationship

·        Must also treat any co-morbid diagnosis simultaneously


Types of Treatment


·        Medication: Antabuse, naltrexone, opioid substitution

·        Detoxification (inpatient/outpatient)

·        A&D counselling: motivational interviewing, strategies for change, relapse prevention

·        Psychotherapy: CBT, psycho-education

·        Self-help groups 

·        Addressing specific issues: grief, anxiety, childhood sexual abuse, sexual assault, anger, relationship problems, parenting issues, financial, housing, employment issues, etc


Readiness to Change/Motivational Interviewing


       See Topic: Behavioural Change


Services for dependency


·        Detox: Kenepuru (inpatient)

·        AA

·        Narcotics anonymous

·        Queen Mary – Hamner: uses 12 step process

·        Odyssey House (Auckland)

·        Alcohol and drug service


Making the change


·        Takes a long time

·        Involves changing lifestyles, supports, habits

·        GP can assist with motivation for change:


Methadone Treatment


·        For opiate addiction 

·        Methadone is highly addictive, but is regular, long acting (a dose a day holds for 24 – 46 hours), free (® ¯crime), legal, more effective taken orally than other opiates, no risks from injection

·        Doesn‟t give a high – just stops „hanging out‟ (withdrawal)

·        Has to be taken every day 

·        Can cause high mood, drowsiness, ¯pain, small pupils, constipation, histamine release (sweating, itching, etc), ¯saliva ® ­tooth decay, ¯libido – it is a powerful drug 

·        It doesn‟t affect senses, or damage body organs, shouldn‟t affect pregnancy or breast-feeding 

·        Is dangerous in conjunction with tranquillisers and/or alcohol ® overdose situation (eg vomit and choke while sedated) 

·         Is taken as part of a planned programme, including counselling, to build a life away from opiate abuse        can concentrate on sorting out debt, relationships, etc

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Medicine Study Notes : Psychological Medicine : Treatment of Substance Abuse |

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