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Help Me... I’m Addicted

Help Me... I’m Addicted. Dr Richard de Ferrars November 29 th 2012. ICD-10 criteria for dependence. A strong desire or sense of compulsion to take the substance Difficulties in controlling substance-taking behaviour (onset, termination, level of use)

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Help Me... I’m Addicted

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  1. Help Me...I’m Addicted Dr Richard de Ferrars November 29th 2012

  2. ICD-10 criteria for dependence • A strong desire or sense of compulsion to take the substance • Difficulties in controlling substance-taking behaviour (onset, termination, level of use) • Physiological withdrawal state when substance use has ceased or been reduced • Evidence of tolerance • Progressive neglect of alternative interests • Persisting with substance use.

  3. Attitudes to Addiction Discuss! Addiction is a choice, a personality flaw - not a disease The NHS should not waste money on treating people with drug and alcohol related problems Addicts only have themselves to blame.

  4. Sympathy Manipulation Gung-ho Denial Reactions to Addiction

  5. What Addictions Are There? • Chemical substances - smoking, alcohol, drugs • Body things - exercise, food, weight loss, appearance, sex • Material gain - work, shopping, money • Risk & danger - gambling, pornography, hazardous sports • Less tangible - perfectionism, computer games.

  6. Do They Matter? Harm from.... • Chemical substances - smoking, alcohol, drugs • Body things - exercise, food, weight loss, appearance, sex • Material gain - work, shopping, money • Risk & danger - gambling, pornography, hazardous sports • Less tangible - perfectionism, computer games.

  7. No real chance of change: – lost cause Why bother? What can we do? • People who might change: • Precontemplation • Contemplation • Preparation • Action • Maintenance

  8. No real chance of change: – lost cause Why bother? What can we do? • Acute “medica” • Harm reduction • People who might change: • Precontemplation • Contemplation • Preparation • Action • Maintenance • Energising Change - • Raising awareness • Knowing the services • Direct support • (prescribing & pastoral)

  9. No real chance of change: – lost cause Why bother? What can we do? • Acute “medical management” • Harm reduction • People who might change: • Precontemplation • Contemplation • Preparation • Action • Maintenance

  10. Alcohol Why bother? What can we do? Drugs

  11. Alcohol Elizabeth Braddock: Mr. Churchill, this is a disgrace. You are quite drunk. Winston Churchill: That may well be true, but in the morning I will be sober and you will still be ugly.

  12. Know Your Limits How many units of alcohol in: a single measure (25mls) of vodka? a bottle of standard strength beer (5%)? a pint of very strong cider (9%)? a small 125ml glass of wine (10%) a large 250ml glass of wine (14%) a bottle of alcopop?

  13. Know Your Limits How many units of alcohol in: a single measure (25mls) of vodka? a bottle of standard strength beer (5%)? a pint of very strong cider (9%)? a small 125ml glass of wine (10%) a large 250ml glass of wine (14%) a bottle of alcopop? 1.0 1.7 5.1 1.5 3.5 1.4

  14. Alcohol - The Problem • 8.2 million people consume more alcohol than the recommended guidelines • 16.3% of the population are hazardous drinkers • 4.1% are harmful drinkers • The harm associated with alcohol misuse is estimated to be in excess of £15B a year • 10% of all psychiatric admissions are alcohol related • Stay alert. Remember CAGE.

  15. Alcohol - The Problem

  16. Brief Intervention Therapy • Ideal for primary care setting • Evidence based, quick and cost effective £20 per intervention • Effective in reducing alcohol intake by 20% • Estimated that £10,000 invested could save £43,000 health care costs • Suited for reduction rather than abstinence • Aim for 2-3-4 consultations over a few weeks.

  17. Brief Intervention -FRAMES • Feedback about risks of misuse , linking it to current problems • Responsibility emphasis placed on the patient for change (talk ‘you’) • Advice to cut down/ abstain etc. • Menu talk through a variety of strategies (see GP, SADAS, AA...) • Empathy avoid confronting, explore with patient reasons to change • Self-efficacy empower the patient in their ability to change, set goals.

  18. Brief Intervention -FRAMES • Feedback • Responsibility • Advice • Menu • Empathy • Self-efficacy This is good & proper patient-centred consulting Don’t succumb to “Why bother” Think “What can I do?”

  19. Drugs Consider your own professional (and personal experiences) of drug misusers What is the overall perception? What kind of problems, stress, worries?

  20. Problems Perceived by Professionals: • Difficult group of patients • Lack of training • Possibility of ‘swamping’ • Doubtful value of intervention • Possibility of GP/pharmacist/psychiatrist etc getting blamed • Possibility of diversion of prescribed drugs

  21. Name That Drug (Talk to Frank) Cannabis Resin Spliff Cocaine Charlie White Ecstacy M&M’s Heroin Brown Gear Smack LSD Lucy Tranqs Jellies Cannabis Cocaine Ecstacy Heroin LSD Tranqs • Brown • Charlie • Gear • Jellies • Lucy • M & M’s • Resin • Smack • Spliff • White.

  22. Why Should GP’s Get Involved? • “Drugs” is a common chronic relapsing condition • Any worse than other addictions? • Patients prefer treatment in primary care • Evidence that primary care treatment works • Government policy promotes GP involvement • Good support and training now exists.

  23. No real chance of change: – lost cause Why bother? What can we do? • Acute “medical management” • Harm reduction • People who might change: • Precontemplation • Contemplation • Preparation • Action • Maintenance • Energising Change - • Raising awareness • Knowing the services • Direct support • (prescribing & pastoral)

  24. What Can We Offer Drug Misusers? Feedback about personal risks of substance use and misuse Responsibility emphasis placed on the patient for change Advice to cut down/ abstain etc. Menu give them a variety of strategies/ resources Empathy avoid confronting, explore reasons to change Self-efficacy empower patient in their ability to change, set goals. • Harm reduction advice • Health check, e.g. blood pressure • Screening for blood borne viruses • Contraception, smear • Sexual health advice • Check general immunisation status • Information on local services • “Medical services” – Tier 2 (SADAS), Tier 3 (ACORN, Windmill) • Voluntary services – SDAC (phone), AA & NA [Narcotics Anonymous]. • Signpost to additional help • Citizen’s Advice Bureau, benefits, housing • Counselling

  25. Summary – Key Messages • Don’t “cherry pick” with addictions • Is your heroin user a worse person that your fat diabetic? • No change – harm reduction, help & support • Change – energise the cycle • Brief Intervention works – FRAMES • Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy • Drug misusers can be very rewarding people to work with!

  26. The End

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