Drug Addiction Joint Tutorial 12/06/08

DSM IV Stage I – Preoccupation/anticipation Stage II – Binge/intoxication Stage III – Withdrawal/negative affect

Most Harmful Drugs of abuse Arguably Alcohol and Nicotine

Drugs of abuse Cocaine/Crack Cocaine Amphetamines Heroin Cannabis LSD (“Chasing the Dragon”) Cannabis LSD Ectasy

Morbidity and Mortality Heroin addicts have 12 times greater mortality Injectors 22times more likely to die than non injecting peers

Blood borne infections Hep B Hep C HIV

Ethical Principles 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 Drug treatment works (at least methadone does –no good evidence for benzos) For stimulants mainstay is psychosocial therapy

Detection times in urine 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 Local drug treatment tailored to local needs Effective MDT working (joined up thinking) Fully involve patients Involve carers

GP training RCGP Certificate in the Management of Drug Misuse (parts 1 and 2)

NICE psychosocial interventions 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 Honesty Humility Faith Willingness Surrender Forgiveness Soul searching Maintenance Integrity Making contact Acceptance Service

DETOX Community In patient

Useful reference Drug misuse and dependence UK guidelines on clinical management 2007