1. Title of presentation Name of presenter Introduction to addictions Andrea Williamson GP ST learning about Health Inequalities, Tuesday 17 th January 2013

2. Slide heading goes here Intended learning outcomes Explore some of the core concepts of addiction – Models of addiction – The meaning of “recovery” Describe the role of health care Explore “chronic homelessness” Discuss the role of GP ST’s Explore models of effective working

3. Models of addiction Disease Psychodynamic Socio-cultural Systems and family Medical Learning Moral Temperance

4. Recovery Journey metaphor Chronic relapsing and remitting disease Role of – Harm reduction – Abstinence – Social factors – Co-morbidity Recovery capital

5. Role of health care evidence based interventions – Needle exchange – BBV testing and treatment – Opiate substitution therapy – Supported alcohol detoxification and aftercare Role of therapeutic alliance Management of mental health co-morbidities Management of physical health co-morbidities Safeguarding children

7. Homelessness What is know about chronic homelessness All people are individuals and have their own story However many people have had the following experiences: Disrupted family life (poverty, abuse, into care) Poor educational attainment Poverty Experiences of violence Addictions Mental health problems On-going risky relationships (Source National Mental Health Development Unit 2010)

8. Case study Aiden is 22 years old. He comes to see you, the GP. He has lived in hostel accommodation for the past 4 months after moving from Bristol. The hostel staff have been increasingly worried about him because he is isolating himself in his room and they describe his behaviour as odd at times. A SAMH connect worker has brought him along to the surgery. The trigger for being encouraged to come along today is that he has been threatening suicide and the staff are concerned by this. The worker tells you too that he has permission from Aiden to tell you that he has been smoking four bags of heroin a day for the past two years on and off. He also had a hospital admission about six weeks ago following a heroin overdose but signed himself out and would not consider treatment. He is initially reluctant to speak at all. Describe what might help him to talk about his situation today, prioritise what might be done?

9. Knowledge Managing street drugs withdrawal Managing alcohol withdrawal Physical consequences of alcohol and drug dependency Safeguarding children Skills Good consultation skills Boundaries Mental health assessment Attributes Empathy

10. Adult attachment Personality disorder Complex trauma Important concepts for effective consultations

11. Impact on: Thinking Feeling Behaving Impulsiveness…self sabotaging…self harm…emotional lability….dissociation...unexplained physical symptoms Features

12. Listen to what your emotions tell you when you interact with patients: frustration, anger, disgust, fear Accept your response is often a reaction to patients psychological function (not always) Encourage safety: physical, emotional and social: for you and patients Be very careful of verbal and non verbal leakage (including psychological environments) How to respond?

13. Patients respond, feel safe and function better (so you might actually get to addressing health issues) You will waste less emotional energy getting angry, frustrated, upset Professional patient relationships are key to an effective health service Why?

14. Further reading resources Overview of current thinking in addictions: – Sellman D, (2009). The ten most important things known about addiction. Addiction 105, 6-13 Web based resource for primary care orientated addiction guidelines and information: http://www.smmgp.org.uk/ Review of neurobiological approaches – Kalant H,(2009). What neurobiology can’t tell us about addictions Addiction 105, 780-786