1. Drug Addiction
Joint Tutorial 12/06/08

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

3. Most Harmful Drugs of abuse
Arguably Alcohol and Nicotine

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

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

6. Blood borne infections
Hep B
Hep C
HIV

7. 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

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

9. 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

10. Guide Principles Local drug treatment tailored to local needs
Effective MDT working (joined up thinking)
Fully involve patients
Involve carers

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

12. 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

13. 12 Step principle Honesty Humility Faith Willingness
Surrender Forgiveness
Soul searching Maintenance
Integrity Making contact
Acceptance Service

14. DETOX
Community
In patient

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