Principles of drug abuse treatment institute.pptx

This presentation includes the principles of drug abuse treatment

1. Treatment Approaches & Principles of Substance Use Disorder Dr.K.Navyaja Rao Assistant professor, IMH

2. Vulnerability to Psychoactive Substances

3. Vulnerability

4. Why do some people take drugs ?

5. Some want to try out new things SENSATION SEEKERS RISK TAKING CURIOSITY

6. PEER INFLUENCE Some want to be like their friends

7. Some may be suffering from mental illnesses SELF MEDICATION

8. Some may feel socially anxious/shy/awkward Loosening themselves

9. Sensation seekers Risk taking Curiosity Loosening themselves in parties Self medication Experimentation Peer influence

10. Depends upon Availability Socio-cultural norms Neighborhood role models STEP 1 Experimentation Depends upon Initial experiences Peer pressure S TEP 2 Occasional / Irregular use Stages leading to addiction

11. Diagnosis Can Be Made S TEP 4 Dependence / Addiction Depends upon - Availability - Peer pressure - Socio-cultural norms STEP 1 Experimentation Depends upon - Initial experiences -Peer pressure S TEP 2 Occasional / Irregular use May be ‘Abuse’ or ‘harmful use ’ -Symptoms of harm start appearing S TEP 3 Regular use Any individual who experiments with a particular substance does not always become a regular or dependent user Many individuals may not use the substance again Some may only use it occasionally or in moderation Stages leading to addiction

12. Drugs produce addiction by acting on the brain

13. Reward pathway is amongst the most important pathway involved in addiction Brain regions and reward pathway Makes us repeat the act: Taking food Having sex Taking drugs Releases neurochemicals, e.g., Dopamine

14. Experimentation FAMILY PROBLEMS broken family PERSONALITY poor coping skills, sensation/novelty seeking MENTAL ILLNESS GENETIC BIOLOGICAL Addiction?

15. Early stage of drug use Later stage of drug use NOT Taking drugs… ..makes you feel miserable… (withdrawal) ..to avoid which you will continue.. Negative reinforcement Taking drugs… ..makes you feel good… (euphoria) ..likely that you will continue.. Positive reinforcement

16. Quiz Click the Quiz button to edit this object

17. Substance use is seen as an immoral act Exhibited by a person with weakness of character Spirituality seen as the solution Substance use seen as an illness Users seen as ill / individual suffering from an illness Medical treatment seen as solution Substance use seen as a social environmental problem Substance use develops due to influence of peers Social modelling seen as solution Models of drug addiction Social Model Medical Model Moral Model

18. Principle One Holistic Perspective towards care

19. Motivation Enhancement Therapy Cognitive Behavioral Therapy Withdrawals management Substitution therapies Alcohol Anonymous Narcotic Anonymous Treatment modalities Medical Psychological Support groups

20. Principle One

21. Medical model of substance use disorder Substance use is a BIO-PSYCHO-SOCIAL phenomenon

22. Medical model of substance use disorder Drug dependence recognised as brain disorder and characterised by loss of control Drugs have long-lasting effects on the pathways in the brain Chronic drug use causes physiological derangements lasting years after the last drug taking episode Substance use increasingly seen as a MEDICAL DISEASE , requiring treatment, care and support

23. PRINCIPLES!

24. Principle One The effect of drug use occurs over multiple domains Interpersonal Domain Physical Domain Psychological Domain Social Domain Legal Domain

25. Principle Two No single treatment is appropriate for everyone

26. Principle Two Individuals are at different stages of change

27. Principle Two

28. Principle Three Treatment needs of an individual are different at different stages of recovery

29. Principle Three

30. Treatment goals

31. Principle Three

32. Principle Four Recovery from drug dependence is a long-term process

33. Principle Four Drug dependence = Chronic medical illness Comparable to Diabetes, Hypertension, Asthma Multi-factorial causation Roles of genes, environment and personal choice similar All require long term treatment Rates of adherence to treatment is similar

34. Principle Four

35. Principle Four Research shows that most individuals require at least three months in treatment to reduce/stop their drug use Longer the duration  Better the outcome The duration of treatment differs with individuals and depends on :- The duration of addiction Severity of dependence Complications in other spheres of life – social, family, occupational, legal Availability of social support

36. Principle Five Drug use is characterized by relapses and remissions

37. Principle Five Drug addiction is a chronic relapsing condition Rates of relapse are similar to other chronic medical illnesses Preventing and managing relapse is an integral part of substance use treatment Relapse should be seen as part of recovery McLellan et al, 2000

38. Principle Five

39. Principle Six Treatment is more effective if individuals participate in the decision process

40. Principle Six 04 Agreeing on the duration of treatment 03 Agreeing on the process of treatment 02 Agreeing on the setting of treatment 01 Agreeing on the modality of treatment The patient should be considered as an active partner in the treatment

41. Principle Six

42. Principle Seven Individuals have needs in addition to treatment of substance use disorder

43. Principle Seven

44. Principle Seven

45. Drug treatment principles: Summary Multimodal treatment approach Menu of options Different goals at different stages; continuous assessment and monitoring required Adequate duration of treatment Relapse is inherent part of recovery Clients must be made active partners in treatment Treatment should address other comorbidities

46. Quiz Click the Quiz button to edit this object

47. Treatment Approach and Issues

48. Treatment modalities Medical Psychological Support groups

49. Management of short term withdrawals Long term medical Management Management of physical harms associated with drug use Medical Management

50. Management of short-term withdrawals Withdrawals occur when the drug is stopped abruptly or the dose is lowered too quickly and a person experiences unpleasant symptoms. Usually opposite of acute effects: Depressants will have withdrawal in the form of – increased activity Stimulants will have withdrawal in the form of - lethargy

51. Management of short-term withdrawals Management of Alcohol withdrawal - Benzodiazepines Management of Opioid withdrawal Agonist – Buprenorphine, Methadone, Tramadol

52. Long term medical management: 02 Naltrexone in opioid use disorder ANTAGONIST THERAPY 03 Disulfiram in Alcohol use disorder DETERRENT 04 Acamprosate in alcohol use disorder CRAVING 01 Buprenorphine and methadone in opioid use disorder SUBSTITUTION THERAPIES

53. Psychological therapies Counselling / psychotherapy Can be delivered individually or in group settings Examples Motivation Enhancement Therapy Relapse prevention Cognitive Behavioral Therapy Contingency management

54. Psychological therapies Family Dysfunction Thinking Distortion Motivation Relapse Motivation enhancement Therapy Relapse prevention Therapy Cognitive Behavioural Therapy Family Therapy Intervention provided by counsellors Delivered over a period of weeks Regular meeting with clients

55. Support group A group of individuals set up to support each other during process of recovery Regular meetings following established protocols and procedures Often who has passed through the phase of recovery can Help others to stay abstinent Help others to change the lifestyle

56. Support groups

57. Support groups Open meeting - AA Closed meeting - AA

58. Support groups

59. Other issues in treatment Locus of treatment: where should patients be treated? Should patients be treated exclusively in inpatient ? Is outpatient treatment equally effective? It is a myth among patients, their family members and among service providers that abstinence is possible only in confinement Studies show that the outcome of patients is equally good with outpatient treatment Majority of the patients can be managed with outpatient treatment Only minority of patients require hospitalization

60. Other issues in treatment Should patients with only fair degree of motivation be treated? ANS: Not true Patients at any stage of change can be helped The interventions differ depend on the stage at which the patient is in Patient’s motivation should be enhanced by ‘Motivation enhancement therapy’

61. SUMMARY Substance use disorder/addictive disorder is increasingly recognized as a medical disorder, and requires treatment, care and support Addiction is seen as a chronic relapsing illness similar to non-communicable diseases such as diabetes or hypertension Various principles laid down in treatment of addictive disorders can help improve treatment outcome Treatment of addictive disorders require multi-modal treatment of medical, psychological and social approaches

62. QUIZ

63. Quiz Click the Quiz button to edit this object

64. Management Strategies for Substance Use Disorder

65. Let’s consider ‘ Road traffic accident ’

66. WHAT ALL CAN BE DONE TO MANAGE THE PROBLEM OF ROAD TRAFFIC ACCIDENT?

67. Helmet More number of Hospitals Stricter traffic rules Separate lanes/ no pothole Ambulance services near highways Road safety awareness programs Seat belt & air bag Strategies to tackle Road traffic accident

68. Drug Abuse Management Strategies Demand Reduction Strategies Supply Reduction Strategies Harm Reduction Strategies

69. Supply Reduction Strategies Aim to disrupt the supply and availability of drugs Control the supply of licit drugs used for recreational purpose Regulate the distribution of drugs used as medication Eliminate the availability of illicit drugs

70. Supply reduction - legal drugs

71. Supply reduction – illegal drugs

72. Supply reduction - Issues Only ‘supply reduction’ has never been an complete success

73. Supply Reduction: Issues Even high income countries fail to do with very high investment  

74. Supply reduction - Issues

75. Supply reduction - Issues Investment for supply reduction strategies results in diverting the money spent on treatment of drug users However well-applied, reliance on only this approach Unlikely to be effective in preventing all harms Drug use remains a part of human civilization

76. Demand reduction

77. Demand Reduction Strategies Aim to reduce the desire to use drugs To prevent, reduce or delay the initiation of drug use To reduce the demand among drug users

78. Demand Reduction

79. Different population Different strategies Late drug users Combination of various treatment, long term rehabilation Early drug users Early detection, Psychological intervention General population Mass Media, School based awareness programme Demand Reduction

80. Demand reduction - Issues Success rate of preventive strategy is very less

81. Demand reduction - Issues People often don’t seek treatment in early stages of drug use  Difficulty in identification Treatment often requires the person to be abstinent for treatment initiation Not everyone will be willing to give up the drug use

82. Harm Reduction Strategies Focus on reducing the negative consequence of drug use rather than drug use itself

83. Why Harm Reduction? Drug users can potentially incur harm due to their drug use  need to be protected from harms

84. Harm Reduction: Examples Needle Syringe Exchange Programs for People Who Inject Drugs

85. Needle Syringe Exchange Programs Incorporate a variety of other preventive strategies such as outreach, risk reduction education, referrals to other health and social services, etc.

86. Harm reduction: Examples Dilute the drink; drink in sips Avoid drink and drive Eat along with alcohol drink

87. Harm reduction: Examples

88. Continue injecting with new needles Substitution – agonist medicines Stop drug use Advantages of harm reduction Help available to individuals in different stages of drug use….

89. Advantages of harm reduction Sets easier to achieve goals (? Suboptimal) compared to difficult to achieve utopian goals (Abstinence) Pragmatic approach to address the drug use problems Respects the right of drug users

90. Issues/challenges in HR Unpopular among general public and policy makers Often believe: Harm reduction can encourage the drug user to continue drug use/ non users to start drug use Research often shows this to be a myth Usually assumed to be against the demand reduction approach

91. Summary Supply Reduction Strategies aim to disrupt the supply and availability of drugs Demand Reduction Strategies aim to reduce the desire to use drugs and to prevent, reduce or delay the initiation of drug use Harm Reduction Strategies focus on reducing the negative consequence of drug use rather than drug use itself No single strategy is sufficient Combinations of strategies are required for optimal benefit and outcome

92. Road traffic accident: Strategies Supply reduction Minimum age limit for drivers Speed limit Stricter traffic rules Demand reduction Road safety awareness programs in schools Message in media on road traffic accidents Harm reduction Hospitals and ambulance services near high ways Wearing of helmets/seat belt Life insurance/ Car insurance policy

93. Quiz Click the Quiz button to edit this object

94. THANK YOU