Substance Use Disorder and Harm Reduction

A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite substance-related problems.
Marked with underlying change in brain circuits that may persist beyond detoxification.
Useful mnemonic for criteria: WILD ADDICTD
- W: Work, school, home obligations failure
- I: Interpersonal or social consequences
- L: Dangerous use
- A: Activities given up or reduced
- D: Dependence → tolerance, withdrawal
- D: Dependence → duration or amount of use greater than intended

Pattern of recent drug use: when was it last used, alone or with other drugs, why, and how?
Dependence: evidence of psychological and/or withdrawal symptoms
Addiction: behaviors associated with self-regulation loss, drug-seeking behaviors

47% of the population (10.2 million) have used an illicit drug at some point in their life
1 in 6 Australians have used an illicit drug in the past 12 months
Rise of 264% in drug-induced deaths over the past decade
3% of the total burden of disease and injury in 2018

Men are most likely to try and have a higher hospitalization rate
Young adults, aged 20-29 years, are most vulnerable
20% of drug treatment service clients in WA identified as Indigenous
Highest rate of drug-induced deaths among 45-64-year-olds living in disadvantaged areas

Health impacts: drug-induced deaths, cardiovascular disease, respiratory problems, addiction
Social impacts: increase in risky, criminal activities, domestic violence, child maltreatment
Economic impacts: $80.3 billion in addiction costs, $4.5 billion in cannabis-related costs, $5 billion in methamphetamine-related costs

Cannabis: most used illicit drug in Australia, accounts for 52% of national illicit drug seizures, and 47% of arrests
Methamphetamine: reported increased consumption, 3 in 5 users were male, 1 in 5 were Indigenous, and 58% were aged 20-39

Cannabis: short-term effects include mild euphoria, relaxation, and perceptual alterations, long-term effects include long-term dependence, mental health conditions, anxiety, and appetite disturbances
Methamphetamine: short-term effects include euphoric sense, increased attention, and aggression, long-term effects include mood and anxiety disorders, psychotic symptoms, and poor concentration and memory

Addiction is a treatable disorder
Individuals with chronic substance dependence achieve 58% sustained recovery
Amphetamine users may remit from drug dependence in a given year
Cannabis users may remit from drug dependence in a given year
Typical time it takes between first substance use to stable recovery is 27 years

Demand reduction: prevention approach, delaying first use, and integrated care and accessible treatment and support services
Supply reduction: restricting availability and access, dismantling manufacturing facilities, and regulating sale, age restrictions, and border control
Harm reduction: identifying specific risks, encouraging safer behaviors, and effective public policy and safer settings

Requirements for recovery: safe place, freedom from physical and psychiatric distress, empowerment, and longitudinal support
Strongest predictor of higher life quality: engaging in activities like volunteering, education, work, family, and social support
Recovery is mediated by social and cultural support

Community-based counseling and case management: patients can require self-referrals
Needle and syringe programs: provide sterile needles and syringes to prevent transmission of blood-borne viruses
Better Access initiatives: give Medicare rebates to help people access mental health professionals and care
Drug Aware: 24-hour alcohol and drug support line
Family Drug Support: for help dealing with drug and alcohol use in the family