PSYC251 Substance Use Disorders Lecture 1 PDF

PSYC251 Substance use disorders Lecture 1 Dr Briony Larance Senior Lecturer School of Psychology We acknowledge the traditional custodians of the lands on which UOW is situated. We pay our respects to Aboriginal Elders past and present, who are the knowledge holders and teachers. We acknowledge th...

PSYC251 Substance use disorders Lecture 1 Dr Briony Larance Senior Lecturer School of Psychology We acknowledge the traditional custodians of the lands on which UOW is situated. We pay our respects to Aboriginal Elders past and present, who are the knowledge holders and teachers. We acknowledge their continued spiritual and cultural connection to Country. As we share knowledge, teaching, learning and research within the University, we also pay respect to the knowledge embedded forever within Aboriginal Custodianship of Country.  In Lecture 1 we will… Describe the use and effects of alcohol and other drugs Examine alcohol-related harms Examine how hazardous drinking is identified Think carefully about the language Overview we use to describe alcohol and other drug use and use disorders In Lecture 2 we will… Compare and contrast international classification systems for substance use disorders Describe treatment approaches for substance use disorders  What is a drug? “any substance w hich alters the mood or behaviour as a result of alterations in the function of the brain” (WHO 1988) Drugs may be: 1. Legal, but controlled/regulated. 2. Illegal to possess or supply. 3. Medicines, usually classified as drugs of dependence (and regulated) Some terms used in this lecture… Alcohol and other drugs Alcohol use Alcohol use disorder (not ‘alcoholic’ or ‘alcoholism’) Substance use (not ‘misuse’ or ‘abuse’) Substance use disorder (not ‘addiction’) Person who uses substances/drugs (not ‘drug user’) Person with a substance use disorder (not ‘addict’)  Drugs are typically classed according to their effects… Sedatives/depressants Alcohol Reduce tension and anxiety Benzodiazepines (e.g., Valium, Enhance feelings of relaxation temazepam) Increase sleepiness Sleeping pills Facilitate social interaction *Cannabis Numbs/blunts feelings or events Opioids Stimulants Amphetamines Increase alertness and confidence Cocaine Decrease feelings of fatigue *Ecstasy Increase wakefulness/endurance Stimulate sex drive Hallucinogens *Cannabis Induce changes in mood, thought, LSD and behavior Psilocybin Entactogens *Ecstasy Increased empathy/connection Q: What are the main substances of concern in Australia? Alcohol use  Alcohol Short-term effects: depressant; decreased inhibitions; feelings of relaxation; aggression; impaired judgement; loss of coordination; impaired memory; vomiting; very high doses can lead to unconsciousness and death. Long-term effects: dependence; oral, throat and breast cancers; liver cirrhosis; brain damage and dementia; some forms of heart disease and stroke. Alcohol- related harms  Other alcohol-related disorders Alcohol Use Disorders Foetal Alcohol Syndrome Alcohol Amnesic Disorder (formerly Korsakoff's Syndrome) Alcohol-induced psychotic disorders Alcohol withdrawal delirium (‘delirium tremens’) Concept of hazardous drinking Hazardous drinking is defined as a quantity or pattern of alcohol consumption that places individuals at risk for adverse health events  Q: How many standard drinks are in a stubbie of full-strength beer? a. 1 standard drink b. 0.8 standard drinks c. 1.4 standard drinks d. 2 standard drinks Standard drinks  1. How often do you have a drink containing alcohol? 0. Never 1. Monthly or less Screening tool 2. 2-4 times a month 3. 2-3 times a week for alcohol: 4. 4 or more times a week AUDIT-C 2. How many standard drinks containing alcohol do you have on a typical day of drinking? 0. 1 or 2 1. 3 or 4 2. 5 or 6 3. 7 to 9 4. 10 or more 3. How often do you have six or more drinks on one occasion? 0. Never Source: 1. Less than monthly http://w w w.integration.samhsa.gov/images 2. Monthly /res/tool_auditc.pdf 3. Weekly 4. Daily or almost daily  Generally, the higher the score, the more likely it is that the person’s drinking is AUDIT-C affecting their safety. In men, a score of 4 or more is considered In women, a score of 3 positive, optimal for or more is considered identifying hazardous positive (same as drinking and/or active above) alcohol use disorder. Higher cut-offs may apply to university students: 7 or more among men and 5 or more among w omen(Barry et al., 2013; Campbell & Maisto, 2018).  Q: What are the national guidelines for safer drinking? NHMRC drinking guidelines Healthy men and women: Long-term harm: No more than 2 SDs on any day reduces the lifetime risk of harm from alcohol-related disease or injury. Short-term harm: No more than 4 SDs on a single occasion reduces the risk of alcohol-related injury arising from that occasion. Children and under 18s: Not drinking is the safest option. Under 15s are at greatest risk of harm from drinking - not drinking alcohol is especially important. For 15−17 yos, the safest option is to delay the initiation of drinking for as long as possible. Pregnant, planning a pregnancy, or breastfeeding: Not drinking is the safest option. Photo by Sebastian Staines on Unsplash  People aged 14 years+, drinking alcohol at risky levels or abstaining, 2001 to 2016 Other drug use Q: What proportion of the Australian population have used an illicit drug?  Lifetime use of selected illicit drugs by people aged 14 and over, 2016 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Na tiona l Drug Stra tegy Household Survey, AIHW  Recent* use of selected illicit drugs by people aged 14 and over, 2016 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 *Pa st 12 months Na tiona l Drug Stra tegy Household Survey, AIHW  Cannabis Short-term effects: Highly variable effects. Feeling ‘stoned’ (relaxed, euphoric, uninhibited); enhanced sensory perception; increased appetite; loss of co-ordination; anxiety, confusion & paranoia. Long term effects: dependence; increased risk of respiratory disease and cancers of upper respiratory tract; cardiovascular disease; decreased memory and learning ability; decrease motivation; clear links to psychosis/negative mental health effects. (Meth)amphetamine Short-term effects: Stimulant; euphoria & well being; hyperactivity; Increase attention; talkativeness; jaw clenching/teeth grinding; decreased appetite; dry mouth; increase BP and HR; paranoia/anxiety; changes in libido. Long-term effects: Dependence; sleep problems; weight loss; depression; extreme mood swings; paranoia/anxiety; seizures;‘speed psychosis; cardiovascular disease; injection-related injuries and diseases such as HCV. Possibly associated with permanent brain changes (e.g. Parkinsons disease). NSW methamphetamine-related hospitalisations  Methamphetamine use Occasional Regular users users 70% 30% Speed, not dependent, Ice, dependent, smoking Swallowing or Snorting or injecting, mental health, sleep, nutrition Harm minimisation, Reduce harm & risk, Prevent risker use Treat dependence & health  Heroin and other opioids (Morphine, oxycodone, codeine, fentanyl) Short-term effects: depressant; analgesia; euphoria; sedation; nausea, vomiting, severe itch; dry mouth; reduced alertness; constricted pupils; respiratory depression/overdose risk. Long-term effects: dependence; severe constipation; tooth decay; irregular menstrual cycles; injection-related injuries and diseases such as HCV; sexual dysfunction; poor physical health; weight loss; dependence; withdrawal symptoms; depression; anxiety; elevated mortality risk. Street drugs: summary Quality, quantity & consistency may change Drug names reported by clients may not correspond to the drug used Poly drug use (drug interactions) is common Drug use is often accompanied by a comorbid mental health disorder A note about stigma…  Importance of language Use person-centred language. Don’t define a person by their substance use or diagnosis —emphasise the person first (e.g., ‘person who injects drugs’) Avoid terms like ‘clean’ and ‘dirty’. Avoid expressions like ‘has a drug habit’ or ‘suffering from addiction’- can disempower by trivialising or sensationalising AOD use. See Language Matters guide: https://www.nada.org.au/resources/language-matters/ See the person, not the drug…. Alcohol and Drug Foundation: Breaking the Ice campaign https://www.youtube.com/watch?v=UHtnjnbMngI  Q: Any questions or comments so far? PSYC251 Substance use disorders Lecture 1 Dr Briony Larance Senior Lecturer School of Psychology THANK YOU!