Insight Addictionary

Transcription

1 Insight Addictionary

2 This resource contains a range of definitions of common clinical terms in the alcohol and drug sector and suggested ways that they can be explained to clients. It has been developed by Queensland alcohol and drug workers and their clients as part of the Coming to Terms Project. If you have any suggestions or corrections please them to insight@health.qld.gov.au Abstinence The full cessation of AOD use. Worker / client contributions: When (you/someone) (was/were) using alcohol or other drugs on a regular basis (each day/week) and they decide to stop and don t use anything at all. Quitting; Deciding to have a break or stop using altogether. An example of abstinence is when someone decides to never have another drink in their life. It's different to reducing your use, where for example someone decides to cut back to just drinking on weekends instead of every day. NB: We avoid using the term 'staying clean' or 'being clean' as it implies that substance use may be considered dirty which can add to feelings of shame and/or stigma. Assessment Assessment is the process of a worker gaining an understanding of the individual circumstances of a client. It is undertaken on an ongoing basis, and can be a formal or informal process. Worker contributions: Getting to know your story so that we can work out how we can help you. Have a chat to talk about what's happening for you now, what's happened in the past and where you want to go from here. Where we sit down and look at all the different parts of your life e.g. your substance use, goals, relationships, work or study, physical and mental health, feelings and emotions. To gather information, to enable us to look at the best treatment plan for you. Client contributions: Formally or informally, finding out as much about you as they can in order to help you get the best help you need. Information is for the purpose of helping the client get resources. It s not about keeping tabs or keeping information to use against the clients, it s basically about where are you at and how can we best help you. Coming into a place like this and working out what drugs I m on, what I ve been taking and what treatment I m going to receive. 1

3 Assessment (cont.) Dependence You will see a doctor or nurse, they will take your history and they will find out what you ve been taking and make a plan of what they are going to do to help you out. Find out as much information as you can about me to figure out how best to help me. Taking notice of where a person is at clinically and how they are presenting; Observation of somebody and how they are presenting. If we re talking medical assessment, it would be a clinician looking at blood tests and looking at whatever information they ve got and explaining to you or writing down what they feel your health problems are. When you first go in and see a medical professional and ask them can you help me to get off this? What s the process I go to get off this?. A person has a strong desire to take a particular substance, cannot control its use and prioritises it over other things, despite experiencing harmful effects. If someone experiences 'withdrawal' when they reduce or stop using the substance, they are likely to be 'dependent' upon that substance. Worker contributions: When you need to have it to get through the day. Feeling like you rely on (drug of choice) to get by and/or feel sick or rubbish, if you don t take it. You might feel rubbish physically which is when your body needs it and that s physical dependence or you might feel rubbish mentally which is when your mind needs it and that s a mental dependence. When the drug has more control than you want it to. When you rely on it to do daily things. You end up needing it to be happy or you re relying on it to give you a certain feeling that it gives you. Physical and mental need for a certain substance. When you take away that substance, you can get side effects- both physical and mental side effects. Physical relationship to a drug or alcohol that someone has to maintain even if there are harmful side effects or harmful effects to your life. Addiction Do you have a habit? Are you addicted to this drug? Do you get sick without it? Do you get withdrawals without it? Need to use a substance to ease the pain that s being felt. You can t live without it, you need it. Like addiction, only worse. If you re dependent on something, and you can t get it, it can give you really bad health effects. 2

4 Dependence (cont.) Detoxification When you either physically or emotionally are used to having a substance in your body and to go without for a period of time, you will experience some side-effects. You might get ill and get emotional effects. If you have a habit, you are not going to feel well or be able to function each day unless you get up and have some of the substance of choice. And you do become dependent on it, you need it to feel normal each day. Once you have a habit, that s what you loose, the choice. It s like you re a robot. You cross lines in the sand that you might have had in place for yourself, thinking I ll never do this or never do that, but one at a time they fall like dominos because the drugs become all important. I depend on this drug to see me through and help me get through the bad times that I don t want to feel anymore. Usually refers to a supervised treatment where a drug or drugs are removed from the body, particularly when a person has become dependent on the drug/s. (Also, sometimes referred to as withdrawal management). A program/treatment to help manage the side-effects of stopping use. When a person decides to stop using alcohol or other drugs- what happens when they stop using. Can be supported by AOD staff, may be in a residential setting, self-managed or helped with medication. Having a break from using so that your body can have a chance to remove the substance from your body. The process your body goes through when you stop using a substance and the drug leaves your body. It s when you first stop using drugs and they leave your body. This can take up to 2 weeks to happen for some people. Sometimes you might need medical support to do this safely. Diversion Program Court/Police diversion is aimed at diverting people who have committed a minor drug offence away from the criminal justice system and into alcohol and drug treatment. Worker contributions: If it's your first time, you get in trouble with the cops, they might get you to go talk to someone about your drug use instead of going to court. To have another pathway to help other than just the police system. NB: Diversion has an alternative meaning when it refers to prescription medication being used in a way other than as intended including being given to someone else to take. 3

5 Dual Diagnosis (Or Comorbidity) Refers to more than one health condition occurring at the same time. In the context of alcohol and drug treatment, it refers to the co-occurrence of substance use with a mental health condition. When you have an Alcohol or Drug problem (I'd then explain that) and a mental health issue (I'd then explain that and give examples). When someone has some mental health concerns and is also using drugs or alcohol. Some people find that using substances can affect their mental health (e.g. moods, energy, feelings, thoughts). Mental health can also make people more likely to use substances (to help them cope). Dual diagnosis can often be explained by that old "chicken and the egg" debate- Which one came first? Did someone use substances and has developed some mental health concerns as a result or as a withdrawal symptom? Or is someone experiencing mental health concerns and using substances to cope with the symptoms? When you ve been diagnosed with two things or rely on two things. You have more than one health condition or more than one drug addiction. Not really a word to use with clients. It s a big word. Where there are drug and alcohol dependence issues but also mental health issues, or where someone is self-medicating on drugs to help with mental health issues. If you have problems with drugs and stopping use and other problems like mental health issues, there s no shame in it, but if you have this and that at the same time, that s your dual diagnosis. Being diagnosed with two different ailments - More than one problem. In my youth when I had severe depression and was addicted to heroin. Is somebody who has a mental health concern, who also has a substance use issue. I think it a very common thing that happens. People try to manage their mental health concerns by self-medicating, and for a lot of people, at least initially, that works. There s so much stigma about putting your hand up and saying you have mental health concerns, that people would rather smoke too much pot or drink too much to get through that mental health concern. Statistics don t say that ¼ or 1/5 of people, at some point in their life, have a mental health concern and a lot of those people will turn to drug use or alcohol use or use of medications as a coping mechanism and its, for people who have mental health concerns, it s a very high percentage who do end up using and using drugs. It s not a derogatory term, it s just a statement of fact. People shouldn t be ashamed of having mental illness. It s a diagnosis, like any other. It s a health issue. You have two things, your drug addiction on the one hand and mental health issues on the other. 4

6 Harm Minimisation Measures to minimise the harms that a person may experience as a result of their substance use. Aims to reduce the impact of drug-related harm within society, at an individual and community level. Means we will support you regardless of whether we want to keep using, reduce your use or stop use fully. We will help you do so safely and without judgement. Means that we do encourage you to consider abstinence or to stop your use. But, if you choose not to, we work with you to look at other options to reduce harms that are or could happen as a result of your use. So, this might include encouraging you to reduce or control your use, safer methods of use, making sure you have the correct information, etc. Accepting that somebody may not choose quitting something altogether but it helps with other things that might go along with drug use like health issues, Hep C, housing, etc. It might be things like slightly healthy eating to go along with the unhealthy things they may be doing, to reduce the harm to somebody so they are less likely to die, be hospitalised or have bad health conditions. (individualise it to their circumstance) Making safer choices like using clean equipment, not sharing anything with blood on it, not sharing spoons or tourniquets, there s many things you can do to reduce harm. Also means always using fit bins to avoid infecting anyone else and getting regular blood tests (3 months) if you re using regularly. From my own experience, places like QuiHn operate from the premise that they neither condemn nor condone injecting drug use. They accept that it happens and they, through their services, attempt to minimise the harm to people that is, having a NSP where people can hygienically use, educating people how not to get Hep C or Hep B or blood borne viruses. Accepting the individual and not judging them in any way goes a long way to the harm reduction that occurs. Intervention Actions that aim to raise awareness of, and reduce, risky behaviours by sharing information and motivating people to change those behaviours. The plan that we are going to make together to help you. An action which talks about someone s AOD use, behaviour or options. The steps, actions and strategies that we are going to work on together to help you achieve your set goal. 5

7 Pharmacotherapy The use of medications to respond to drug dependence, including to manage withdrawal, to block drug effects, as replacement or substitution therapy, and/or to treat co-occurring and related psychological disorders. When you are prescribed medication to help you achieve your set goal. A medication used as a drug substance that is monitored and prescribed by a doctor or opiate replacement clinic. Poly-drug Use When a person uses more than one drug, either simultaneously or at different times over the same period, for non-medical purposes. Using more than one drug. Can be much more harmful than using just one. Using more than one drug e.g. drinking and smoking. Prevention Action that is taken to stop people from starting to use drugs, delay when they start using or reduce further harms if already using them. Anything workers do to prevent people from using drugs, or reduce future harms if already using. Shutting the gate before the horse has bolted; Heading off harm. Rehabilitation In the alcohol and drug sector, rehabilitation (often shortened to rehab ) refers to a specific type of inpatient treatment, whereby a person lives in a dedicated service for a period of time (usually between 3 months and 12 months). When you go stay somewhere for a while (time frame) to help you stop using drugs and get into a routine. Generally, somewhere you live for a while that has in-house support. They help you to develop living skills and you ll participate in programs to help you stay substance free. Refers to the time following detox treatment- can be things people do to stay well or a place people go to get better. A residential or live-in program that focuses on building structures and activities in a person s life to replace substances. When you become an inpatient somewhere and you re being treated for an amount of time. To a young person- So it s a place where you can go where there s people who are going to help you while you re going through the hardest part of coming off the drugs. 6

8 Rehabilitation (cont.) Relapse Rehabilitation is used in mental health as well and I understand it to be recovery. You have to be quite dedicated to go to rehab, you have to ring up every day. You need to go to detox first. It s a safe place to stay away from drugs and alcohol. Rehabilitation doesn t have to be residential, it can also be done in the community just as effectively. There are pros and cons to residential rehabilitation because if you re doing a residential rehabilitation, you re being institutionalised and for a while. While you re there, you don t have to do your normal daily functional things like making toast, vacuuming, etc which is good while you re detoxing but going months and months without doing your normal daily functions, isn t always appropriate. It s quite disempowering. If you ve been using drugs for a long time or psychiatrically unwell for a long time, there are going to be skills gaps and the function of rehabilitation is to get those skills met so you can learn how to relax, learn how to manage your emotions, learn how to manage your finances, education towards getting a job, learn how to have a healthy routine, have healthy sleep cycles, etc. To return to drug use after a period of not using the drug/drugs. Going back to drinking/smoking/using at much the same level as before. When you decide to make some changes to your drug use and have a set back and start using again. Start using again Substance Use Disorders Develop after repeated use (over months or years) of a substance. They can manifest by a behavioural change in which using a substance is allocated a much higher priority than other behaviours that previously had value. Using a substance in a way that affects your work, home, study and relationships. When a person's substance use becomes a problem. You can tell if it is becoming a problem when you feel like it is becoming a huge focus of your life. When a substance/drug is used in a harmful, out of control way. When substance use becomes the priority in your life, or you use it to problem solve stuff that s happening in your day-to-day life. 7

9 Tolerance Using larger amounts of a substance than previously used to get intoxicated or to get the desired effects. Needing more of a drug to get the same effect. Getting used to the drug and needing more. Both the thoughts and the physical feelings that you might experience when you cut back or stop substance use. To a young person, I d say When you re looking for more and you need more. How much is needed to get by, to not be sick, to not be really stressed out. It s to keep you going at the same level as when you started. To get the desired effects or to even feel well at all. At some points you re not going to get the desired effects at all, you re just going to feel sick. The amount of drugs, quantities, you are taking. If I was talking to someone who is actively taking, I would say, how much do you need to use to get high/get your desired results. You re looking for larger and larger doses to get the hit. The more you use anything, your body builds up an acceptance and tolerance to it. How much you put up with before you break; How much painkillers you need before to relieve the pain; How much you can put up with. In drug terms, how much it takes you to get stoned. If your tolerance level goes up, you need more to get stoned which increases your chances of overdosing, if you re using something you can overdose on. You need increasing amounts of that substance to feel the effect/get the high or low of it. When you ve been using a particular substance for a period of time, you don t feel it so much on the same amount and you end up having to use more and more each time you use to get the effect your wanting out of the substance that you re using. Tolerance to a particular substance, for instance heroin. Being addictive, one develops a tolerance, therefore needs more to achieve the same results. With any addictive drug, tolerance means you are going to need more and more of it to get off, as we would say, each time. Which can lead to a habit, which leads to how are you going to make that kind of money to support a habit. How much you can use or can tolerate. The level I can handle. 8

10 Withdrawal Describes a range of physical and psychological symptoms that occur when a person stops or substantially reduces substance use. What happens when you stop using and start feeling unwell. The thoughts, feelings and behaviours that occur when someone stops AOD use. Symptoms that appear when the drug ceases. Both the thoughts and the physical feelings that you might experience when you cut back or stop substance use. Client Contribution: A range of symptoms and side-effects that occur when a person reduces or stops substances. Maintenance Sample definitions: 1. A stage of behaviour change, in which someone who uses substances sustains the change they set out to achieve, and new behaviour replaces old. 2. Maintenance Program - a specific treatment program for people who have problems related to dependence on opioids. Methadone and buprenorphine may be prescribed as treatment for people who have a dependence on opioids. Keeping on track and sticking to the goal you set for yourself. When someone was using e.g. opioids on a regular basis/every day and couldn t stop, a program where medication is given every day to stop the person from using. Trying to stick to the changes you have made. Methadone, Suboxone programs, I think these are a substitute for what you re taking so that you re not having to score every day. If you are using X amount of heroin, morphine, opiates, etc, you will be going to a chemist every day and picking up a dose of methadone or buprenorphine which will stop you getting sick. Insight would like to thank all of the workers and clients who provided their time, input and feedback into developing this resource. Copyright Insight 2018 Metro North Mental Health Alcohol and Drug Service Queensland Health 9