Wessex Core Psychiatry Course Specialty Module Handbook SUBSTANCE MISUSE PART B1 2017-18 Health Education Wessex School of Psychiatry
Contents 1. Introduction to Module 2. Aims 3. Objectives 4. Topic Timetable Understanding and managing alcohol use disorders Understanding and managing drug use problems 5. Resources IT/Library Reading: Textbooks Journals National Journals Websites Edition 5 1 December 2017 2
1 Introduction Substance Misuse This module should build on previous Core Psychiatry modules, particularly the adult mental health course and on previous experience of clinical drug and alcohol use problems. The addiction component of paper B comprises 10% of the clinical topic section. The module covers a wide range of substance misuse areas, which should not only help you to pass the exam but also lead to a greater awareness of the challenges associated with addictive behaviour. This handbook should be read in conjunction with the other course handbooks (Course Handbook, Educational Supervisors Handbook and Facilitators Handbook). These are all available to download from the Postgraduate Centre website: http://www.southernhealth.nhs.uk/career/postgraduate-centre/ We have tried to balance the content of Curriculum for Specialist Training with the realities of everyday clinical practice in order to provide some framework to begin to tackle the MRCPsych exam. However it is impossible to cover the entire curriculum and we would advise you to familiarise yourself with that and other relevant Royal College Guidance: A Competency Based Curriculum for Specialist Training in Psychiatry (Specialist Module in Addictions Psychiatry) http://www.rcpsych.ac.uk/pdf/tw_tr_substance_misuse_psychiatry_curricul um_august_2017.pdf A Competency Based Curriculum for Specialist Core Training in Psychiatry : http://www.rcpsych.ac.uk/traininpsychiatry/corespecialtytraining/curricula.as px Module lead Dr Nicola Herod Consultant Psychiatrist Inclusion South Staffordshire and Shropshire NHS Foundation Trust Winchester Drug and Alcohol Service The Winchester Centre 68 St George s Street, Winchester, SO23 8AH Tel: 0300 1240103 choose option 7 for the Winchester service Nicola.Herod@sssft.nhs.uk 3
Role of the Facilitators The facilitators will be experienced clinicians who work with the groups throughout the topic to support their learning. There will be a clear introduction to the topic and time to summarise the topic at the end of the session. It is the responsibility of the lead facilitator to ensure that: a work plan is received from each group at the end of the initial session. the sessions run to time. to introduce the speaker and the format of the Masterclass allow time for reflection at the end of topic. We would like to remind you to fill in the feedback forms as we need to know from you what you felt worked well and perhaps more importantly what didn t. 2 Aims The aim of this module is in line with the overall aim of the new format of the Core Psychiatry course; To enable you to assess and manage people with substance use problems and to reduce the frequent misconceptions associated with this client group. To increase awareness of the social consequence and the public health agenda of drug and alcohol use problems. To enable you to have an awareness of the College Curriculum and develop a framework to approach the MRCPsych exam. At the end of the module you should have a greater understanding of the nature of addictive behaviour and of the health and social cost of substance use. We hope that we can raise awareness of the challenges that patients with dependence needs experience when in contact with health services and promote your interest and enthusiasm for addiction treatment opportunities. 4
3 Objectives At the end of this module you should be able to: Confidently make an assessment of a patient with dependency and initiate a treatment/management pathway. Have an understanding of the basic models of addictive behaviours. Understand the degree of substance problems within the United Kingdom and understand the impact on society of such problem. Comprehend the neurophysiology and neurochemistry behind drug and alcohol use and how this can lead to mental and physical health change. Be aware of recent research which considers treatments and psychosocial models for managing or ameliorating substance use. Appreciate the impact of modern substances and how legislation can influence substance use behaviour. To gain a better understanding of the National Treatment Agency and how service delivery has changed and the introduction of targets and data collection. To understand the different risks associated with specific substance using groups such as those in pain, younger people and pregnant women. Improve knowledge around a range of medical treatments employed in managing addicted patients and treatments that support abstinence. 5
4 Topic Timetable Group work for afternoon of 7th December 2017 (13:30-15:30) Understanding and managing alcohol use disorders Task 1) Explore the psychology of addictive behaviour consider the cycle of change and other models. Debate the use of motivational interview techniques. Talk to a patient with alcohol dependence and consider the impact of their use on their carers. Find a piece of literature, artwork or cinematography that explores issues around alcohol use. Task 2) What is the current public health agenda around alcohol consumption in the United Kingdom. How common are alcohol related problems and what factors influence consumption? How has alcohol use changed in younger people and what is the impact of legal initiatives? Propose a model of a legal framework to reduce the negative impact of alcohol on society and the individual. Task 3) Explore the neurochemistry in relation to alcohol/benzodiazepine use how does this lead to physiological dependence and associated withdrawal syndromes. What is the pharmacology behind abstinence based medical treatments and what is the evidence base of this treatment? How is the alcohol dependent person vulnerable to thiamine deficiency and how should this be managed and for how long? Task 4) Consider the impact of excess alcohol use on the physical and mental health of patients. What are the most common associated ill effects and who are most vulnerable to such conditions? Discuss the impact of an alcohol related harm with a patient. Masterclass Recovery in substance misuse treatment services. Lead facilitators Dr Nicola Herod & Dr Rob Jackson 4 th January 2018 morning (09:00-11:30) - feedback facilitators: Dr Nicola Herod & Dr Rob Jackson 6
Group work for afternoon of 4th January 2018 (13:30-15:30) Understanding and managing drug use problems Task 1) What are the risks of drug use in pregnancy how does the change in physiology alter the pharmacodynamics of opioid drugs, particularly methadone? What considerations need to be in place when treating pregnant patients? What are the interactions between the experience of pain and opiate dependency? Explore how the management of patients in pain is altered by opioid treatment. Discuss the experience with a patient on opiate painkilling medication. Task 2) Consider the impact of novel psychoactive drugs (those previously known as legal highs ) and drugs such as ketamine, khat, crack cocaine and crystal meth on society and the pathophysiological effects of these drugs. Explore the neurochemical changes associated with a range of drugs. Find a piece of music or an artist that demonstrates how drug use can influence artistic works. Find out about the psychoactive substances act 2016, arguments for implementation and its impact. Task 3) What are the essentials of community drug treatment including psychosocial interventions as well as community prescribing programmes and detoxification interventions. What is the evidence of cardiovascular changes with high doses of methadone? What is contingency management and the evidence that this can improve patient engagement in opiate treatment programmes? Task 4) What is the evidence behind injectable prescribing for opiate dependence consider the cost associated with this treatment. Explore the ethical issues in the context of the historical prescribing system in the United Kingdom. What is the prevalence of Hepatitis C in injecting drug users in the UK and what are the challenges to managing this disease? Discuss a piece of literature or cinematography that highlights the issues around injecting drug use. Masterclass Recognising drugs of misuse Lead facilitator Dr Nicola Herod Co-facilitators Dr Tim Bradbeer & Dr Faiz Bhatti 18th January 2018 - morning (09:00-11:30) - feedback facilitators: Dr Nicola Herod, Dr Tim Bradbeer & Dr Faiz Bhatti 7
5 Resources You will have access to Library facilities in your own local area and you will be able to use the library at Tom Rudd Unit on course days. You should ensure that you have a NHS Athens account: this is a username and password which allows you to use information resources paid for by the NHS. All NHS staff are entitled to an NHS Athens account. Your Learning Set will have a laptop, with internet access, to use in the Education Room on course days. Some useful websites are: http://www.library.nhs.uk/ and http://www.evidence.nhs.uk/ - locate libraries, search for articles / books / other publications, register for an Athens account, My Library facility http://www.swims.nhs.uk - catalogue of what is available (books, journals, audiovisual, etc) in all libraries in the south west http://webarchive.nationalarchives.gov.uk/20100304090133/library.nhs.uk/tools/ The Medical Search Initiative has developed electronic tools for use on the desktop, making it much easier for all NHS staff to check details while they are working. The tools created give easy access to reliable sources such as the British National Formulary, Medicines.org.uk and the National Library for Health Basingstoke, Southampton, Winchester and South West Hampshire: http://www.hantshealthcarelibrary.nhs.uk/ Dorset: East Dorset NHS Library Service, Haven Road, Canford Cliffs, Poole PGMC.library@poole.nhs.uk Isle of Wight: http://www.iow.nhs.uk/working-with-us/oliveira-library/oliveira-library.htm library@iow.nhs.uk Portsmouth: http://www.porthosp.nhs.uk/library/library.htm Salisbury: Beechlydene, Fountain Way, Salisbury SP2 7EP Education Centre, Salisbury District Hospital, Salisbury SP2 8BJ library.office@salisbury.nhs.uk 8
Reading In addition to the reading list in the AMH module you may find some of the following useful: Textbooks Seminars in Alcohol and Drug Misuse Ed J. Chick & R. Cantwell. (RCPsych Publications) Drugs Dilemmas and Choices (Gaskell - RCPsych Publications). The Methadone Briefing Martindale Pharmaceuticals. Drugs of Abuse Simon Wills. (The Pharmaceutical Press) Assessment of Addictive Behaviour Ed D. Donovan, G. Marlatt. (The Guildford Press) Relapse Prevention Maintenance Strategies in the Treatment of Addictive Behaviours Ed G. Marlatt, D.Donovan. (The Guildford Press) Clinical Topics in Addiction Ed Ed Day. (RCPsych Publications) Addiction and Change Carlo DiClemente (The Guildford Press) Journals Drug and Alcohol Dependence Addiction Drug and Alcohol Review National Publications Drug Misuse and Dependence UK Guidelines on clinical management. DOH. Inpatient Treatment of Drug and Alcohol Misusers in the National Health Service SCAN Consensus Project. 9
Review of the Effectiveness of Treatment for Alcohol Problems National Treatment Agency for Substance Misuse. Choosing Health in the South East Alcohol. South East Public Health Observatory. Models of Care for Treatment of Adult Drug Users National Treatment Agency for Substance Misuse. NICE Guidelines Drug Misuse methadone and buprenorphine TA114 Drug Misuse naltrexone TA115 Drug Misuse - Psychosocial interventions CG51 Drug Misuse Opioid detoxification CG52 Alcohol dependence and harmful use of alcohol CG115 NTA documents - Medications in Recovery - Re-orientating Drug Dependence Treatment 2012 - Medications in Recovery best practice in reviewing treatment 2013 Useful Websites Nice guidelines: www.nice.org.uk Information leaflets: www.rcpsych.ac.uk College CPD On Line: www.rcpsych.ac.uk but need to be registered National Treatment Agency: www.nta.nhs.uk This is clearly not an exhaustive list and facilitators may bring additional information and references if relevant to the topic. Edition 5 1 December 2017 10