drugs, dependence and medicine d b double. outcome to discuss the importance of promoting...

Drugs, dependence and medicine

D B Double

Outcome

To discuss the importance of promoting independence, empowering patients and allowing them to take control of their lives, particularly in long-term conditions

To appreciate that people can become dependent on substances, both physically and psychologically

The problem of long-term conditions

Seventeen and a half million people in this country report a long term condition (such as diabetes, asthma or arthritis).

The problem of long-term conditions

Seventeen and a half million people in this country report a long term condition (such as diabetes, asthma or arthritis).

For some people, especially older people and those with more than one condition, discomfort and stress is an everyday reality.

The problem of long-term conditions

The impact on the NHS and social care for supporting people with long term conditions is significant.

The problem of long-term conditions

The impact on the NHS and social care for supporting people with long term conditions is significant.

Care for many people with long term conditions has traditionally been reactive, unplanned and episodic. This has resulted in heavy use of secondary care services

The problem of long-term conditions

The impact on the NHS and social care for supporting people with long term conditions is significant.Care for many people with long term conditions has traditionally been reactive, unplanned and episodic. This has resulted in heavy use of secondary care services Just 5% of inpatients, many with long term conditions, account for 42% of all acute bed days.

Long-term Medical Conditions Alliance

Umbrella body in the UK for over 100 national voluntary organisations

Long-term Medical Conditions Alliance

Umbrella body in the UK for over 100 national voluntary organisations

Mission to ensure people affected by long-term conditions have access to the services and support they need and can be active participants in determining their care.

Long-term Medical Conditions Alliance

Patients working in partnership with healthcare professionals

Long-term Medical Conditions Alliance

Patients working in partnership with healthcare professionals

Persons with a particular condition can play an important, and sometimes leading part in their own care and in the management of their disease

Persons with a particular condition can play an important, and sometimes leading

part in their own care and in the management of their disease

Most patients' organisations believe that this ideal has not yet been generally

accepted.

Why not?

Patient autonomy

Adversely curbed or restrained within contemporary healthcare

Patient autonomy

Adversely curbed or restrained within contemporary healthcare

Patients are often envisaged as more or less passive recipients rather than active contributors

Patient autonomy

Adversely curbed or restrained within contemporary healthcare

Patients are often envisaged as more or less passive recipients rather than active contributors

Powerful position of many doctors

Patient autonomy

Patriarchal attitudes continue to exist among healthcare professionals

Patient autonomy

Patriarchal attitudes continue to exist among healthcare professionals

Lack of appropriate training in how to work in partnership

with patients still prevents the appropriate use of patients' expertise and wisdom

Patient autonomy

Lack of political commitment? - in practice, involvement of users has been confused

with public participation

Patient autonomy

Lack of political commitment? - in practice, involvement of users has been confused with public participation - health professionals have been given the authority to define users' needs for them

Patient autonomy

Lack of political commitment? - in practice, involvement of users has been confused with public participation - health professionals have been given the authority to define users' needs for them

Lack of time available to clinicians to invest in forming partnerships with patients?

New Hippocratic Oath?

Hippocratic oath, which granted physicians the right to practice in the patient's best interest, may conflict with modern trend toward patient rights

Do doctors promote the independence of patients?

What is dependence?

Living with drugs

Legal vs illicit drugs

Living with drugs

Legal vs illicit drugs

Individual freedom vs. state control

Living with drugs

Legal vs illicit drugs

Individual freedom vs. state control

Cultural factors eg alcohol

Units of alcohol

Unit of alcohol is 10mls of pure ethanol

Units of alcohol

Unit of alcohol is 10mls of pure ethanol

One pint (568mls) of 3.7% ABV beer is therefore 568 x 3.7 / 1000 = 2.1 units

Units of alcohol

Unit of alcohol is 10mls of pure ethanol

One pint (568mls) of 3.7% ABV beer is therefore 568 x 3.7 / 1000 = 2.1 units

Small pub measure (25ml) of spirits (40% ABV) = 1 unit

Units of alcohol

Unit of alcohol is 10mls of pure ethanolOne pint (568mls) of 3.7% ABV beer is therefore 568 x 3.7 / 1000 = 2.1 unitsSmall pub measure (25ml) of spirits (40% ABV) = 1 unit750ml bottle of wine (12% ABV) = 9 units

Alcohol safety

Sensible drinking (DoH 1995)

Alcohol safety

Sensible drinking (DoH 1995)

No significant risk to health - men 3-4, women 2-3 units/day

Alcohol safety

Sensible drinking (DoH 1995)

No significant risk to health - men 3-4, women 2-3 units/day

Increasing risk to health - men > 4, women >3 units/day regularly

Alcohol safety

Royal College of Physicians

Alcohol safety

Royal College of Physicians

Low risk: men <21, women <14 units per week

Alcohol safety

Royal College of Physicians

Low risk: men <21, women <14 units per week

Increasing risk: men 22-50, women 15-35 units per week

Alcohol safety

Royal College of Physicians Low risk: men <21, women <14 units per week Increasing risk: men 22-50, women 15-35 units per week Harmful: men >50, women >35 units per week

Prevalence of alcohol use

In 2002, average weekly alcohol consumption in England was 17.0 units for men and 7.6 units for women

Prevalence of alcohol use

In 2002, average weekly alcohol consumption in England was 17.0 units for men and 7.6 units for women

Increasing slightly for men and much more markedly for women, especially 16-24 year olds

Syndromal concept of dependence

(i)    a narrowing in the repertoire of drug use

behaviour

Syndromal concept of dependence

(i)    a narrowing in the repertoire of drug use behaviour

(ii)   increased salience in drug-seeking behaviour

Syndromal concept of dependence

(i)   a narrowing in the repertoire of drug use behaviour

(ii)   increased salience in drug-seeking behaviour

(iii)  increased tolerance to the drug

Syndromal concept of dependence

(i)    a narrowing in the repertoire of drug use behaviour

(ii)   increased salience in drug-seeking behaviour

(iii)  increased tolerance to the drug

(iv) repeated withdrawal

symptoms

Syndromal concept of dependence

(v)    repeated relief or avoidance of withdrawal symptoms by further drug use

Syndromal concept of dependence

(v)    repeated relief or avoidance of withdrawal symptoms by further drug use

(vi)   subjective awareness of a compulsion to use the drug

Syndromal concept of dependence

(v)    repeated relief or avoidance of withdrawal symptoms by further drug use

(vi)   subjective awareness of a compulsion to use the drug

(vii)  rapid reinstatement of the syndrome after relapse.

Psychological dependence

Reliance on medication

Psychological dependence

Reliance on medication

Negative affect experienced in absence of drug

Psychological dependence

Reliance on medication

Negative affect experienced in absence of drug

People may form attachments to their medication more because of what they mean to them than what they do

Conclusions

Promoting independence and empowering patients is important

Dependence can be psychological as well as physical