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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