Substance misuse/abuse

Ferguson, H. (2005) Working with violence, the emotions and the pyscho-social dynamics of child protection reflections on the Victoria Climbie Case. Social Work Education 24, 7, 781-795. Forrester, D. (2000) Parental substance misuse and child protection in a British sample a survey of children on the Child Protection Register in an Inner London district office. Child Abuse Review 9, 235-246. 

Within the personal factors, clearly family disruption, trauma and physical or sexual abuse can all predispose to conduct disorder in adolescence and personality disorder in adulthood (Paris 1996b, Spataro et al. 2004). Links between such factors and subsequent substance misuse have been consistently found (Bartholomew Rowan-Szal 2002, Poikolainen 2002), while the associations between established personality disorder and drug... 

Cochrane Review). The Cochrane Library. Chichester John Wiley Sons Solberg U, Burkhart G Nilson M (2002). An overview of opiate substitution treatment in the European Union and Norway. International Journal of Drug Policy, 13, 477-84 Soyka M (2000). Substance misuse, psychiatric disorder and violent and disturbed behaviour. British Journal of Psychiatry, 176, 345-50 Spataro J, Mullen PE, Burgess PM, Wells DL Moss SA (2004). Impact of child sexual abuse on mental health. Prospective study in males and females. British Journal of Psychiatry, 184, 416-21... 

By far the most common and pervasive approaches to substance-misuse prevention have been education and mass media efforts. Traditionally these programs have been aimed at adolescents and young adults, two of the more visible groups at risk for substance abuse. More recently efforts have been made to extend these interventions to children. 

For some reason, doctors feel compelled to tell patients what s best for them, even though it doesn t work. In psychiatry, you ll meet people who can t or won t change behaviours which could improve their health and wellbeing, e.g. substance misuse, exercise, medication adherence, or leaving an abusive parmer. Understand that the behaviour provides them with significant benefits - if not, they d have changed ages ago. Remember ... 

Cleaver, H., Unell, Land Aldgate, J. (2011) Children s Needs - Parental Capacity. Child Abuse Parental Mental Illness, learning disability, substance misuse and domestic violence, 2nd Edition. The Stationery Office, Norwich UK... 

In this chapter, we will focus primarily on treatments for the substance use disorders. However, because detoxification during a substance-induced withdrawal is often the first step in treating a substance use disorder, we will discuss withdrawal states to some extent. The substance use disorders include both substance abuse and the more serious substance dependence. Substance abuse consists of a pattern of misuse that causes recurring problems in at least one aspect of life. This can be a failure to fulfill responsibilities at home or work, reckless use of the substance such as drunken driving, repeated substance-related arrests, and ongoing substance use despite resulting problems in family relationships. See Table 6.1 for the diagnostic criteria for substance abuse. 

When diagnosing a substance use disorder, it is named in accordance with the substance that is being misused. Patients can be said to have alcohol abuse or dependence, cocaine abuse or dependence, opiate abuse or dependence, and so forth. In severe cases when the patient is misusing several substances, (s)he is diagnosed with polysubstance dependence. The complete list of DSM-IV substance use disorders is shown in Table 6.3. Although the diagnostic criteria for the specific substance use disorders are uniform from substance to substance, certain features of the addiction are specihc to the substance being misused. The typical age of onset, the course of the disorder, and the treatment of the disorder vary by substance. Nevertheless, many features of substance abuse and substance dependence are similar across substances. 

The good news is that treatment can have a profound impact on the clinical course of substance dependence. Most patients who have been treated are eventually able to stop their pattern of compulsive misuse. Some abstain altogether while others are able to manage long periods of sobriety with only brief episodes of substance use. Those who are able to maintain periods of sustained abstinence from substance abuse and dependence also find improvement in job performance and social functioning. Those who do the best had little comorbid psychiatric illness, were able to... 

Additional restrictions on supply are imposed by the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations. Substances that have a potential for abuse are scheduled under three categories. Class A, B and C. 

Children (younger than 12 years ofagej- Clinical experience is limited use is not recommended.Pentazocine tablets are intended for oral use only. Severe, potentially lethal reactions may result from misuse by injection or when combined with other substances. Oral pentazocine tablets contain 0.5 mg naloxone, a narcotic antagonist, to aid in elimination of the abuse potential. 

Many victims of dependence have apparently normal backgrounds. Some simply make the mistake of trying a substance in some social situation which supports the pleasurable affects, and the substance s pharmacology merely takes over, after a variable period of misuse and abuse. Other victims may have personalities which lead them to escape life s normal pressures, therefore their need for mood enhancement or alteration of consciousness can be an additional pressure on the need to continue the substance. This may be particularly true as tolerance develops and dose increase is necessary to attain the initial effect. 

It is clear that legislation alone will not prevent substance abuse. Education is an essential complement and all health care workers should play their r51e in individual or group education. They should also be good role models. Health professionals have easy access to drugs and they must be very careful that they do not fall temptation to the misuse of psychoactive products to alleviate their mood, prevent tiredness, and to combat other stress related symptoms. They should manage their patients along the same lines. 

There are many different kinds of toxicants. Chemicals that are used for industrial and household purposes can be poison when misused or when there is an accident. Agricultural pesticides in the field can also cause poisoning. Chemicals might come in the form of conventional drugs which we use in a legitimate way, or in the form of designer drugs used illicitly for recreational substance abuse. Natural toxins found in the environment, such as mushrooms, plant toxins, snake/insect toxins and marine toxins, can also inadvertently harm a patient. 

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