The following information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006, 2007).
ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.

If you are a professional in need of help for yourself or for others, Triage Healthcare Ltd will deal with your request with sensitivity whilst formulating a care plan taking into account your special circumstances. All our telephone advisors are professionally qualified addictions counsellors, who are bound by strict rules of confidentiality and ethics. We can arrange immediate access to advice from a consultant addiction psychiatrist at your request.

Guidelines for the best practice treatment of SUBSTANCE MISUSE

• Basic Principles
  • Use, problem use and dependency
  • Prevalence of substance misuse
  • The approach with the client/patient
  • A needs-led approach which integrates psychosocial and pharmacotherapeutic interventions
• Identification of Substance Misuse
• Brief Interventions
  • What are brief interventions?
  • How do i deliver a 'Brief Intervention'?
  • What are brief interventions?
• Referral to Specialist Services
  • Referral to Specialist Services
  • Brief Interventions
• Initial Appraisal
  • Several decisions
  • Direct the immediate action plan
  • National drug treatment monitoring system reporting
  • Deliver harm-minimisation advice
  • Motivation through assessment
• Basic counselling interventions
• Principles of joint working in shared care
• Pharmacological approaches - basic principles
• The medical management of intoxication
  • General principles
  • Alcohol intoxication
  • Opiate intoxication
  • Sedative-hypnotic intoxication
  • Intoxication with solvents
  • Stimulant intoxication
  • Intoxication with other substances
  • The medical management of intoxication
• The management of withdrawal syndromes
  • General principles
  • Basic principles
  • The five key themes of successful progression to abstinence
  • Detoxification from alcohol
  • Detoxification from opiates
  • Detoxification from sedative-hypnotics
  • Detoxification from stimulant drugs
  • Detoxification from nicotine
• Community prescribing for opiate dependency
  • Community prescribing for opiate dependency
  • Induction onto methadone
  • On-going stabilisation with methadone
  • Slow methadone reduction regimes
  • Prescribing methadone
  • Other drugs for opiate substitution therapy
• Medication to prevent relapse
  • Naltrexone
  • Acamprosate
  • Disulfiram (antabuse)
• Prescribing sedative-hypnotics
• Viral hepatitis and HIV
  • HIV
  • Viral hepatitis
  • Hepatitis A (HAV)
  • Hepatitis B (HBV)
  • Hepatitis C (HCV)
  • Hepatitis D (HDV)
  • Hepatitis E
  • Hepatitis G
• The management of 'dual diagnosis' 1
• The management of 'dual diagnosis' 2
  • The management of 'dual diagnosis' 2
  • Treatment principles
• In-patient detoxification methods
• Full needs assessment
• Risk assessment
• Care-planning & care-coordination
  • Care-planning & care-coordination
  • Care-planning
  • Care-coordination
• Social interventions
• Psychosocial interventions
  • Common tasks for psychosocial interventions
  • Specific intervention
  • Disease model approaches (traditional, minnesota model, 12-step-oriented)
  • Setting: residential and community psychosocial services
  • Therapists and counsellors
  • Conclusion
• Alternative therapies
  • Shiatsu
  • Homeopathy
  • Traditional chinese medicine (TCM)
  • Acupuncture
  • Conclusion
• Specialist pharmacological & biochemical interventions
  • Dispensing services
  • The opiate addiction test
  • Tolerance testing
  • Tolerance testing: specialist community services - Day 1, Day 2
  • Tolerance testing: specialist community services - Day 3, Day 7/14
  • Specialist in-patient detoxification
  • Specialist opiate detoxification techniques
  • Specialist community prescribing interventions - Prescribing injectable formulations
  • Specialist community prescribing interventions - Prescribing stimulants
  • Biochemical techniques for monitoring of substance misuse - Testing technology
  • Biochemical techniques for monitoring of substance misuse - Body matrix
  • Biochemical techniques for monitoring of substance misuse - Urine testing
  • Biochemical techniques for monitoring of substance misuse - Breath testing: alcohol detection
  • Biochemical techniques for monitoring of substance misuse - Saliva testing
  • Biochemical techniques for monitoring of substance misuse - Plasma tests
  • Biochemical techniques for monitoring of substance misuse - Hair testing
  • Biochemical techniques for monitoring of substance misuse - Testing protocols
• Pregnancy
  • Pregnancy
  • Objectives of care
  • Effects of drugs on the foetus
  • Methods used to detect substances in the neonate
  • Substance specific management during pregnancy
  • Management of labour
  • Treatment options for drug-exposed neonates
  • Breast-feeding
  • HIV and viral hepatitis in pregnancy
• Polydrug misuse
  • Polydrug misuse
  • Polydrug misuse: stabilisation phase
  • Polydrug misuse: detoxification phase
• Chaotic behaviour & poor concordance
  • Chaotic behaviour & poor concordance
  • Services which attract clients into treatment
  • Full engagement and retention in treatment
  • Delivering effective treatments - the one-stop shop
  • When to discharge poorly concordant clients from treatment
• The management of stimulant, solvent and steroid misuse
• References