Alcohol and other drugs 2
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Unit 618
December 2024
The purpose of this activity is to provide you with an understanding of a harm-minimisation approach to the treatment of people who use alcohol and other drugs.
Harm minimisation has been central to the Australian approach to addressing the range of issues that occur as a result of alcohol, tobacco and other drug use since 1985. The three pillars of harm minimisation are: supply reduction, demand reduction and harm reduction. These pillars are focused on individuals, families and the community as a whole. Supply reduction is focused on policing and customs to decrease availability of drugs and precursors. Demand reduction is focused on prevention and education to stop or delay use as well as treatment to decrease need to use. Harm reduction is focused on reducing the harms of use and includes needle and syringe programs, the national Take Home Naloxone program, safer injecting education, treatment of blood-borne viruses and infections, alcohol and other drug treatments, safe consumption rooms and education about risks of substance use, including alcohol and nicotine. Harm reduction can, at times, be tricky for us as healthcare workers. We can see the harm occurring to our patients and also know that they may not be ready to change their behaviour, as much as we would like this to happen. This approach allows us to assist our patients to decrease harm. It creates a therapeutic alliance and keeps the door open to change and treatment access when the person is ready for it.
Some of these cases require alcohol and other drug specialist support, treatment and advice. As general practitioners, we are important members of the treatment team. We support our patients to ensure access to specialist care and can support ongoing engagement in treatment, prescribing medications once people are stable on their treatment, whether this be for alcohol relapse prevention or methadone or buprenorphine for the management of opioid dependence. Our role in holistic longitudinal care and the strong therapeutic alliance we can create with our patients over time are core to our patients’ success and long-term health outcomes.
At the end of this activity, participants will be able to:
Anna, aged 28 years, is a woman who presents to your general practice with an area of painful spreading erythema in her left cubital fossae. She has depression but no other significant medical history and has no known allergies. Anna has attended the practice intermittently for her escitalopram prescription.
You have been consulting with Mary, age 50 years, for the past few years since she moved into the local area. She sees you regularly for prescriptions and check-ups. She is a non-drinker, and she successfully ceased smoking with your assistance last year. She lives alone and has a busy life with work, friends, bushwalking and volunteering. She has talked in the past about her son Jono, aged 27 years, who lives in another state, and she has told you about her concerns regarding his drinking.
She attends today and asks for your help.
Melissa, a patient aged 40 years who has been attending your practice for two years, comes to see you for advice regarding palpitations and anxiety.
Denise, a woman aged 35 years, presents to your general practice with a history of chronic back pain. She works full time as a legal clerk; lives with her partner, Sam, and two teenage children; and describes herself as the ‘family taxi’, driving her kids to various extracurricular events throughout the week and on weekends.
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Each unit of check comprises approximately five clinical cases, and the choice of cases will cover the broad spectrum of the unit’s topic. Each unit will be led by a GP with an interest and capability in the topic, and they will scope the five different cases for that unit in collaboration with the check team.