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Drug misuse
About this booklet
This is a quick reference guide that summarises the recommendations NICE has made to the NHS
in `Drug misuse: psychosocial interventions' (NICE clinical guideline 51) and `Drug misuse: opioid
detoxification' (NICE clinical guideline 52).
Who should read this booklet?
This quick reference guide is for healthcare professionals and other staff who care for people
who misuse drugs. It contains what you need to know to put the guidelines' recommendations
into practice.…read more

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Drug misuse Contents
Key priorities for implementation 4
Organising and developing care for people who
misuse drugs 7
Supporting families and carers 7
Identification and assessment 8
Brief interventions and self-help 9
Formal psychosocial interventions 10
Opioid detoxification 12
Settings of care 16
Implementation 18
Further information 18
Person-centred care
Treatment and care should take into account service users' individual needs and preferences. Good
communication is essential, supported by evidence-based information, to allow service users to reach
informed decisions about their care.…read more

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Drug misuse Key priorities for implementation
Key priorities for implementation: psychosocial
Brief interventions
Opportunistic brief interventions focused on motivation should be offered to people in limited
contact with drug services (for example, those attending a needle and syringe exchange or
primary care settings) if concerns about drug misuse are identified by the service user or staff
member.…read more

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Drug misuse Key priorities for implementation
Contingency management to improve physical healthcare
For people at risk of physical health problems (including transmittable diseases) resulting from
their drug misuse, material incentives (for example, shopping vouchers of up to £10 in value)
should be considered to encourage harm reduction. Incentives should be offered on a one-off
basis or over a limited duration, contingent on concordance with or completion of each
intervention, in particular for:
­ hepatitis B/C and HIV testing
­ hepatitis B immunisation
­ tuberculosis testing.…read more

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Drug misuse Key priorities for implementation
The choice of medication for detoxification
Methadone or buprenorphine should be offered as the first-line treatment in opioid detoxification.
When deciding between these medications, healthcare professionals should take into account:
­ whether the service user is receiving maintenance treatment with methadone or buprenorphine;
if so, opioid detoxification should normally be started with the same medication
­ the preference of the service user.…read more

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Organising and developing care
Drug misuse Supporting families and carers
Organising and developing care for people who
misuse drugs
At initial contact and at formal reviews, explain options for abstinence-oriented, maintenance-
oriented and harm-reduction interventions.
Discuss with people who misuse drugs whether to involve families and carers in their assessment and
treatment plans. Respect the service user's right to confidentiality.
Ensure that there are clear and agreed plans to facilitate effective transfer of people who misuse
drugs between services, to reduce loss of contact.…read more

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Drug misuse Identification and assessment
Identification and assessment
Asking questions about drug misuse
In mental health and criminal justice settings (in which drug misuse is known to be prevalent),
routinely ask service users about recent legal and illicit drug use, including type, method of
administration, quantity and frequency.…read more

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Drug misuse Brief interventions and self-help
Brief interventions and self-help
At routine contacts and opportunistically (for example, at needle and syringe exchanges), provide
information and advice to all people who misuse drugs about reducing exposure to blood-borne
­ Give advice on reducing sexual and injection risk behaviours.
­ Consider offering testing for blood-borne viruses.
Do not routinely provide group-based psychoeducational interventions that give information about
reducing exposure to blood-borne viruses and/or about reducing sexual and injection risk behaviours.…read more

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Drug misuse Formal psychosocial interventions
Formal psychosocial interventions
Contingency management
Drug services should introduce contingency management programmes ­ as part of the phased
implementation programme led by the NTA ­ to reduce illicit drug use and/or promote:
engagement with services for people receiving methadone maintenance treatment
abstinence and/or engagement with services for people who primarily misuse stimulants.…read more


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