Addiction: understand the condition and care
Addiction is a treatable illness which affects individuals’ health, their relationships and their way of living. The degree of harm caused by substance use disorders varies.
Look at control, harm and daily life
Substance use disorders are often characterised by: difficulty in controlling the amount used; a persistent desire to continue using substances even though they have been causing harm. Assessing the pattern of use as opposed to one single event is required. In addition to physical health issues and the social circumstance of the person, assessing mental health issues and how they may be contributing to this problem is important. Do not reduce the complexity of a problem such as a drug disorder into a question of someone having ‘will power’.
The effect on daily life is part of the assessment, not an optional extra. Substance use may affect sleep, work, relationships, physical health or safety in different combinations. A respectful account describes those effects and the person's own priorities. It avoids assuming that a diagnosis explains everything about their circumstances or that difficulties reflect a lack of character.
Related terms have different meanings
Tolerance means needing more of a substance to produce the same effect. Adaptation occurs in physical dependence. When a person reduces their intake or stops altogether, withdrawal may occur. Dependence can develop in response to prescribed medicines, and it is different from addiction.
Tolerance and physical dependence describe adaptations to a substance. They can occur with some prescribed medicines and do not, by themselves, establish addiction. The wider pattern of control, use despite harm and impact on life needs consideration. Withdrawal risk is another question, which is why a general guide cannot decide whether it is safe for someone to stop a substance suddenly.
Care starts with the person's circumstances
The assessment process can include consideration of all aspects of an individual’s life including employment, housing, family/relationship issues and health needs. Once an assessment has occurred, a treatment plan that takes account of each individual’s specific needs will be developed.
A care plan may need to address several problems together. Physical illness, mental health, housing, family circumstances and access to care can affect what support is practical. The person's goals are important when planning next steps. In a teaching case, distinguish an immediate safety concern from a longer-term support need rather than expecting one intervention to resolve every difficulty.
Support can take several forms
Treatment options may include various forms of psychotherapy, medication if indicated and recovery support. Practical assistance and ongoing review may also be beneficial. Differentiate support during withdrawal from longer-term needs related to health, daily functioning and preventing a return to harmful use. Each individual may require a different combination of care.
Recovery can involve ongoing support and changes to a treatment plan over time. A return to substance use is a reason to reassess needs and care, rather than proof that help is pointless. Behavioural treatments, medicines where appropriate and recovery support serve different roles. The useful question is how the plan fits the person and what needs reviewing.
Check your understanding
A short quiz, with an explanation after each answer.
What does tolerance mean?
Practise identifying separate symptoms, risks and support needs for a person in a case note summary. Identify the person's goals and barriers to receiving treatment.