31st January 2024

Substance Misuse

NICE guidance defines substance misuse as frequent and excessive consumption of psychoactive substances, as well as intoxication by and dependence on these substances (NICE, 2022), which can result in psychosocial and physical health complications. Substance misuse patterns vary across the UK; cannabis, cocaine, and ecstasy are currently the most misused substances; however, opioids present the most harmful health profile. The UK also has higher rates of heroin misuse compared to other Western countries, as well as higher rates of overdose-related death.

Alongside alcohol use, substance misuse is also more prevalent in lower socioeconomic areas and associated with worse physical health outcomes, e.g., blood-borne infections secondary to injecting heroin. Therefore, it is important that any intervention and management plans focus on improving quality of life, supporting recovery, reducing risk and preventing premature death. Groups that may require more comprehensive assessment include prison occupants and the homeless, particularly when considering issues such as injecting practice, as these groups are more vulnerable to complications that can arise, e.g., infection risks from sharing needles. NICE have identified several quality statements in relation to substance misuse and dependence, which are designed to improve the safety and care of those affected. These statements include:

Source: Adapted from Drug use disorders in adults [Internet]. NICE. 2012 [cited 2022Dec3]. Available from: https://www.nice.org.uk/Guidance/QS23

Risk assessment is a key part of substance misuse management. This should include:

1. Consideration of overdose risk.
2. Assessing for polydrug use and coinciding alcohol misuse.
3. Screening for common coexisting mental health conditions.
4. Assessing for unsafe injecting practices.
5. Considering safeguarding issues, e.g., any dependents.

Treatment for drug misuse should take a holistic approach and always include a psychosocial component. Some current evidence-based interventions include contingency management (CM) and behavioural couples therapy (BCT).

References

• Clinical Guidelines on Drug Misuse and Dependence Update 2017 Independent Expert Working Group. Drug misuse and dependence: UK guidelines on clinical management. UK: Department of Health; 2017.
• Drug use disorders in adults [Internet]. NICE. 2012 [cited 2022Dec3]. Available from: https://www.nice.org.uk/Guidance/QS23