1. Substance Misuse Dr. Graham Roberts

2. Content  Benzodiazepine management  Alcohol screening and brief intervention.  Substance misuse update.  Benzodiazepine management  Alcohol screening and brief intervention.  Substance misuse update.

3. Benzodiazepine Management  BNF section 4.1.2 Anxiolytics Benzodiazepine anxiolytics can be effective in alleviating anxiety states. Although these drugs are sometimes prescribed for stress- related symptoms, unhappiness, or minor physical disease, their use in such conditions is inappropriate. Benzodiazepine anxiolytics should not be used as sole treatment for chronic anxiety, and they are not appropriate for treating depression or chronic psychosis. In bereavement, psychological adjustment may be inhibited by benzodiazepines. Anxiolytic benzodiazepine treatment should be limited to the lowest possible dose for the shortest possible time. Dependence is particularly likely in patients with a history of alcohol or drug abuse and in patients with marked personality disorders.  BNF section 4.1.2 Anxiolytics Benzodiazepine anxiolytics can be effective in alleviating anxiety states. Although these drugs are sometimes prescribed for stress- related symptoms, unhappiness, or minor physical disease, their use in such conditions is inappropriate. Benzodiazepine anxiolytics should not be used as sole treatment for chronic anxiety, and they are not appropriate for treating depression or chronic psychosis. In bereavement, psychological adjustment may be inhibited by benzodiazepines. Anxiolytic benzodiazepine treatment should be limited to the lowest possible dose for the shortest possible time. Dependence is particularly likely in patients with a history of alcohol or drug abuse and in patients with marked personality disorders.

4. Benzodiazepine Management  Good drugs at what they are prescribed for but not always prescribed correctly.  Potential for addiction and abuse.  Street value.  Interactions and risk of OD.  Good drugs at what they are prescribed for but not always prescribed correctly.  Potential for addiction and abuse.  Street value.  Interactions and risk of OD.

5. Benzodiazepine Management  Management of street dependency:  Stable on other drugs, no alcohol.  Proven dependency.  Titration and agreed reduction  Long-term prescribed use.  Cognitive impairment Vs Long term control.  How to reduce different Benzos/ Z drugs.  Management of street dependency:  Stable on other drugs, no alcohol.  Proven dependency.  Titration and agreed reduction  Long-term prescribed use.  Cognitive impairment Vs Long term control.  How to reduce different Benzos/ Z drugs.

6. Benzo conversion.  Drug Dose equivilent to 5mg Diazepam:  Chlordiazepoxide 15 mg  Loprazolam 500 micrograms  Lorazepam 500 micrograms  Nitrazepam 5 mg  Oxazepam 15 mg  Temazepam 10 mg  Zaleplon 10 mg  Zopiclone 7.5 mg  Zolpidem 10 mg  Drug Dose equivilent to 5mg Diazepam:  Chlordiazepoxide 15 mg  Loprazolam 500 micrograms  Lorazepam 500 micrograms  Nitrazepam 5 mg  Oxazepam 15 mg  Temazepam 10 mg  Zaleplon 10 mg  Zopiclone 7.5 mg  Zolpidem 10 mg

7. Benzodiazepine Management.  Rate of Reduction :  Approx 2mg per 2-4 weeks.  Regular review.  Establish Treatment Goals.  Rate of Reduction :  Approx 2mg per 2-4 weeks.  Regular review.  Establish Treatment Goals.