1. What Is Addiction or Dependence?
A syndrome defined by the presence of 3 or more features as defined in ICD-10 (and DSM-IV) consisting of:
4 psychological features
2 biological features (tolerance & withdrawal)
I.e. It is primarily a psychological state, the treatment of which is primarily psychological
Not just “physical addiction” - a characteristic withdrawal state (which need not be present)
The ICD-10 Criteria for Drug Dependency
Need  3 of 6 criteria in last 12 months:
2 drug related criteria:
Compulsion/cravings to take drug
Difficulties in controlling drug use
2 consequences of use criteria:
Progressive neglect of alternative pleasures/interests due to drug use
Persistent drug use despite harmful consequences
2 physiological criteria:
Characteristic drug withdrawal state
Evidence of tolerance to the drug
Note: No mention of frequency or amount or chronicity of drug use

2. Drugs Licensed for Use in Opiate Addiction Treatment
Substitute opiates:
Methadone oral soln or mixture 1mg/ml (& branded Methadose® 10mg/ml & 20mg/ml for dilution - but not recommended)
NOT injectable methadone, tablets or linctus (2mg/5ml)
Buprenorphine (Subutex/Suboxone or generic) sublingual tabs 0.4, 2, 8 mg (Suboxone also contains naloxone)
NOT Temgesic (0.2 & 0.4 mg tablets or 0.3 mg ampoules) , not the patches, films or depot
NOT codeine, DF118, MST, diamorphine or any other opiate
Detox agents:
Lofexidine (NOT clonidine)
Maintenance of abstinence:
Naltrexone tablets (NOT implant or depot)

3. Prochaska and DiClemente (1983, 1992, 1997)
Long term change
Action
Maintenance
Preparation
As noted with Vietnam vets, psychosocial interventions are INTEGRAL to recovery. Addiction is a social and emotional issue, not (just) a physical one.
Change is scary, drug use is a (dys)functional way of coping with the world (The actual world and the internal world)
Therefore appropriate psychosocial scaffolding is required.
Resolving ambivalence
Fear of change process
‘Denial’
lWhat people will lose
What people will have to deal with after change
Fear of failure
…………..
Equipping people with skills
Drugs have been coping strategy for a long time
life skills, managing money, keeping accomodation, cooking
interpersonal, having relationships not linked to substance use, being able to communicate assertively, trusting people, ‘being’ a person
emotional coping skills – dealing with things they have previously ‘used’ to block out, anger, anxiety, sadness
Addressing underlying trauma
Maintaining these changes
Dealing with knock backs without going back to drugs, dealing with lapses
Building on rebuilding a new life away from drugs – work/education, social network, ‘a life worth living’
Change can be a slow and complex process, people need different things at different times. They need supporting and scaffolding with firm boundaries and encouragement in personal responsibility taking, NOT confrontation.
Contemplation
Lapse
Relapse
Pre-contemplation

4. Four Simple Steps to Recovery: 1. Connect… With people around you
Four Simple Steps to Recovery: 1. Connect… With people around you. Go to meetings (AA, NA, CA, SMART) 2. Be Active…do something, go for a walk, exercise, do anything. 3. Give… Do something for someone else. Volunteer. 4. Keep Learning… Try something new. Become a student of recovery? 5. Take Notice… Be curious. Be present. ‘The Power of Now’ (Ekhart Tolle)