Presentations
- Substance use, gaming and gambling in:
- older people
- prison and post-release populations
- younger people
Conditions
- Older people:
- behavioural addictions
- harmful substance use
- substance use disorders
- Younger people:
- behavioural addictions / gaming gambling
- harmful substance use
- substance use disorders
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Substance use in prison and post-release populations
- Substance use in younger or older people with cognitive impairment or reduced capacity
Conditions
- Cognitive impairment from:
- alcohol-related brain injury (ARBI)
- fetal alcohol spectrum disorder (FASD)
- other brain injuries
- Conduct disorder, and other related disorders of young people
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Epidemiology
- Higher prevalence of substance use, gaming and gambling in Māori and Aboriginal and Torres Strait Islander communities
Pathophysiology
- Underlying principles of brain development
- Understanding of different effects of substance use in older people, younger people, and different vulnerabilities
- Understanding of gender and sexual health development during the adolescent period, and the impact this could have in the development of substance use disorders and addictive behaviours, such as the increase of vaping among teenagers
Adults
- Alcohol Smoking and Substance Involvement Screening Test (ASSIST)
- Alcohol Use Disorders Identification Test (AUDIT)
- Frontal Assessment Battery (FAB)
- Montreal Cognitive Assessment (MoCA)
Younger people
- Alcohol Smoking and Substance Involvement Screening Test – youth (ASSIST-Y)
- Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT)
- Home, Education / Employment, Eating, Activities, Drugs, Sexuality, Suicide / Depression, and Safety (HEEADSS) framework
- Adopting a systems-based approach involving families and/or carers where relevant
- Advise regarding evidence-based management options, considering patient wishes, underlying diagnoses, and associated risks
- Coordinate a multidisciplinary and sometimes multi-agency response
- Developing a therapeutic partnership with the patient while upholding patient autonomy
- Different contributing factors behind substance use, gaming, and gambling in older people, such as the role of loss and bereavement
- Importance of working with youth-focused treatment services as primary providers
- Need to take a psychiatric and psychosocial history, including developmental, when relevant
- Normal patterns and variations in patterns of development and experimental substance use, gaming, and gambling in younger people
- Patterns of substance use, gambling, and gaming, and associated risks and harms
- Paucity of evidence to support mandated treatment for younger people in difficulty
- The ethical, legal, and practical issues with mandated / compulsory treatment for adults with questionable capacity, such as legal measures where capacity is diminished and other options have been exhausted
- The patients’ readiness for change in the development of action / management plans
- The role of developmental factors and social environment behind younger people’s substance use, gaming, and gambling
- The role of specialist addiction services working with prison and post-release populations
- The role of specialist addiction services working with youth-focused services
