DRP: Drug Related Problems – Mental Health Matters

Introduction

Drug addiction recovery groups are voluntary associations of people who share a common desire to overcome their drug addiction.

Outline

Different groups use different methods, ranging from completely secular to explicitly spiritual. Some programmes may advocate a reduction in the use of drugs rather than outright abstention. One survey of members who found active involvement in any addiction recovery group correlates with higher chances of maintaining sobriety. Although there is not a difference in whether group or individual therapy is better for the patient, studies show that any therapy increases positive outcomes for patients with substance use disorder. The survey found group participation increased when the individual members’ beliefs matched those of their primary support group (many addicts are members of multiple addiction recovery groups). Analysis of the survey results found a significant positive correlation between the religiosity of members and their participation in twelve-step programs (these programs describe themselves as spiritual rather than religious) and to a lesser level in non-religious SMART Recovery groups, the correlation factor being three times smaller for SMART Recovery than for the twelve-step addiction recovery groups. Religiosity was inversely related to participation in Secular Organisations for Sobriety.

A survey of a cross-sectional sample of clinicians working in outpatient facilities (selected from the SAMHSA On-line Treatment Facility Locator) found that clinicians only referring clients to twelve-step groups were more likely than those referring their clients to twelve-step groups and “twelve-step alternatives” to believe less strongly in the effectiveness of Cognitive Behavioural and psychodynamic-oriented therapy, and were likely to be unfamiliar with twelve-step alternatives. A logistic regression of clinician’s knowledge and awareness of Cognitive Behavioural Therapy effectiveness and preference for the twelve-step model was correlated with referring exclusively to twelve-step groups.

Twelve-Step Recovery Groups

Twelve-step programs are mutual aid organizations for the purpose of recovery from substance addictions, behavioural addictions and compulsions. Developed in the 1930s by alcoholics, the first twelve-step programme, Alcoholics Anonymous (AA), aided its membership to overcome alcoholism. Since that time, dozens of other organisations have been derived from AA’s approach to address problems as varied as drug addiction, compulsive gambling, sex and overeating. All twelve-step programmes utilise a version of AA’s suggested twelve steps first published in the 1939 book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.

As summarised by the American Psychological Association (APA), the process involves the following:

Admitting that one cannot control one’s alcoholism, addiction, or compulsion;
Coming to believe in a Higher Power that can give strength;
Examining past errors with the help of a sponsor (experienced member);
Making amends for these errors;
Learning to live a new life with a new code of behaviour; and
Helping others who suffer from the same alcoholism, addictions, or compulsions.

Participants attend meetings and are able to make new connections with other members who are striving towards a similar goal. If a person is unable to attend a meeting face-to-face, many of the groups have meetings by phone or online as another option. Each group has its own textbook, workbooks or both, which provide information about their program of recovery and suggestions on how to “work the steps”. Often, free literature is available for anyone who asks for it at a meeting. This provides potential new members or family members with relevant information about both the addiction and that specific groups’ version of the twelve-step process of recovery. New members are invited to work with another member who has already been through the twelve-steps at least once. That person serves as a guide to the new member, answers questions and provides feedback as the new member goes through the steps. These groups are spiritually based and encourage a belief in a power greater than the members. Most do not have one specific conception of what that means and allow the member to decide what spirituality means to them as it applies to their recovery. The groups emphasize living on a spiritual yet not necessarily religious basis. Groups typically advocate for complete abstinence, usually from all drugs including alcohol. This is because of the perceived potential for cross-addiction, the idea that there is a tendency to trade one addiction for another. Despite the idea of cross-addiction being accepted as real in many addiction recovery groups, there is said to be little empirical evidence to support it and recent research suggests that the opposite is more likely to be true.

The following is a list of twelve-step drug addiction recovery groups. Twelve-step programmes for problems other than drug addiction also exist.

Alcoholics Anonymous (AA) – This group gave birth to the twelve-step programme of recovery. Meetings are focused on alcoholism only and advocate complete abstinence. Meetings are held all over the world.
Cocaine Anonymous (CA) – This group is focused on cessation of cocaine and all other mind-altering substances. The programme advocates complete abstinence from all mind-altering substances in order to recover from the disease of addiction. Meetings are held all over the world.
Celebrate Recovery (CR) – Celebrate recovery is a recovery programme for any life problem, including addiction to alcohol and other drugs. In contrast to most 12-step programmes, the group recognises Jesus Christ as their higher power. Their groups are located in the United States.
Crystal Meth Anonymous (CMA) – This group focuses on abstinence from crystal meth although it does recognise the potential for cross-addiction, the tendency for an addict to substitute one addiction for another. Meetings are currently available in eight countries.
Heroin Anonymous (HA) – This group is focused on abstinence from heroin along with all other drugs including alcohol. Meetings are held in England and the United States.
Marijuana Anonymous (MA) – This group focuses of recovery from marijuana addiction. Groups meet in eleven countries.
Nicotine Anonymous (NicA) – This group is for those desiring to stop the use of nicotine in all forms. Groups are available in many countries.
Narcotics Anonymous (NA) – This group has meetings in 139 countries and focuses on recovery from the use of all drugs and alcohol. The group makes no distinction between any mood or mind-altering substance and encourages members to look for similarities the common problem they all share, rather than focusing on the differences.
Pagans in Recovery (PIR) – Pagans in recovery have adapted the twelve-step programme of recovery into language that is not overtly Christian as it was originally written so that those with other belief systems can more comfortably work the programme. They have their own literature but do not currently have an official site for meeting availability.
Pills Anonymous (PA) – This group is focused on addiction to pills and all other mind-altering substances. Groups are available in seven countries.

Non-Twelve-Step Recovery Groups

These groups do not follow the twelve-step recovery method, although their members may also attend twelve-step meetings. It is common for individuals to try many different meetings and groups while in recovery. What works for one may not work for another, so trying different types of meetings can be helpful to someone seeking recovery from drugs and alcohol.

The Washingtonians – A defunct 19th Century mutual aid society founded by alcoholics with a desire to maintain sobriety
Association of Recovering Motorcyclists (ARM) – This association of recovering motorcyclists is a brotherhood of men recovering from alcohol and/or drug addiction. They support one another in remaining abstinent from drugs and alcohol while continuing to ride motorcycles together regularly.
Recovering Women Riders (RWR) – Recovering women riders is a sisterhood of recovering women motorcyclists. Affiliated with the association of recovering motorcyclists, they also seek to support one another in remaining abstinent from drugs and alcohol while continuing to enjoy the lifestyle of riding bikes together.
LifeRing Secular Recovery (LSR)
Moderation Management (MM)
Rational Recovery (largely defunct)
Recovery Dharma (RD)
Refuge Recovery (RR)
Secular Organizations for Sobriety (SOS)
SMART Recovery
Women for Sobriety (WFS)

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Drug_addiction_recovery_groups >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

Introduction

Drug therapy problems (DTPs) (or drug related problems, DRPs) represent the categorisation and definition of clinical problems related to the use of medications or “drugs” in the field of pharmaceutical care. In the course of clinical practice, DTPs are often identified, prevented, and/or resolved by pharmacists in the course of medication therapy management, as experts on the safety and efficacy of medications, but other healthcare professionals may also manage DTPs.

A drug-therapy (related) problem can be defined as an event or circumstance involving drug treatment (pharmacotherapy) that interferes with the optimal provision of medical care. In 1990, Strand and colleagues (based on previous work of Mikeal et al. (1975) and Brodie et al. (1980)) classified the DTPs into eight different categories. According to these categories, pharmacists generated a list of the DTPs for each patient. As a result, pharmacists had a cleaner picture of the patient’s drug therapy and medical conditions. A second publication of Cipolle et al. (1998; 2004; 2012) changed the eight categories into seven, grouped in four Pharmacotherapy needs: indication, effectiveness, safety and adherence.

Examples

Patients who have chronic pain that are prescribed opioid painkillers (such as morphine) may build up a tolerance to the effect of the painkillers, requiring higher doses to achieve the same pain reducing effect. This risky practice of dose escalation can lead to drug overdoses.
Some drugs reduce the body’s absorption of essential nutrients from food, which could lead to nutritional deficiencies.

The Original Eight Problems

According to page 73 in Introduction to Health Care Delivery: A Primer for Pharmacists, drug therapy problems (DTP) originated from Strand et al. (1990) who defined eight problems that could result in poorer health outcomes in an attempt to categorise DTP. Helper and Strand later in 1990 stated the mission statement or raison d’être of pharmacists should be to correct these drug therapy problems.

The original eight problems have now been condensed into seven categories of problems. As given by Shargel, they are:

Unnecessary drug therapy: This could occur when the patient has been placed on too many medications for their condition and the drug is simply not needed.
Wrong drug: This could occur when a patient is given medication that does not treat the patient’s condition, e.g. heart medication to treat an infection.
Dose too low: This could occur when a patient is given medication that is not strong enough to get beneficial or therapeutic effects.
Dose too high: This could occur when a patient is given medication that is too strong and is causing detrimental effects or is simply not necessary.
Adverse drug reaction: This could occur when a patient has an allergic response to a medication.
Inappropriate adherence: This could occur when a patient chooses not to or forgets to take a medication.
Needs additional drug therapy: This could occur when a patient needs more medication to treat their condition.

Further Breakdown of Categories

DRPs can be broken down further into the following categories (or four pharmacotherapy needs):

Indication

Requires Additional Drug Therapy:
- Untreated condition.
- Preventative / prophylactic.
- Synergistic / potentiating.
Unnecessary Drug Therapy:
- No medical indication.
- Duplicate therapy.
- Non-drug therapy indicated.
- Treating avoidable ADR.

Effectiveness

Requires Different Drug Product

More effective drug available:
- Condition refractory to drug.
- Dosage form inappropriate.
- Not effective for condition.
Dosage Too Low:
- Wrong dose.
- Frequency inappropriate.
- Duration inappropriate.
- Drug interaction.

Safety

Adverse Drug Reaction

Undesirable effect:
- Unsafe drug for patient.
- Dose changed too quickly.
- Allergic reaction.
- Contraindications present.
Dosage Too High:
- Wrong dose.
- Frequency inappropriate.
- Incorrect administration.
- Drug interaction.

Adherence

Non-adherence:
- Directions not understood.
- Patient prefers not to take.
- Patient forgets to take.
- Drug product too expensive.
- Cannot swallow/administer.
- Drug product not available.

Reference

Brodie, D.C., Parish, P.A. & Poston, J.W. (1980) Societal Needs for Drugs and Drug-Related Services. American Journal of Pharmaceutical Education. 44(3): pp.276-278.

Cipolle, R.J, Strand, L.M. & Morley, P.C. (1998) Pharmaceutical Care Practice. Illustrated Edition. New York: McGraw Hill.

Cipolle, R.J., Strand, L.M. & Morley, P.C. (2012) Pharmaceutical Care Practice: The Patient-Centred Approach to Medication Management Services. Third Edition. New York: McGraw Hill.

Cipolle, R.J., Strand, L.M. & Morley, P.C. (2004) Pharmaceutical Care Practice: The Patient-Centred Approach to Medication Management Services. Second Edition. New York: McGraw Hill.

Mikeal, R.L., Brown, T.R., Lazarus, H.L. & Vinson, M.C. (1975) Quality of Pharmaceutical Care in Hospitals. American Journal of Hospital Pharmacy. 32(6), pp.567-574.

Strand, L.M., Morley, P.C., Cipolle, R.J., Ramsey, R. & Lamsam, G.D. (1990) Drug-Related Problems: Their Structure and Function. DICP. 24(11), pp.1093-1097. doi:10.1177/106002809002401114.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Drug_therapy_problems >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.