UCC Library and UCC researchers have made this item openly available. Please let us know how this has helped you. Thanks! Title Substance misuse in young people in Ireland - a focus on benzodiazepines Author(s) Murphy, Kevin D. Publication date 2014 Original citation Murphy, K. 2014. Substance misuse in young people in Ireland - a focus on benzodiazepines. PhD Thesis, University College Cork. Type of publication Doctoral thesis Rights © 2014, Kevin Murphy. http://creativecommons.org/licenses/by-nc-nd/3.0/ Embargo information No embargo required Item downloaded http://hdl.handle.net/10468/1903 from Downloaded on 2021-10-07T14:54:39Z Substance Misuse in Young People in Ireland - A Focus on Benzodiazepines Kevin Murphy BPharm (Hons) MPSI A thesis submitted to the National University of Ireland, Cork for the degree of Doctor of Philosophy in the School of Pharmacy June 2014 Head of School Prof. Stephen Byrne Supervisors Prof. Stephen Byrne Dr. Laura Sahm Dr. Suzanne McCarthy Overview of Contents Declaration ...................................................................................................... ii Table of Contents ........................................................................................... iii Table of Figures ........................................................................................... viii Table of Tables .............................................................................................. ix Table of Equations .......................................................................................... x Table of Abbreviations ................................................................................... xi Publications.................................................................................................... xi Thesis Abstract ............................................................................................ xvi Acknowledgements ...................................................................................... xxi Chapter 1 - Thesis Introduction ....................................................................... 1 Chapter 2 - Substance use in young persons in Ireland, a systematic review30 Chapter 3 - Benzodiazepine prescribing guideline adherence and misuse potential in Irish minors ................................................................................. 68 Chapter 4 - Use of addiction treatment services by Irish youth: does place of residence matter? ........................................................................................ 94 Chapter 5 - Benzodiazepine use amongst young attendees of an Irish substance treatment centre ........................................................................ 108 Chapter 6 - “You Don’t Feel” – The Experience Of Youth Benzodiazepine Misuse ........................................................................................................ 125 Chapter 7 -“They’re too good” - Health-care worker views on youth benzodiazepine misuse ............................................................................. 169 Chapter 8 - Thesis Discussion ................................................................... 204 Chapter 9 - References .............................................................................. 218 Appendices ................................................................................................ 242 i Declaration I declare that this thesis has not been previously submitted for a degree at this, or any other university. It is entirely my own work, apart from due acknowledgement. The library may lend or copy this thesis upon request. Signed:____________________________ Date:_______________ ii Table of Contents Table of Contents ........................................................................................... iii Table of Figures ............................................................................................. vi Table of Tables ............................................................................................. vii Table of Equations ....................................................................................... viii Table of Abbreviations ................................................................................... ix Publications.................................................................................................... xi Thesis Abstract ............................................................................................ xvi Introduction ............................................................................................... xvi Methods .................................................................................................... xvi Results . ................................................................................................... xviii Conclusion ................................................................................................. xx Acknowledgements ...................................................................................... xxi 1. Thesis Introduction ................................................................................ 1 1.1 Drugs Policy in Ireland .................................................................... 2 1.2 Defining addiction and dependence ............................................... 7 1.3 Diagnosing dependence ................................................................. 9 1.4 Psychological dependence ........................................................... 13 1.5 Physiology of psychological dependence ..................................... 16 1.6 Physical dependence ................................................................... 20 1.7 Mechanisms of action of misused substances .............................. 23 1.8 Summary ...................................................................................... 29 2. Substance use in young persons in Ireland, a systematic review ....... 30 2.1 Introduction ................................................................................... 31 2.2 Methods ........................................................................................ 34 2.3 Results.......................................................................................... 39 iii 2.4 Discussion .................................................................................... 60 3. Benzodiazepine prescribing guideline adherence and misuse potential in Irish minors ................................................................................................ 68 3.1 Introduction ................................................................................... 69 3.2 Methods ........................................................................................ 71 3.3 Results.......................................................................................... 77 3.4 Discussion .................................................................................... 87 4. Use of addiction treatment services by Irish youth: does place of residence matter? ......................................................................................... 94 4.1 Introduction ................................................................................... 95 4.2 Methods ........................................................................................ 98 4.3 Results........................................................................................ 101 4.4 Discussion .................................................................................. 105 5. Benzodiazepine use amongst young attendees of an Irish substance treatment centre .......................................................................................... 108 5.1 Introduction ................................................................................. 109 5.2 Methods ...................................................................................... 112 5.3 Results........................................................................................ 113 5.4 Discussion .................................................................................. 120 6. “You Don’t Feel” – The Experience Of Youth Benzodiazepine Misuse125 6.1 Introduction ................................................................................. 126 6.2 Method ....................................................................................... 128 6.3 Results........................................................................................ 133 6.4 Discussion .................................................................................. 159 7. “They’re too good” - Health-care worker views on youth benzodiazepine misuse .............................................................................. 169 7.1 Introduction ................................................................................. 170 7.2 Method ....................................................................................... 171 iv 7.3 Results........................................................................................ 175 7.4 Discussion .................................................................................. 194 8. Thesis Discussion ............................................................................. 204 8.1 Discussion .................................................................................. 205 8.2 Limitations .................................................................................. 215 8.3 Future