Addiction Flashcards
Class A drugs
Ecstasy, LSD, heroin, cocaine, crack, magic mushrooms
(whether prepared or fresh), methylamphetamine (crystal meth),
other amphetamines if prepared for injection
Class B drugs
Amphetamines, Methylphenidate (Ritalin), Pholcodine.
Class C drugs
Cannabis, tranquilisers, some painkillers, GHB (Gamma-
hydroxybutyrate), ketamine
ICD-10 criteria for alcohol dependence
requires at least 3 out of following list satisfied in last 12 months:
- Intense desire to drink alcohol
- Difficulty in controlling the onset, termination and the level of drinking
- Experiencing withdrawal symptoms if alcohol is not taken
- Use of alcohol to relieve from withdrawal symptoms
- Tolerance as evidenced by the need to escalate dose over time tom achieves same effect
- Salience – neglecting alternate forms of leisure or pleasure in life
- The narrowing personal repertoire of alcohol use.
Criteria for alcohol dependence (Edward and Gross criteria)
- Narrowed repertoire
- Salience of alcohol-seeking behaviour
- Increased tolerance
- Repeated withdrawals
- Drinking to prevent or relieve withdrawals.
- Subjective awareness of compulsion
- Reinstatement after abstinence
What is salience?
refers to the neglect of all leisure and alternate forms of pleasure apart from
alcohol. One’s life revolves around getting alcohol, storing it, saving money to buy it,
making opportunities to drink, etc.
Time course of alcohol withdrawal
- Onset of shakes (4-12 hours)
- Onset of perceptual disturbances (8-12 hours)
- Seizure onset (12-24 hours); peaks at 48 hours
- Delirium onset (72 hours)
Peak of alcohol withdrawal sx
48 hours
When do alcohol withdrawal sx start
Within 12 hours of last sx
Initial sx of alcohol withdrawal sx
Tremor Sweating Insomnia GI distress Anxiety Craving
Risk factors for alcohol withdrawal seizures
Previous seizures
HI
Electrolyte imbalance - low sodium or K+
How many patients with alcohol withdrawal develop DT?
5%
Sx of DT
Disturbed autonomic functions (pulse, temperature and blood pressure changes in either
direction), clouded consciousness with hallucinations (often Lilliputian) and agitation can
occur.
Incidence of seizures in untreated alcohol dependent patients
8%
3% if treated
What causes seizures in alcohol dependent patients
Kindly process; episodic alcohol withdrawal sensitises brain leading to increased likelihood of seizure with each future episode
How many patients with withdrawal seizures develop DTs
30%
Risk factors for DT
Severe dependence
History of DTs
Older patient
Acute physical illness
How many patients with DT will die if untreated
10%
Withdrawal sx of heroin
o Dysphoric mood o Nausea or vomiting o Muscle aches o Lacrimation or rhinorrhea o Pupillary dilation, piloerection (gooseflesh), or sweating o Diarrhea o Yawning o Fever o Insomnia
Time frame of withdrawal sx of heroin
Begin 6-8 hours after last dose
Peaks in 2 days
Reduces in a week
Withdrawal sx of cannabis
Irritability
Insomnia
Anorexia
Nausea
Withdrawal sx of benzos
prominent anxiety and autonomic hyperactivity,
increased tremor, insomnia, nausea or vomiting, transient visual, tactile, or auditory
hallucinations or illusions, psychomotor agitation, in some cases - grand mal seizures.
Kinaesthetic hallucinations are also reported in some individuals. Note that withdrawal
delirium can be fatal.
Management of benzo dependence in non-abusing patients mild dependence
Advisory letters
Shourt courses of relaxation
Management of benzo dependence moderate/severe
Graded discontinuation of prescribed benzos with aim of cessation