Addiction

Question 1

What are 2 screening tools used for identifying alcohol dependence, harmful drinking and hazardous drinking? Which is more sensitive to alcohol dependence?

Answer 1

• AUDIT

- CAGE - more sensitive to dependence

Question 2

What is hazardous drinking?

Answer 2

Pattern of alcohol consumption that increases risk of physical, mental and social harm
Applies to anyone drinking over 14 units of alcohol

Question 3

When someone drinks more than what number of units is it consider harmful drinking?

Answer 3

More than 35 units

Question 4

What is the calculation for working out how many units of alcohol in a drink?

Answer 4

Strength (ABV) x volume (ml) ÷ 1000 = units

Question 5

Over what units per day & per week are considered higher risk for both men and women?

Answer 5

Men: over 8 units per day and over 50 units per week
Women: over 6 units per day and over 35 units per week

Question 6

What are 7 different types of cancer that alcohol can cause from most common to least (roughly)?

Answer 6

• Bowel
• breast
• oesophagus
• mouth and upper throat
• larynx
• liver

Question 7

What is the really important question for alcohol screening and its scoring system?

Answer 7

How often have you had 6 or more units if female, or 8 or more units if male, on a single occasion in the last year? 
0 = never
1 = less than monthly 
2 = monthly 
3 = weekly 
4 = daily/almost daily

Question 8

When should AUDIT be completed after asking?

Answer 8

Weekly or daily/almost daily

Question 9

What are the score cutoffs on AUDIT and what is management for those?

Answer 9

Audit 0-7
Score 8-15 brief intervention
Score 16-19 brief intervention
Score 20+ refer specialist

Question 10

What is brief intervention FRAMES?

Answer 10

Feedback - review problems
Responsibility - patient responsible for change
Advice
Menu - provide options for behaviour change
Empathy
Self-efficacy

Question 11

What is motivational interviewing?

Answer 11

Conversation style in which is guiding, listening and encouraging and is all about patients words
Helps support change

Question 12

How many deaths per annum does harmful drinking cause?

Answer 12

2.5 million

Question 13

Which is a bigger problem in terms of prevalence in society - alcohol dependence or harmful drinking?

Answer 13

Harmful drinking is more prevalent (approx 20-30% population)

Question 14

What are some effects of alcohol on brain & nervous system and mental health?

Answer 14

Brain damage
Disrupted sleep
Memory loss
Stroke 
Nerve damage 
Mood disorders

Question 15

What are Korsakoffs and Wernicke’s?

Answer 15

Korsakoffs - chronic memory disorder caused by severe deficiency of thiamine most commonly caused by alcohol misuse
Wernicke’s encephalopathy - degenerative brain disorder caused by lack of thiamine often caused by alcohol misuse

Question 16

What is the mechanism of alcohol withdrawal?

Answer 16

Alcohol inhibits action of excitatory NMDA-glutamate ion channels & potentates actions of inhibitory GABA-A channels so when sudden stop - without alcohol to cause CNS depression you get unopposed unregulated excitation (excess glutamate activity and reduced GABA activity) leads to alcohol withdrawal symptoms
I.e. balance of CNS depression caused by alcohol and responding CNS excitation is then imbalanced when CNS depression is removed

Question 17

If 3 or more of what 6 symptoms are present together or at same time during the previous year, patient has alcohol dependence syndrome. What 6 symptoms?

Answer 17

1. Strong desire or sense of compulsion for it
2. Difficulty in controlling use of substance in terms of onset, termination or level of use
3. Physiological withdrawal state
4. Evidence of tolerance
5. Progressive neglect of other interests
6. Persistence with use despite clear evidence of harmful consequences

Question 18

What are important risk of alcohol withdrawal syndrome and what can this progress to? (Only 5% of cases)

Answer 18

Generalised seizures in first 24hrs

Can progress to Delirium Tremens within 2 days of abstinence

Question 19

List symptoms of delirium tremens?

Answer 19

Insidious onset with night time confusion 
Agitation 
Hypertension
Fever
Visual and auditory hallucinations
Paranoid ideation

Question 20

What is mortality rate of delirium tremens?

Answer 20

2-5%

Question 21

What is management of alcohol withdrawal?

Answer 21

-Benzodiazepines
Long acting agents diazepam/chlordiazepoxide
Titration against withdrawal symptoms and gradually withdrawn
-vitamins supplementation
-thiamine as prophylaxis

Question 22

List some psychosocial interventions for relapse prevention for alcohol dependence?

Answer 22

CBT
Motivational enhancement therapy
12 step facilitation therapy 
Behavioural self control training 
Family/couple therapy

Question 23

What is the mechanism of action of disulfiram, what are symptoms if alcohol is ingested & why might it not be good?

Answer 23

inhibits acetalydehyde dehydrogenase leading to accumulation of acetalydehyde if alcohol is ingested which causes flushed skin, tachycardia, n&v, arrhythmias, hypotension
- not good cos relies on compliance

Question 24

What is the mechanism of action of acamprosate and what are side effects?

Answer 24

Acts centrally on glutamate and GABA systems and reduces cravings
Headache, diarrhoea, nausea

Question 25

What is the mechanism of action of naltrexone and is it first/second line for relapse prevention?

Answer 25

Opioid antagonist and reduces reward from alcohol

First line

Question 26

What is basic treatment for alcohol dependence?

Answer 26

Detox + relapse prevention (psychosocial & drugs)