Addiction Flashcards
what is the moral model of addiction?
addicts take drugs for themselves with no consideration for others or their actions
ICD-10 classification of dependence
strong desire to take substance difficulties in controlling substance abuse physiological withdrawal state tolerance neglecting alternative pleasures persistence despite evidence of harm
name a drug that may cause physical dependence but not psychological
opiates
name a drug that causes psychological dependence but not physical
cannabis
types of addiction?
Drug use
Pathological - gaming, gambling, eating, extreme sports, social media
describe the physical components of the mesolimbic pathway
ventral tegmental area connection to nucleus accumbens to ventral striatum
connections to prefrontal cortex, amygdala, hippocampus
describe the mechanism of action of addiction on the mesolimbic pathway
modulation of dopaminergic activity leading to raising of dopamine levels
leads to sense of reward and incentivises behaviour to repeat
describe the action addiction has on dopaminergic tolerance on the mesolimbic pathway
repeated stimulation leads to downregulation of D2 receptors leading to needing higher quantities of drug needed
normal life is impaired leading to it becoming boring
describe how tolerance leads to -ve reinforcement of addiction
initially drug taking is by +ve reinforcement due to dopamine reward
once tolerance develops +ve reinforcement stops and as life becomes boring -ve reinforcement removes dullness or unpleasant effects
reasons for lesser prefrontal cortex activity in those with addiction
ACEs
drug use during brain maturation
genetics
describe the function of amygdala and hippocampus in addiction
associated with consolidation and expression of drug stimulus learning
so drug association can lead to cravings in addiction ie pictures or seeing drug
function of orbitofrontal cortex in drug addiction
internal representation of events and assigns them to action
drug cues activate OFC and increases drug cravings
true/false - those with genetically more D2 have a higher level of addiction in their population
false - it is those with lower D2 as they seek reward more
how does stress lead to addiction
acute stress triggers dopamine reward
chronic stress downregulates D2 and encourages exposure to more rewarding behaviour and drug seeking
natural forms of opiate?
morphine, codeine
semi-synthetic forms of opiate
hydrocodone
synthetic forms of opiate
metadone
tramadol
who to treat for opiate or other drug addiction?
>3 for >1m sense of compulsion craving physiological withdrawal evidence of tolerance preoccupation with substance use persistent despite consequence
what is included in an opiate safety bundle
drug diary, screening
opiate withdrawal scale
recovery care plan
risk assessment
true/false - opiate withdrawal is life threatening
false
true/false - opiate toxicity/overdose is life threatening
true - warrant for immediate administration of naloxone due to respiratory depression
what is the reason for ORT
substitute prescribing to control administration and introduce order and control into addicted individuals life
mechanism of action of methadone, metabolism, dose, means of taking
Mu receptor agonist and long half life
hepatic metabolism
30mg initially, 60-100mg
liquid
mechanism of action of buprenorphine, means of taking, dose
Mu partial agonist with low intrinsic activity and high affinity
sublingual tablet
12-24mg
considerations to make before which ORT to prescribe
QTc ECG sedation combination therapy diversion
what is hazardous drinking
anyone drinking >14units alcohol weekly and <35
no alcohol related consequences
calculation of units in a drink
strength (ABV) x volume (ml)/1000
where may alcohol related cancers appear
larynx mouth or URT oesophagus breast bowel liver
brief intervention question to ask in emergency care about drinking?
how often have you had 6 (F) or 8 (M) units in one occasion in the last year
if weekly to almost daily then full AUDIT scoring needed
AUDIT score - 0-5, what is the risk and what intervention needed
No action needed
ver low risk
AUDIT score - 6-7, what is the risk and what intervention needed
Brief intervention
low risk
AUDIT score - 8-15, what is the risk and what intervention needed
Brief intervention
Moderate risk
AUDIT score - 16-19, what is the risk and what intervention needed
Brief intervention
High risk
AUDIT score - >20, what is the risk and what intervention needed
Specialist referral
Very high risk
What is brief intervention, what framework should it follow
5-15 min intervention by NHS or another service
FRAMES
motivational interviewing
what is motivational interviewing
guiding change
collaborative conversation
respect autonomy
what is the FRAMES framework?
Feedback on problems Responsibility on pt Advice Menu to change Empathy Self-efficacy and optimism
Diagnosis of alcohol dependence syndrome
>3 for >1m sense of compulsion difficulty controlling substance withdrawal state tolerance neglect of other interests/pleasures persistence despite evidence of harm
mechanism of action of alcohol withdrawal
Adapted chronic CNS depression reduces GABA leads to upregulation of glutamate
when stopping alcohol there is unopposed glutamate so unopposed excitation
features of alcohol withdrawal
restless, tremor, sweating, N&V, anorexia, insomnia, tachy, systolic HTN
passes in 5 days but can have seizure in 24hr
what may alcohol withdrawal progress to
delirium tremens
features of delirium tremens
peak 2 days
night time confusion, disorientation, agitation, HTN, fever, hallucination
cardiovascualr collapse or infection
best way to prevent delirium tremens
do not allow dependent drinkers stop abruptly without support
management of alcohol withdrawal
BZD cross titrated and reduction over 7 days
pavbrinex
vitamins
thiamine
when would you detox a patient in hospital rather than community
>30 units or AUDIT >30 severe dependence hx delirium tremens poor support cognitive impairment poor health psychiatric comorbidity
when to refer to specialist intervention for alcohol dependence
failed to benefit from brief intervejntion, extended intervention
co-morbidity
AUDIT >20
non-pharmacological relapse prevention?
CBT motivational therapy 12 step facility self control training family/couple therapy
true/false - give BZD as a pharm intervention for relapse prevention
false - only during detox
what medications can be given for alcohol rehabilitation and which is first line
naltrexone - first line
acamprosate
disulfiram
mechanism of action of naltrexone
opiate antagonist so reduces reward pathway
mechanism of action of acamprosate, what to prescribe with and side effects
acts on glutamate and GABA to reduce craving
psychosocial intervention
headache, diarrhoea and nausea
mechanism of action of disulfiram, caution and side effects
inhibits acetaldehyde dehydrogenase so accumulation of acetaldehyde
leads to flushed skin, hypotension, N&V, tachy, arrhythmia
needs compliance as can lead to severe side effects
core features of addictive behaviour
salience mood modification tolerance withdrawal conflict relapse
describe the moral model of addiction
addiction seen as violation of societal rules, weakness
individuals fault and law enforcement and courts are agents of change
describe the dispositional disease model of addiction
primary cause individual, loss of control and restraint
no cure for addiction besides abstinence
what is the personality model of addiction
roots of addiction lie within individuals personality
poor impulse control, low self esteem, cant cope woth stress, manipulation
what is the biological model of addiction
gene and physiological precess determine addiction in individual
identify biological conditions that contribute to addiction
agent of change is medical establishment to support
what are the limitations to the medical model of addiction
medical tx reduces harm but not always abstinence
medical tx doesnt exist for many addictions but there is recovery
behavioural addiction?
what is the behavioural model of addiction
learning through action
influenced by behaviour, environment and consequences
engagement is underpinned by reinforcement
what is conditioning
through repeated pairings, previously neutral stimuli will elicit a response with something paired with it
ie going to parties as alcoholic conditions response to crave alcohol
what is the conditioned compensatory response theory
in overdoses, those who are conditioned to the substance are more likely to survive
eg rats heroin experiment
what is operant conditioning
learning by connecting consequences of action woith behaviour
what is +ve reinforcement
encourages addictive behaviour by reward
what is -ve reinforcement
removal of stimuli to increase behaviour frequency
what is +ve punishment
use of stimulus to decrease frequency
what is -ve punishment
loss of stimulus to decrease frequency
what is the biopsychosocial model to addiction
interaction of biological, physical and social factors contribute to addiction and no one factor is dominant over another
holistic
what is the cognitive behavioural model of addiction
patient vulnerable from genetic factors
exposure to social factors or availability of psychoactive substance lead to cognitive and behavioural processes
become increasingly automatic
