Addiction Flashcards
What clues in someone’s health may indicate substance misuse?
Stroke in younger people (stimulants) Hep C (IV drug use) Alcoholic hepatitis (alcohol) COPD (smoking crack cocaine if young, tobacco, cannabis) Infertility (alcohol) Hallucinations/psychosis (LSD/cannabis)
How do you quantify someone’s drug use?
Using cost
How much do they spend per week/night out
Source of money?
How are court orders relevant in substance misuse?
Court order for drug treatment requirement can be decided instead of going to prison/being sentenced
What 8 things show dependence?
CAN'T STOP Compulsion and intense desire Aware of harms but persistent use Neglect of other activities Tolerance Stopping causes physiological withdrawal symptoms Time spent preoccupied with substance increased Out of control use Persistent, futile wish to cut down
What drugs aren’t tested for?
Cannabis
Tramadol
Gabapentin & pregabalin
Newer psychoactives (spice)
What is drug induced psychosis?
When a drug is no longer in system but has triggered psychosis
Only for up to 6 months after using drug
Cannabis, cocaine, amphetamines, methadone, LSD
What psychiatric diagnoses may use substances to self manage their thoughts and mood?
EUPD Borderline PD Antisocial PD Bipolar manic episodes Depression (alcohol)
Is alcohol associated with memory problems?
Yes:
Wernicke’s encephalopathy (thiamine deficiency)
Korsikoff’s irreversible damage (opthalmoplegia, ataxia, confusion)
Alcohol withdrawal includes:
Psychotic symptoms after 72 hrs of abstinence
Insects and creatures (somatic hallucination)
Delirium tremens
What are the 3 questions in AUDIT-C?
How often do you have a drink containing alcohol? (Never = 0, 4+ per week =4)
How many units of alcohol do you drink on a typical day when you are drinking? (1-2=0, 10+ = 4)
How often have you had 6 or more units on a single occasion in the last year? (never = 0, daily/almost daily=4)
What are the other AUDIT questions?
How often during the last year have you:
-found that you were not able to stop drinking once you started?
-failed to do what was normally expected from you because of your drinking?
-needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
-had a feeling of guilt or remorse after drinking?
-been unable to remember what happened the night before because you had been drinking?
-been injured as a result of your drinking?
Has a relative/friend/health professional been concerned about your drinking or suggested that you cut down?
Scoring of AUDIT Qs
0-7= lower risk 8-15= increasing risk 16-19= higher risk 20+ = possible dependence
Treatment of alcoholism?
- Thiamine and B12 (to help with Wernicke’s and peripheral neuropathy)
- Acute stomach pumping
- Medically assisted detox with chlordiazepoxide (admit, esp if hx of delerium tremens) Attempt every 6 months
- Drink diaries (reduce by 10% each week)
What can prevent relapse of alcoholism?
Acamprosate (anti craving meds)
Psychological intervention (counselling/group work)
Naltrexone (opiate antagonist, anti craving, reduces pleasurable effects of drinking)
Disulphram (blocks aldehyde dehydrogenase enzyme, reaction can be fatal, headaches sweating vomiting. NOT if suicidal /cognitively impaired)
What is disulphram?
Drug to aid not relapsing in alcoholism
Blocks aldehyde dehydrogenase enzyme, reaction can be fatal, headaches sweating vomiting. NOT if suicidal /cognitively impaired
What is methadone?
Green sugar free syrup, full opiate agonist
Addictive, respiratory depression, pain relief, constipation
Controllable, known strength
Taken orally
24hr half life so more time, decreases chaos of 4x/day and decreases crime
What are the pro’s of needle exchange
Clean needles to reduce transmission of Hep C/HIV
Maintains contact w/services -> get engaged
How is naloxone used in community substance misuse centres?
Kits given to users of opiates (heroin)
Like epipens, can use IM to prevent overdose
What is bupranorphine?
Partial opiate agonist, partial antagonist
Decreases risk of overdose
High affinity for opiate receptors (can precipitate withdrawal, must already be in withdrawal)
Can get on max dose in 1st day
Blocks effects of other opiates
Pain relief will be awkward
Name the 3 drugs used in opiate addiction treatment
Methadone
Naloxone
Bupranorphine
What psychological interventions are used in substance misuse?
AUDIT CBT, motivational interviewing Group activities to replace time (sports, art, farm, chess) Counselling AA (+ other 12 step programmes) Contingency management WRAP
What is delirium tremens?
Delirium tremens is a short-lived, but occasionally life-threatening, toxic-confusional state with accompanying somatic disturbances. It is usually a consequence of
absolute or relative withdrawal of alcohol in severely dependent users with a long history of use.
Clouding of consciousness and confusion, vivid
hallucinations and illusions affecting any sensory modality, and marked tremor. Delusions, agitation, insomnia or sleep-cycle reversal, and
autonomic overactivity are usually present
Name 5 negative effects of LSD and other hallucinogens
Fatal dehydration
Hyponatraemia due to excessive water consumption
Flashbacks/psychosis
Seizures (in OD)
Name 5 negative effects of cannabis
Conjunctival irritation Decreased spermatogenesis Lung disease Transient psychosis/schizophrenia Depression/apathy
Define acute intoxication
Transient disturbances of consciousness, perception, affect or behaviour following the administration of a psychoactive substance
Name 3 class A drugs
Opioids (eg heroin)
Hallucinogens (eg LSD)
Injected stimulants
Name 2 class B drugs
Cannabis
Amphetamines
Name 2 class C drugs
Ketamine
GHB
Name some features of acute intoxication with alcohol
Slurred speech Impaired coordination and judgement Labile affect Hypoglycaemia Stupor Coma
Prevalence of alcohol dependence in UK?
6% in men, 2% in women
What is the CAGE questionnaire?
have you tried to Cut down?
have people Annoyed you by suggesting you do so?
have you felt Guilty about drinking?
have you needed an Eye opener?
What is repeated heavy drinking associated with?
Wernicke's encephalopathy Peripheral neuropathy Erectile dysfunction & testicular atrophy Cerebellar dysfunction Dementia 40% risk of temporary depressive episodes Suicidal ideas and attempts Severe anxiety Insomnia
What is seen in fetal alcohol syndrome?
Decreased muscle tone Poor coordination Developmental delay Heart defects Range of facial abnormalities
What can be done in ‘harm minimisation’ for those not wanting to quit?
Preventinginfectionsfromneedlesharing(particularly
hepatitisA,B,CandHIV),avoidingoverdoseandpreventing
othermedicalproblems
Hepvaccination
BBVtests
Drug purity testing (eg at festivals)
What need to be part of an addict’s examination?
Withdrawals Intoxication Sites DVT Cardiacdisease Chestinfections Chronicliverdisease Cerebellardysfunction+gait Cranialnerves Depression,Anxiety Psychoticsymptoms Orientationandcognition(DT’s,Wernickes) Memory
