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
