Addiction

Question 1

Define Addiction

Answer 1

A relapsing remitting disorder compromising behaviours that are performed in a compulsive manner in spite of potential for self harm

Question 2

How can drug dependence be classified?

Answer 2

Psychological
Physiological
Tolerance

Question 3

Outline the 4 dopamine pathways

Answer 3

Nigrostriatal: SNPC to Striatum
Mesolimbic: VTA to limbic system
Mesocortical: VTA to PFC
Tuberoinfundibular: Hypothalamus to pituitary gland

Question 4

How are behaviours associated with addiction categorised?

Answer 4

Drug-seeking/Craving - anticipation of taking drug
Binging/Intoxication - covers ‘highs’, tolerance and dependence
Withdrawal - negative effects of removal of the drug

Question 5

What parts of the brain are involved in the positive and negative behaviours of drug taking/addiction? What happens in ‘the crash’?

Answer 5

Striatum, Thalamus, Nucleus Accumbens, PFC involved in positive reinforcement behaviour

Striatum and Amygdala responsible for negative/low effects

‘Crash’ - plasma concentrations remain stable but positive brain area activity starts to subside and activity of amygdala dominates

Question 6

What is the transtheoretical model of behaviour change and how can this be linked to addiction?

Answer 6

5 phases:
Pre-contemplation
Contemplation
Preparation
Action
Maintenance

Relapse common in addiction so takes a few goes of the cycle until maintenance is achieved

Question 7

What are common drugs of addiction?

Answer 7

Alcohol
Nicotine
Opioids (codeine and heroin)
Caffeine
Cocaine
Amphetamine
Benzodiazepine
Cannabis
MDMA
PCP
Ketamine

Question 8

What are the 3 main approaches taken in addiction management?

Answer 8

Abstinence based
Harm reduction
Recovery oriented

Question 9

What are some psychosocial interventions used in addiction management?

Answer 9

Brief interventions
Motivational interviewing
Structured counselling
CBT
Contingency management
Relapse prevention

Question 10

What are two opioid drugs that can be used to manage addiction?

Answer 10

Methadone and Buprenorphine

Question 11

What is FAST and when is it used?

Answer 11

Fast Alcohol Screening Test (also Face, Arms, Speech, Time for Stroke)

4 question rapid screen for alcohol misuse:

1. how often have you had more than 6/8 units?
2. how often in the last year have you failed to do what you planned because of alcohol?
3. how often in the past year have you been unable to remember something because of alcohol?
4. has a relative/friend been concerned about your drinking?

Question 12

What syndrome is linked with Thiamine (vitamin B1) deficiency?

Answer 12

Wernicke-Korsakoff: Wernicke’s encephalopathy (abnormal gait, posture, eye paralysis, deranged mental function) and Korsakoff alcoholic amnesia (confabulation and deterioration of higher functions, anterograde and retrograde amnesia)

Question 13

Why would a heroin user have miosis?

Answer 13

Pupil constriction via CN III parasympathetic branch

Heroin in opioid drug that reduces sympathetic tone and increases parasympathetic activity

Question 14

Which opioid antagonist is used to help relapse in addictive behaviour? Which conditions is it used for and how does it work?

Answer 14

Naltrexone - competitive antagonist that prevents block of administered opioids to reduce opioid high
Used in heroin and alcohol addition

Question 15

Why do heroin addicts lose their teeth?

Answer 15

Opioids reduce salivary secretions = dry mouth
Bacteria not washed away = increase acidity around gums/teeth causing tooth decay

Opioids activate chemotactic area in brainstem causing vomitting = more acid in oral cavity

Heroin users often have sugary craving and self-care often low

Question 16

What psychosocial interventions are available for addiction management?

Answer 16

Brief interventions
Motivational interviewing
Structured counselling
CBT
Relapse prevention
FRANK - national support group enabling confidential discussion

Question 17

How does valium work? What class of drug is it?

Answer 17

Benzodiazepine - Diazepam
Binds to y-subunit on GABAa (co-agonist) to increase inhibitory activity in NS by increasing Cl- movement through the channel to hyperpolarise the cell

Question 18

What drug can reverse BDZ symptoms? Why is it only prescribed short term?

Answer 18

Flumazenil = BDZ competitive agonist
BDZ users can develop dependence/tolerance quickly which when withdrawn can lead to rebound seizures, anxiety, panic, hallucination

Question 19

What are similar drugs to BDZs, which subunit do they bind to?

Answer 19

Barbituates - bind to B-subunit to increase GABA activity

Most commonly used as anaesthetics but also in euthanasia

Question 20

What’s AUDIT and what score should be considered clinically significant?

Answer 20

Alcohol Use Disorders Identification Test
10 questions, max score 40
Men 8/40
Women 4/40

Question 21

What’s the CAGE questionnaire?

Answer 21

4 questions determining problems with alcohol misuse

Have you ever felt you should CUT down?
Have people ANNOYED you by criticising your drinking?
Have you ever felt GUILTY about your drinking?
Have you ever had an EYE opening to steady nerves/hangover?

Question 22

What type of gait would you see with vitamin B12 deficiency?

Answer 22

Heavy stomping gait due to loss of proprioceptive inputs from dorsal columns - have to stamp to active pain pathways to determine where feet/legs are for conscious movement