Addiction Flashcards
With thanks to Ed Underwood
What is acute intoxication?
A transient state of emotional + behavioural change following drug use. It is dose dependent and time limited.
What is harmful use?
A pattern of use likely to cause physical and/or psychological damage
What is dependence syndrome?
A cluster of psychological, behavioural and cognitive symptoms in which the use of a substance takes on higher priority than other behaviours that once had greater value
What is physical dependence?
A state of physiological adaptation of the body to a presence of a drug. It is defined by the development of withdrawal symptoms when the drug is removed or an antagonist is administered.
What is psychological dependence?
Dependence on a psychoactive substance for the reinforcement in provides
What is tolerance?
A physiological state characterised by a decrease in the effects of a drug
What is withdrawal?
The distressing physical and psychological symptoms experienced by a person once a drug is removed
What are the (ICD-10) features of dependence?
What are the safe limit recommendations for alcohol consumption?
- men and woman should drink no more than 14 units of alcohol per week
- they advise ‘if you do drink as much as 14 unites per week, it is breast to spread this evenly over 3 days or more’
- pregnant women should not drink → risk of foetal alcohol syndrome
What is an example of one unit of alcohol?
- 25ml single measure of spirit (ie. one shot)
- a third of a pint of beer
- half a 175ml ‘standard’ glass of red wine
What are key points to ask in an alcohol history?
- CAGE screening
- details of alcohol intake
- assess impact of alcohol
- effects on daily living
- past medical history
- psychological assessment
What are the signs and symptoms of acute intoxication?
Symptoms
Signs (depending on blood alcohol content)
- Low levels → Euphoria, relaxation
- Moderate levels → Irritability, aggression, weepy, disinhibited. Impulsivity and poor judgement are common
- High levels → Sedation, memory impairment, LOC
- Slurred speech
- Ataxic gait
- Sedation
- Confusion
- Coma
- Respiratory depression
What is the management of acute intoxication?
- ABC approach
- manage hypoglycaemia w/ 50ml of 50% dextrose infusion (ethanol induced hypoglycaemia is unresponsive to glucagon)
- administer thiamine
- check U+Es to guide fluid replacement
- haemodialysis if concentrations are dangerously high
Think about impact on body systems
Patients who have a chronic drinking problem may present with the complications of alcohol abuse; these may be direct (as a result of alcohol) or indirect (as a result of malnutrition).
What are the physical complications of chronic alcohol abuse?
- Liver → alcohol hepatitis (malaise, hepatomegaly, ascites), cirrhosis, hepatic encephalopathy
- GI → pancreatitis, varices, gastritis, peptic ulcers
- Neuro → peripheral neuropathy, seizures, dementia
- Cancer → bowel, breast, oesophageal, liver
- CVS → HTN, cardiomyopathy
- Obstetric → foetal alcohol syndrome
What are psychological complications of chronic alcohol abuse?
- depression, anxiety + self-harm all increased
- amnesia (due to blackouts)
- cognitive impairment
- alcoholic halucinosis → experience of auditory hallucinations in clear consciousness
- morbid jealousy → overvalues idea that a partner is cheating on them
What is the management of chronic alcohol abuse?
-
CONSERVATIVE
- Nutritional support → Oral thiamine (NICE)
- Psych therapies → CBT, AA meetings
-
MEDICAL
- Benzodiazepines for acute withdrawal
- Disulfiram → promotes abstinence - works by inhibiting enzyme acetaldehyde dehydrogenase ⇒ many of effects of hangover are felt immediately, even small amounts of alcohol produce: flushing, throbbing headache, nausea, copious vomiting, sweating, syncope, tachycardia + confusion
- Acamprosate → reduces craving, known to be a weak antagonist of NMDA receptors