Addiction

Question 1

ICD-10 criteria of dependence

Answer 1

1. strong desire to take substance
2. difficulties controlling substance use
3. physiological withdrawal state
4. tolerance
5. neglect of alternative pleasures
6. persistent despite evidence of harm

Question 2

what is tolerance and how does it develop?

Answer 2

repeated dopamine release, receptors down-regulate so threshold is increased and normal experiences don’t evoke pleasure response

Question 3

define lapse

Answer 3

single event

Question 4

define relapse

Answer 4

falling into old pattern of behaviour

Question 5

define conditioning

Answer 5

process of behaviour modification where an individual associates a desired behaviour with a previously unrelated stimulus

Question 6

two types of conditioning

Answer 6

pavlov= classical conditioning
skinner= operant conditioning

Question 7

define reinforcement

Answer 7

increases frequency of behaviour

Question 8

positive reinforcement

Answer 8

positive reward e.g. feeling more relaxed after using

Question 9

negative reinforcement

Answer 9

getting rid of withdrawals

Question 10

positive punishment

Answer 10

being shouted at

Question 11

negative punishment

Answer 11

losing family or home

Question 12

define habit

Answer 12

acquired pattern of behaviour regularly followed until it becomes almost involuntary

Question 13

thinking errors/ unhelpful ideas

Answer 13

permission-giving
minimisation 
rationalisation
denial
blame

Question 14

what is the biopsychosocial model?

Answer 14

basic formation consists of presenting problems, predisposing, precipitating, protective and maintaining factors to do with addiction

Question 15

define hazardous drinking

Answer 15

drinking alcohol in a way that increases risk of harm (>14 units/week)

Question 16

define harmful drinking

Answer 16

drinking >35 units/week

Question 17

calculate alcohol units

Answer 17

strength (ABV %) x volume (ml) divided by 1,000

Question 18

screening for alcohol use

Answer 18

FAST
AUDIT
CAGE (dependence)

Question 19

management of alcohol dependence

Answer 19

brief interventions e.g. services

motivational interveiwing

Question 20

what causes alcohol withdrawal

Answer 20

CNS depression from alcohol

Question 21

what does a sudden stop in alcohol intake cause?

Answer 21

unopposed excitation with decreased GABA and increased glutamate that is toxic to cells

Question 22

presentation of alcohol withdrawal

Answer 22

24-48 hours
restlessness
tremor
sweating
N&V
insomnia
tachycardia
hypertension
generalised seizures

Question 23

presentation of DTs

Answer 23

confusion
hypertension
fever
hallucinations
paranoid ideation
cardiovascular collapse
infection

Question 24

management of alcohol withdrawal

Answer 24

BZDs
analgesics, adequate hydration, antiemetics, treat concurrent
relapse prevention

Question 25

non-pharmacological management of relapse prevention

Answer 25

CBT
motivational enhancement therapy
12 step facilitation programme
self-control training

Question 26

pharmacological management of relapse prevention for alcohol

Answer 26

avoid BZDs
antabuse (disulfram)
acamprosate
naltrexone (FIRST LINE)

Question 27

what pathway mediates a natural or drug induced high?

Answer 27

mesolimbic pathway

Question 28

physical risks around substance misuse

Answer 28

skin infections
BBV
endocarditis/ embolic events
tract damage

Question 29

psychiatric risks around substance misuse

Answer 29

dependence
seizures
delirium
anxiety
depression psychosis

Question 30

social risks around substance misuse

Answer 30

employment
driving
debt
criminal activity

Question 31

phases of treatment

Answer 31

induction
optimisation
maintenance
reduction

Question 32

options for opiate withdrawal

Answer 32

methadone

buprenorphine

Question 33

action of methadone

Answer 33

Mu receptor agonist
peaks at 4 hour
steady state 5 days
hepatic metabolism CY3P4

Question 34

action of buprenorphine

Answer 34

Mu receptor partial agonists
peak 1.5-2.5 hours
sublingual tablets
community pharmacists under supervision

Question 35

when is methadone not first line/ avoided?

Answer 35

prolongs QT so avoid in cardiovascular disease
methadone causes sedation
polypharmacy
diversion risk