Addiction / Alcohol use disorder Flashcards by Sophie McEntegart

1 unit of alcohol = how many mls & grams?

10mls / 8g

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Female patient says they drink 5 glasses of wine a night. Is this over their weekly limit?

No, 6 glasses of wine = weekly limit of 14 units.

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How much alcohol would a woman have to drink to be within the hazardous drinking category?

> 14 units/week
BUT
<35 / week

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How many units would a man have to drink to be within the hazardous drinking category?

> 14 units/week
bUT
<50 / week

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What is the category above hazardous drinking and what is a definition of this?

harmful drinking - a pattern of alcohol consumption that is causing mental or physical damage.

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A woman who is a harmful drinking consumes how much alcohol/week?

35 or more units/week

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A man who is harmful drinking consumes how much alcohol/week?

50 or more units/week

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Describe alcohol dependence.

A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use.

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What is tolerance?

the need to increase alcohol intake to achieve intoxication
or
a markedly diminished effect with continued use of the same amount of alcohol.

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name the 6 elements of the FRAMES brief intervention.

Feedback
Responsibility 
Advice
Menu
Empathy 
self-efficacy

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Which drug can be used in medically assisted detoxification?

chlordiazepoxide

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What is the major downside of medically assisted detoxification?

high rate of relapse after successful medicated withdrawal

cognitive impairment / cumulative neuronal damage

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What is the kindling effect (seen in medically assisted detoxification)?

the severity of withdrawal symptoms tends to increase after each alcohol withdrawal

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Which drug used in relapse prevention works on GABA and glutamate transmission?

acamprosate

corrects neurotransmission imbalance post-withdrawal and reduced craving

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Which drug would you give a patient to prevent relapse and keep them completely abstinent?

acamprosate

poor compliance since multiple tablets/day

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Which drug can be given to prevent relapse that blocks opioid receptors? What effect does it have?

naltrexone - reduced rewarding effect mediated by endorphin system.

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Which drug can be given to prevent relapse but allows the patient to continue to drink?

nalmefene (selincro)

taken as needed

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Which drug when given causes an unpleasant side effect when mixed with alcohol?

disulfiram

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what is the basic early metabolic pathway of diamorphine?

diamorphine (diacetylmorphine) -> 6-mono-acetylmorphine -> morphine

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How soon do withdrawal symptoms start after heroin is stopped?

6-8hrs

What are some symptoms of heroin withdrawal?

cravings
agitation
tachycardia &amp; hypertension
piloerection (goosebumps)
diarrhoea / N&amp;V
dilated pupils
joint pains
yawning 
runny nose &amp; watery eyes

What is the basic idea of opiate substitution therapy (OST)?

replace a short-acting opiate (heroin) with a long-acting opiate

What are the 2 long-acting opiates used in OST and what is the difference between them?

methadone & buprenorphine

methadone = long-acting full agonist (liquid used)
buprenorphine = long-acting partial agonist (tablet)

Name 3 psychosocial interventions for substance misuse recommended by NICE.

contingency management
behavioural couples’ therapy
CBT & psychodynamic therapy

Describe contingency management.

rewards positive behaviours in order to reduce illicit drug use ± promote engagement with service receiving methadone.

Who is behavioural couples' therapy for?

people who are in close contact with a non-drug misusing partner and who present for treatment of stimulant or opioid misuse.

When is CBT & psychodynamic therapy indicated in opioid addiction?

for co-morbid anxiety and depression (not to treat the drug misuse)

Model of addiction which sees addiction as violations of societal rules and a result of human weakness with the individual s the primary causal factor. Who are the 'agents of change' in this model?

moral model | agents of change = church, law enforcement and courts.

Model of addiction which says addiction is an irreversible disease but can be halted by total abstinence.

dispositional disease model

Model of addiction that says that the roots of a patient's addiction lie in their abnormal personality. Who are the agents of change and which personality traits does this reference?

personality traits such as poor impulse control; low self-esteem; inability to cope with stress; egocentricity; manipulation; need for control & power and feeling of powerlessness. agents of change = psychiatry

Model of addiction which says that substance misuse is a learned behaviour and that the patient has gone through conditioning behaviour modification.

Behavioural models

What is conditioning?

the process of behaviour modification whereby an individual comes to associate a desired behaviour with a previous unrelated stimulus.

Describe classical (Pavlovian) conditioning.

Involve association - repeated pairing with the cue makes a previously neutral stimuli elicit the same response.

Describe Operant (Skinnerian) conditioning.

Involves instrumental value - learnin. by connecting the consequences of an action with the preceding behaviour

Which type of conditioning is this: A bell is rung every time a dog receives food. When the bell is rung but no food presented the dog will go to its food bowl and expect its food.

Classical (pavlovian) conditioning | via associative learning

Which type of conditioning is this: | Patient believes that if they do x then y will happen.

Operant (skinnerian) conditioning | via instrumental learning

Give an example of positive reinforcement felt when a stimulus is present.

feeling more relaxed after using (increases frequency of behaviour)

Give an example of negative reinforcement - when a stimulus is removed.

Getting rid of withdrawals

Give an example of positive punishment.

Being shouted at by a partner for using.

Give an example of negative punishment.

Losing a family member and home due to using.

Model of addiction in which the central premise states that unconscious process, perception & thought influence emotion and behaviour. Changes in addictive behaviour occur due to changes in motivation, cognition and appraisal.

cognitive behavioural model

Thinking errors: | It's just a treat = ?

permission-giving

Thinking errors: | It's only one = ?

minimisation

Thinking errors: | I haven't used in a whole week, so why not?

rationalisation

Thinking errors: | I can use and stay in control = ?

denial

Thinking errors: | She made me angry, so I had to use =?

blaming

What is incentive salience?

Attributing "want" to a stimulus

What is the role of the pre-frontal cortex in addiction?

Helps intention-guide behaviour. Modulates the powerful effects of the reward pathway. Sets goals, focuses attention. Makes sound decisions. Keeps emotions and impulses under control to achieve long term goals.

Which area of the brain is the 'Key creator of motivation to act'?

orbito-frontal cortex