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U15 Spine > Addiction and Substance Misuse > Flashcards

Addiction and Substance Misuse Flashcards

1
Q

WHta is the definition of substance dependence (addiction) - edwards and gross

A
  • A compulsion to take the substance
  • Continuing escalation of the amount used
  • Withdrawal syndrome following cessation/reduction in use
  • Development of tolerance to susbtance
  • Neglect of other activtiies in favour of substance use
  • persistent use despite evidence of harm
  • loss of self control
  • Rapid re-instatement of previous pattern after abstinence
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2
Q

Aetilogy and RFs for addiction

A
  • Neurobiology:
    • Dopaminergic fibres pathway- mesolimbic system - “reward Circuit” - (VTA-nucleus accumbens- prefrontal cortex)
    • Brain endogenous opioid (endoprhin) system
    • Reeated drug use -> pathways of reward drive and memory become overestablished
    • olerance as neuro-adaptive response
  • Vulnerability and genes
  • Personality traits - impulsivitiy, risk taking
  • Environmental influencs (deprivation, abuse, cultural, acceptance, role modelling)
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3
Q

Behvaioural/Psychological Factors to addiction

A

Operant conditions:

  • Reinforcement of positive stimuli - drug sitmulates neural reward mechanisms (eg, dopamine/endorphins) which promotes reptition of drug using behaviours (Psoitive reinforcement)
  • Removeal of aversive stimuli such as craving and withdrawal symptoms by using the substance again (negative reinforcement)
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4
Q

What are lots of types of substances

A

§Alcohol

§Opioids

§Cannabinoids

§Hypnotics / Tranquilizers

§Cocaine

§Other stimulants – e.g. Amphetamine, Methamphetamine

§Hallucinogens

§Tobacco

§Volatile solvents

Others (include Caffeine, Anabolic Steroids and some OTC medicines)

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5
Q

Patterns of drug use

A
  • Vary over time
  • Adolescence - explorationa nd experimentation - “cafeteria style”
  • Evolution from social to problematic regular and mor eoslitary use
  • Concept of a drug “career” or “CV”
  • Often a maind rug of choice - eg, alkies vs junkies but Poly-substance misuse is the norm for more established problematic use.
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6
Q

UK Legal Categories for drug use - a,b,c classes based on harm

A
  • Class A: Ecstasy, LSD, heroin, cocaine, crack, magic mushrooms, amphetamines (if prepared forinjection). Possession - Up to 7 years in prison, an unlimited fine or both. Production / Supply - Up to life in prison, an unlimited fine or both
  • Class B: Amphetamines, Cannabis, Methylphenidate.(Ritalin), MKAT,Ketamine. Possession - Up to 5 years in prison, an unlimited fine or both. Production / Supply - Up to 14 years in prison, an unlimited fine or both
  • Class C: Tranquilisers, some painkillers, Gamma hydroxybutyrate (GHB) Possession - Up to 2 years in prison, an unlimited fine or both. Production / Supply - Up to 14 years in prison, an unlimited fine or both
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7
Q

Other addictive behaviours

A
  • COmpulsive buying - Iniomania “mall disorders”
  • Pathological gambling
  • Kleptomania
  • Compulsive eating
  • Compulsive sexual activity
  • Internet gaming disorder
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8
Q

Alcohol addiction and the MOA

A

80-90%drink it, ltos admissions from it, 10%men show dependence, 3% women

  • Increases cell wall fluidity and permeability
  • ENhancement of GABA-A transmission (anxiolitic effect)
  • Release of dopamine in mesolimbic system (euphorian effect)
  • Inhibition of NMDA glutaminergic transmission (amnesic effect)

Acute effects:Disinhibition, elevation mood, increased socialisation, disinhibition, lability of mood, impaired judgement, aggresiveness, slurred speech, ataxia.

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9
Q

Alcohol Metabolism

A
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10
Q

Aetiology for Alcohol problems

A
  • Genetics: 1st degree relative of alchold ependents increase x2, higher risk MZ twins vs DZ twins and aldh variant in asian pop so intolerant to alcohola nd get flushing
  • Cloninger:
    • type I - geentc environemnt late onset, storng psychological dpeendence, men=women
    • Type II = mor egenetic influence, earlier onset, storng family Hx, antisocial PD, noverlty seeking behaviour, men>women
  • Psychological - trauma/ abuse
  • Behaviours = modelling and peer influence
  • Socio-cultural = deprivation/ poor family support and structure.
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11
Q

Alcohol - Psychiatric complication

A
  • Harmful use and dpeendency
  • Whthdrawals tremens
  • acute alcohol and idnuced amnesia
  • Alcoholic hallucinosis
  • Alcohol induced delusional disorder and pthological jealousy
  • Cognitive impairment and dementia
  • Development of exacerbation of anxiety /depressive symtpoms
  • Dliberation self harm and suicide
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12
Q

Alcohol- Medical Complications

A

Acute Toxicity = Between 300-400mg/100ml (0.3%-0.4%) -> unconcsiosness, coma and death

Chronic Medical Problems:

  • Hepatic
    • alcoholic liver disease
    • Fatty change - >90% of heavy drinkers, reverses with abstinence
    • Alcoholic hepatitis - 40% of heavy drinkers
    • Cirrhosis - up to 30% of hevay drinkers after 10-30years
  • GI: Gastritis, metaplasia, mallory-weiss, diarrhoea, pancreatitis
  • Cancers
  • CVL high BP, cardiomyopathy, atrial fibrillation
  • Respiratory
  • Neuro: Wernicke-Korsakoff syndrome, peirpheral neuropathy, central pontine myelinolyiss, corpus callosume degeneration, optic atrophy, alcohol myopathy
  • GU: Erectiel problems, hypogonadism
  • Other: Haematology, impaired absroption of vitamins/food, gout, foetal alcohol syndrome
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13
Q

Foetal Alcohol SYndrome

A
  • Foetal growth restriction
  • CNS problems including cognitive dysfunctiona nd neurological abnormalities
  • Cluster of characteristic facial abnormalities
  • Failure to thrive
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14
Q

Psychosocial alcohol problems

A
  • LOOT - Financial – Mounting Debt – bankruptcy
  • LAIR - Housing – Re-possession - Loss of stable home circumstances – Homelessness
  • LABOUR - Occupational problems - Job Loss and redundancy – Loss of reputation
  • LEGAL – Driving offences and loss of licence– Public Disorder / Assaults Violence / Theft or Fraud
  • LOVE - Relationship breakdown – Domestic Violence
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15
Q

Assessment of patient with alcohol problems

A
  • Lifetime and current pattern/amount (units)
  • Signs of dependence
  • Physical/mental health
  • Problems related to alcohol
  • Previous treatment attempts
  • Family Hx
  • Attitude to referral/motivation/ goals
  • Physical examination
  • Blood testing
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16
Q

Alcohol screening

A
  • CAGE Quesitonaire (Cut back, annoyed, guilty, eye opener)
  • AUDIT
  • Breath testing
  • Blood testing - raised indices:
    • MCV mean corpuscular vol
    • GGT gamma glutamyl transferase
    • ALT alanine transaminase
    • CDT - carbohydrate deficient transferrin
17
Q

Alcohol consumption - reocmmended

A
  • Men and women should not exceed 2-3 units per day on a regular basis
  • >14 units per week is associared with greater risk of harm
  • Units = volume (litres) x strength %
    • eg 500ml of 5% larger = 0.5 x 5 = 2,5units
    • 125ml of 12% wine = 0.125 x12 = 1.5units
    • 35ml 37% spirits = 0.035 x37 = 1.3 units
18
Q

Alcohol withdrawal symptoms

A
  • Onset = 6-24hrs after last drinl
  • Peak 24-48h
  • duration 5-7d
  • sweating, tremor, tachycardia, high bP, anxiety, insomnia
  • Seizures in 2-5% cases

Delirium Tremens:

  • Potential lif ethreatening
  • onset 48-72h
  • Duration 3-10days
  • Fever, sever anxiety and agitation, clouding of consciousness/ delirium, hallucinations (visual, tactile)
  • ntreated 15% mortality
19
Q

Alcohol - Wernicke/Korsajoff syndrome

20
Q

Aims and principles of alcohol treatment

A
  • Detoxification
  • Establishing goals: continue current dirnking pattern, change to safer pattern -“controlled drinking” or attempt abstinence
  • Stages of change model and otiavtional interveiwing
  • Mintainence of sobriety/relapse prevention
21
Q

Detoxification for alcohola ddiction

A
  • Acute Treatment - withdrawals
  • Vitamin B complex oral or im/iv Pabrinex
  • Benzodiazepines in reducing regime over several days: chlordiazepoxide, diazepam
  • Fluids and electrolytes
  • Antipsychotic meds (Haloperidol usually) foragitation/hallucinations
  • Settings - At home / inpatient elective / hospitalacute
22
Q

Additonal treatment approaches for alcohol addiction

A
  • Adjunctive medications:
    • Acamprosate – reduce craving
    • Naltrexone – reduce reward
    • Nalmefene – reduce reward
    • Disulfiram - aversion
  • Treat comorbidity – e.g. antidepressants for Depression
  • Relapse prevention – CBT based techniques
  • Residential rehab programmes – weeks to months
  • Alcoholics Anonymous – Other peer supportprogrammes
23
Q

Cannabis- Marijuana

A
  • Derived from Cannabis Sativa plant
  • Hashish, Resin,Dope, Grass, Weed
  • Skunk – more potent version – made from unpollinated plants bred for high THC content - buds / tips
  • 4Tetra Hydro-Cannabinol (THC) – active constituent
  • The most widely used illicit drug
  • Smoked via “joint” or Bong
  • Synthetic cannabinoids: very potent, toxic, sold in sachets with attractive names / “legal highs” or “NPS” – New Psychoactive Substance

Effects =

  • Intoxification = euphoria, anxiety, distortion of time and space, red conjuctvae, dry mouth, tachycardia
  • Emerging evidence that early cannabis use may predispose/trigger development of schizophrenia
24
Q

Opiates

A
  • Papaver Somniferum – Opium Poppy
  • Opioid analgesics (e.gs - Codeine, DihydroCodeine, Morphine, Pethidine)
  • Heroin = Diamorphine
  • Smoking, injecting
  • Mu, kappa, delta receptors
25
Q

Treatment principles of opiate addiction

26
Q

Providers of drug treatment

A
  • NHS, through GP surgeries, hospitals and specialistclinics
  • Voluntary organisations and charities - communityand residential settings
  • Private sector organisations – e.g. The Priory
  • Prisons – provided by a combination of HM PrisonService and various providers
27
Q

Sedatives/ Tranquilisers

28
Q

Stimulants - General effects/ side effects

A
  • Increased performance, well- being, excitement, the “rush”, stereotyped behaviour, insomnia, promiscuity, psychosis
  • increase in Pulse and BP, dry mouth, urinary retention, Arrhythmias, MIs, CVAs
  • Exhaustion, extended sleep, lethargy, depression
29
Q

Cocaine

A
  • Alkaloid - dericed from erythroxylum coca
  • SNorted, smoking, IV
  • Coke, charlie, snow, crack…
  • crack = cocaine free base, heated in alkaline solution
  • “snowballing”= iv cocaine + heroin
30
Q

Other stmulants/ amphetamines

31
Q

Hallucinogens

A
  • LSD – Lysergic Acid
  • Synthetics – “Smiles” “N-Bomb”
  • Mescaline –Peyote cactus
  • Psilocybin -magic mushrooms
  • PCP phencyclidine – Angel Dust
  • Ketamine
32
Q

Tobacco

U15 Spine (11 decks)

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