Addiction Disorders Flashcards
What is the ICD-10’s criteria for dependence?
Strong desire Difficulties controlling Withdrawal Tolerance Neglect of alternative pleasures Persistence despite harm
What is the main neurotransmitter in the mesolimbic (reward) pathway?
Dopamine
What effect does drug abuse have on the mesolimbic pathway?
Stimulation
Why do certain drugs (cocaine, nicotine etc.) cause addiction?
As they cause a massive increase in dopamine which the brain craves
What effect does repeated substance taking have on dopamine receptors?
Downregulation
What is the role of the pre-frontal cortex in terms of the mesolimbic pathway?
It controls it and allows us to make sound decisions
The prefrontal cortex is one the earliest developed areas of the brain. True/false?
False - one of the last
The earlier/later the age of drug experimentation the longer the drug relationship
Earlier
What role does the hippocampus and amygdala play in addiction?
They help the brain to learn drug associations and cue craving feelings
Why can acute stress cause seeking of addictive substance?
As it triggers the release of dopamine
Why is heroin so addictive?
Rapid onset of action
Short half-life
Heroin is morphine/diamorphine
Diamorphine
What are the two main ways to take heroin?
Intravenous
Smoking
Give some of the effects of heroin
Euphoria Analgesia Respiratory depression Constipation Bradycardia Pupillary constriction
What is the half-life of heroin?
6-8 hours
Give some of the withdrawal symptoms of heroin
Dysphoria/cravings Agitations Tachycardia Piloerection Diarrhoea Pupillary dilation
Over half of the individuals who have died from heroin overdose lived in the 20% most deprived areas in Scotland. True/false?
True
What drugs are increasing in involvement in drug related deaths?
Gabapentin
Pregabalin
Diazepam presence in drug related death has decreased while etizolam presence has increased. True/false?
True
What is involved in opiate substitution therapy?
Replacing a short acting opiate with a long acting opiate
What drugs are used in opiate substitution therapy?
Buprenorphine
Methadone
Give some of the pros of OST
Reduced mortality rate
Reduced HIV risk
Give some of the cons of OST
Daily chemist visits
Stigma
Is methadone given as a tablet or a liquid?
Liquid
What occurs in opiate detoxification?
Giving patients a reducing dose of the drug until they are not on any at all
What are the main negatives of opiate detoxification?
High mortality risk
High relapse rate
What psychosocial interventions can be done for opiate misuse?
Rewarding positive behaviour
Behavioural couples therapy
What is involved in heroin assisted treatment?
Allowing patients to safely inject heroin while also taking methadone
How do you calculate units of alcohol?
(%ABV x volume) / 10
What is defined as higher risk drinking?
Regularly consuming above 15 units per week
What biological marker is most commonly raised in alcoholism?
MCV
When should a patient be referred for specialist treatment in alcoholism?
Showing signs of moderate/severe dependence
Failed to benefit from previous advice
Showing signs of severe alcohol-related impairment
Alcohol withdrawal causes excess GABA activity and reduced glutamate activity. True/false?
False - excess glutamate activity and reduced GABA activity
Give some of the symptoms of delirium tremens
Confusion Disorientation Agitation Fever Hallucinations
How should short term alcohol withdrawal be managed?
Benzodiazapines Vitamin supplementation (thiamine/pabrinex)
What psychosocial therapy is recommended for relapse prevention?
CBT
What drugs can be used to prevent alcohol relapse?
Disulfiram (antebuse)
Acamprosate
Naltrexone
What is the effect of drinking alcohol on disulfiram?
Flushed skin Tachycardia N + V Arrhythmias Hypotension
What is the effect of acamprosate?
It reduces cravings
