Addictive Behaviour

Question 1

What is Acute Intoxication?

Answer 1

The administration of alcohol and other psychoactive substances, resulting in the disturbances of consciousness, cognition, perception, affect or behaviour. It is dose-dependent and time-limited.

Question 2

What is Harmful Use?

Answer 2

A pattern of psychoactive substance use that is causing actual damage to the mental and physical health of the user.

Question 3

What is Dependence Syndrome?

Answer 3

A cluster of physiological, behavioural and cognitive symptoms in which the use of a substance takes on higher priority than the other behaviours that once had greater value.

Question 4

What is Dependence Syndrome? (6)

Answer 4

3+ from :

1. Craving;
2. Difficulty in Controlling Substance Use (Onset, Termination, Level of Use);
3. Withdrawal;
4. Tolerance;
5. Progressive Neglect of Alternative Pleasures/Interests;
6. Persistent Use Despite Clear Evidence of Harmful Consequences.

Question 5

What is Physical Dependence?

Answer 5

A state of physiological adaptation of the body to a presence of a drug; the drug is used t prevent withdrawal symptoms and/or there is tolerance.

Question 6

What is Psychological Dependence?

Answer 6

Dependence on a psychoactive substance provides relief from tension or emotional discomfort.

Question 7

What is Tolerance?

Answer 7

A decreasing response to repeated constant doses of a drug or the need for increased doses to maintain a constant response.

Question 8

What is Withdrawal?

Answer 8

A substance-specific substance-induced disorder that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication.

Question 9

What is Craving?

Answer 9

A strong desire/sense of compulsion to take the substance.

Question 10

Give 4 reasons why a person might use alcohol/illicit drugs and why people might indulge in risky behaviour.

Answer 10

1. Genetic Predisposition (25-50% in Alcohol Dependence).
2. Occupation.
3. Social Background.
4. Psychiatric Illness (indulge in risky behaviour).

Question 11

What are the safe limits for consumption of alcohol? (4)

Answer 11

1. <14 Units per week.
2. Spread over 3+ Days.
3. Risk of Diseases increases with any amount of alcohol on a regular basis.
4. Several Drink-Free days.

Question 12

Why is Alcohol teratogenic in pregnancy? (2)

Answer 12

1. Nutritional Deficiency.

2. Foetal Alcohol Spectrum Disorders.

Question 13

How do you calculate Alcohol Units?

Answer 13

(ABV/1000) x mL.

Question 14

What is the difference between Abuse and Addiction?

Answer 14

Abuse = Drinking harms a person's work or social life.
Addiction = Dependence Syndrome.

Question 15

Describe the pharmacodynamics of Alcohol consumption. (4)

Answer 15

1. Potentiates transmission through GABA (Inhibitory) Receptors = Sluggish movement and slurred speech.
2. Inhibits NMDA (Glutamatergic - Excitatory) Receptors.
3. Imbalance of Inhibitory > Excitatory.
4. Increases Dopamine levels in the mesolimbic dopaminergic system.

Question 16

Describe the pharmacokinetics of Alcohol consumption.

Answer 16

A = depends on concentration gradient between gut and blood, vascularity and food (slows).
D = soluble in water > fat so more dilute in men (proportionally more water) and crosses BBB quicker.
M = Ethanol Clearance - 0 Order (Rate of Clearance is independent of concentration).
E = Urine, Exhalation, Metabolic Conversion.

Question 17

What causes Ethanol-Induced Hypoglycaemia? (6)

Answer 17

1. Ethanol is converted by hepatic ADH into Acetaldehyde.
2. NAD is converted into NADH by ADH simultaneously.
3. Acetaldehyde is converted by ALDH into Acetate.
4. NAD is again converted into NADH too.
5. NADH inhibits gluconeogenesis (preventing oxidation of Lactate to Pyruvate) because Lactate Dehydrogenase requires NAD.
6. Ethanol decreases glucose concentration.

Question 18

How is Acute Alcohol Intoxication managed (if severe)?

Answer 18

1. ABC Approach.
2. Hypoglycaemia - 50ml 50% Dextrose Infusion.
3. Thiamine Administration.
4. U&Es checked to guide fluid replacement.

Question 19

Describe the pathophysiology of Alcohol Withdrawal.

Answer 19

Alcohol depresses CNS through potentiation of GABA and inhibition of NMDA-type receptors. If alcohol is removed, neural pathways become hyper-excitable e.g. seizures (Delirium Tremens).

Question 20

How does Alcohol Withdrawal present?

Answer 20

Symptoms start at 6-12 hours (peak seizure incidence = 36 hours) :-

1. Confusion ‘Sun-Downing’ Effect.
2. Autonomic Hyperactivity.
3. Visual/Tactile Hallucinations/Illusions.

Question 21

What is the management of Alcohol Withdrawal?

Answer 21

1st Line = Long-Acting Benzodiazepine e.g. Chlordiazepoxide, Diazepam or Lorazepam (Hepatic Failure) in a Reducing Dose Protocol.
Other = Carbamazepine.