Addictive Behaviour Flashcards
What areas are involved in addiction
Ventral tegmental area
Nucleus accumbens
Define “acute intoxication”
Transient condition following the administration of alcohol/psychoactive substances
Results in disturbed levels of consciousness, cognition, perception, affect, or behaviour
Define “harmful use”
A pattern of psychoactive substance use that is causing damage to health
Damage may be physical or mental
Define “dependence”
3 or more of the following, which should have occurred together for at least 1 month:
Compulsion
Aware of harm but continues to consume
Neglect of alternative pleasures/interests
Tolerance
Stopping causes withdrawal
Time - pre-occupied in use
Out of control
Define “tolerance”
Diminished response to a substance over the course of prolonged or repeated exposure
Define “withdrawal”
A group of physical and psychological symptoms that occur on absolute or relative withdrawal of a substance after repeated/prolonged/high-dose use of that substance
Symptoms of alcohol withdrawal
4-12hrs after alcohol
Tremor, nausea, sweating, mood disturbance
Outline delirium tremens
Acute confusional state secondary to alcohol withdrawal
48hrs after alcohol
Medical emergency
5-10% mortality
Symptoms of delirium tremens
Confusion, markedly fluctuating
Marked psychomotor agitation
Visual, auditory and tactile hallucinations
Sweating, paranoia, high temperature
Outline Wernicke’s encephalopathy
Triad: confusion, ataxia, ophthalmoplegia (6th CN)
Reversible
Give thiamine + magnesium
Outline Korsakoff’s syndrome
Anterograde and retrograde amnesia
Poor short-term memory
Confabulation
Minimal content in conversation
Lack of insight
Irreversible
Pharmacology of alcohol
Enhances GABA-A response (anxiolytic)
Promotes release of dopamine
Inhibits glutaminergic response at NMDA receptors (amnesic)
Harmful effects of alcohol
physical, mental, social
Physical:
Fatty liver, cirrhosis, CBD, stroke, hypertension, cancer
Mental:
Depressive disorder, anxiety, suicide, psychosis,
Social:
Unemployment, domestic violence, crime
Symptoms of opiate withdrawal
Sweating Piloerection Malaise and anxiety Yawning and sneezing Tears, rhinorrhoea, diarrhoea Insomnia Nausea and vomiting Severe muscle/joint cramps and aches Fever, hypertension, hyperventilation
Pharmacodynamics of alcohol
Opens GABA chloride channels
Pharmacodynamics of GHB/GBL
Release DA and GABA agonist
Pharmacodynamics of amphetamine
Releases DA and NA/5HT
Pharmacodynamics of cocaine
Reduces DA uptake
Pharmacodynamics of MDMA
Releases 5HT and DA
Pharmacodynamics of heroin
μR agonist
Pharmacodynamics of ketamine
NMDA antagonist and μRs agonist; enhances MA transmission
Investigations in drug/alcohol toxicity
Physical exam (track marks) Breathalyse Mouth swab Hair sample Urine drug screen History
Treatment of alcohol dependence
Don’t suddenly stop (risk of seizures/delirium tremens)
Cravings:
Acamprosate (enhances GABA and inhibits glutamate actvity)
Naltrexone (opioid antagonist)
Nalmefene
Treatment of alcohol withdrawal seizures
PR diazepam or IV lorazepam
When to consider inpatient treatment for alcohol dependence
Failed home detoxification
Co-existing physical/mental illness
Poly-substance misuse
Social isolation
Treatment of cannabis dependence
Education
Gradually reduce
Mix more tobacco
No skunk
Relaxation techniques
Family therapy
Treatment of opioid addiction
Substitution:
Methadone
Buprenorphine
Diamorphine
Post-Detox:
Naltrexone
Psychosocial treatment of opiate addiction
Harm reduction
Day centres
Group therapy
CBT
Residential rehabilitation
Outline alcoholics & narcotics anonymous
Self-help group (self-refer)
Based on “12 steps”
No records kept of meetings
Peer led support and camaraderie
New social connections & structure
Social and vocational interventions for addiction
Housing
Financial support
Employment advice
Basic education and vocation training
Family therapy
