Addictive behaviours

Question 1

What is an addictive behaviour

Answer 1

Repeated behaviours that dominate the patient’s life to the detriment of social, occupational and family commitments as well as physical and psychological health

Question 1

Define tolerance

Answer 1

refers to a loss of effect when taking the same dose

Question 2

What is drug dependence

Answer 2

a physiological and psychological need to keep using a drug

Question 3

Features of alcohol dependence

Answer 3

• daily alcohol consumption
• strong urges and cravings for alcohol
• difficulty controlling consumption
• tolerance to the effects of alcohol
• withdrawal symptoms when stopping

Question 4

Describe the mechanism of action of chronic alcohol consumption

Answer 4

alcohol is a depressant
* stimulates GABA receptors
* inhibits glutamate (NMDA) receptors
Long-term use results in down-regulation of GABA and up-regulation of glutamate (NMDA) receptors to balance the effects of alcohol

Question 5

Give a formula for calculating alcohol units

Answer 5

Volume (ml) x Alcohol content (%) / 1000 = units of alcohol

Question 6

Give 3 recommendations by the department of health on alcohol consumption

Answer 6

• Not more than 14 units per week
• Spread evenly over 3 or more days
• Not more than 5 units in a single day

Question 7

What is the definition of binge drinking for women?

Answer 7

Binge drinking for women is defined as consuming 6 or more units of alcohol in a single session.

Question 8

What is the definition of binge drinking for men?

Answer 8

Binge drinking for men is defined as consuming 8 or more units of alcohol in a single session.

Question 9

Give 5 clinical findings seen with alcohol intoxication

Answer 9

• smelling of alcohol
• Slurred speech
• Bloodshot eyes
• Dilated capillaries on the face (telangiectasia)
• ataxia

Question 10

How is harmful alcohol use investigated

Answer 10

• AUDIT questionnaire
• CAGE questions
• severity of alcohol dependence questionnaire
• blood tests

Question 11

What is the AUDIT questionnaire

Answer 11

• Alcohol Use Disorders Identification Test (AUDIT) screens for harmful alcohol use
• involves ten questions with multiple-choice answers and gives a score

Question 12

What score indicates harmful alcohol use on the AUDIT questionnaire

Answer 12

A score of 8 or more indicates harmful use

Question 13

Describe the CAGE questions used to screen for harmful alcohol use

Answer 13

• CUT DOWN? Do you ever think you should cut down?
• ANNOYED? Do you get annoyed at others commenting on your drinking?
• GUILTY? Do you ever feel guilty about drinking?
• EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?

Question 14

Give 4 abnormal blood results that can occur with alcohol excess

Answer 14

• Raised mean corpuscular volume (MCV)
• Raised ALT and AST
• AST:ALT ratio above 1.5 particularly suggests alcohol-related liver disease
• Raised gamma-GT

Question 15

What are the common withdrawal symptoms and their typical onset times after ceasing alcohol consumption?

Answer 15

• 6-12 hours: tremors, sweating, headache, tachycardia and anxiety
• 12-48 hours: seizures
• 48-72 hours: delirium tremens

Question 16

Explain the mechanism of alcohol withdrawal

Answer 16

• Long-term alcohol use results in the GABA system becoming down-regulated and the glutamate system becoming up-regulated to balance the effects of alcohol
• When alcohol is removed, GABA system under-functions and glutamate system over-functions
• Causes extreme excitability and excessive adrenergic (adrenaline-related) activity

Question 17

Give 5 features of delirium tremens

Answer 17

• acute confusion
• delusions and hallucinations
• tachycardia
• coarse tremor
• hyperthermia

Question 18

How is alcohol withdrawal managed

Answer 18

• Long-acting benzodiazepines - chlordiazepoxide or diazepam (reducing dose protocol)
• lorazepam is often preferred in patients with liver cirrhosis
• carbamazepine as an alternative
• IV/IM thiamine (pabrinex)

Question 19

How is alcohol dependence managed in the long term

Answer 19

• alcohol detoxification programme
• oral thiamine
• maintenance: disulfiram (deterrent), Acamprosate (anti-craving) , naltrexone

Question 20

Give 5 complications of chronic alcohol abuse

Answer 20

• Liver disease: ALD, cirrhosis
• Wernicke-Korsakoff syndrome
• alcoholic cardiomyopathy
• increased risk of CVD - stroke, MI
• Pancreatitis

Question 21

Why are alcoholics at risk of Wernicke-Korsakoff Syndrome

Answer 21

• Alcohol excess leads to thiamine (vitamin B1) deficiency.
• Thiamine deficiency leads to Wernicke’s encephalopathy and Korsakoff syndrome

Question 22

Give 3 features of Wernicke’s encephalopathy

Answer 22

• Confusion and disorientation
• Oculomotor dysfunction - nystagmus, lateral rectus palsy
• gait ataxia

Question 23

Describe the presentation of Korsakoff syndrome

Answer 23

Memory impairment:
* confabulation - person creates false memories or distorts information about themselves or the world
* retrograde amnesia - inability to remember events from the past
* anterograde amnesia - can’t form new memories
* Behavioural changes

Question 24

Give 5 features of substance misuse from ICD-10 criteria

Answer 24

• acute intoxication
• hazardous use
• tolerance to substance
• withdrawal
• prioritising over commitments
• compulsion to take
  3 or more for > 1 month

Question 25

Give 4 features of opioid misuse

Answer 25

• rhinorrhoea
• needle track marks
• drowsiness
• pinpoint pupils
• watering eyes

Question 26

How is an opioid overdose managed

Answer 26

IV/IM naloxone

Question 27

Give 4 complications of opioid misuse

Answer 27

• viral infections - HIV, hep B/C
• bacterial infections - infective endocarditis, septic arthritis
• VTE
• respiratory depression and death

Question 28

How is opioid dependence managed

Answer 28

• specialist drug dependence clinics
• detoxification: methadone (full agonist) or buprenorphine (partial agonist)
• Naltrexone - help prevent relapse

Question 29

How is nicotine dependence managed

Answer 29

• nicotine replacement therapy
• bupropion (reduce pleasure)
• varenicline (reduce cravings)