Addictive behaviours Flashcards
What is an addictive behaviour
Repeated behaviours that dominate the patient’s life to the detriment of social, occupational and family commitments as well as physical and psychological health
Define tolerance
refers to a loss of effect when taking the same dose
What is drug dependence
a physiological and psychological need to keep using a drug
Features of alcohol dependence
- daily alcohol consumption
- strong urges and cravings for alcohol
- difficulty controlling consumption
- tolerance to the effects of alcohol
- withdrawal symptoms when stopping
Describe the mechanism of action of chronic alcohol consumption
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
Give a formula for calculating alcohol units
Volume (ml) x Alcohol content (%) / 1000 = units of alcohol
Give 3 recommendations by the department of health on alcohol consumption
- Not more than 14 units per week
- Spread evenly over 3 or more days
- Not more than 5 units in a single day
What is the definition of binge drinking for women?
Binge drinking for women is defined as consuming 6 or more units of alcohol in a single session.
What is the definition of binge drinking for men?
Binge drinking for men is defined as consuming 8 or more units of alcohol in a single session.
Give 5 clinical findings seen with alcohol intoxication
- smelling of alcohol
- Slurred speech
- Bloodshot eyes
- Dilated capillaries on the face (telangiectasia)
- ataxia
How is harmful alcohol use investigated
- AUDIT questionnaire
- CAGE questions
- severity of alcohol dependence questionnaire
- blood tests
What is the AUDIT questionnaire
- Alcohol Use Disorders Identification Test (AUDIT) screens for harmful alcohol use
- involves ten questions with multiple-choice answers and gives a score
What score indicates harmful alcohol use on the AUDIT questionnaire
A score of 8 or more indicates harmful use
Describe the CAGE questions used to screen for harmful alcohol use
- 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?
Give 4 abnormal blood results that can occur with alcohol excess
- Raised mean corpuscular volume (MCV)
- Raised ALT and AST
- AST:ALT ratio above 1.5 particularly suggests alcohol-related liver disease
- Raised gamma-GT
What are the common withdrawal symptoms and their typical onset times after ceasing alcohol consumption?
- 6-12 hours: tremors, sweating, headache, tachycardia and anxiety
- 12-48 hours: seizures
- 48-72 hours: delirium tremens
Explain the mechanism of alcohol withdrawal
- 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
Give 5 features of delirium tremens
- acute confusion
- delusions and hallucinations
- tachycardia
- coarse tremor
- hyperthermia
How is alcohol withdrawal managed
- 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)
How is alcohol dependence managed in the long term
- alcohol detoxification programme
- oral thiamine
- maintenance:
- disulfiram promotes abstinence: alcohol intake causes severe reactions due to inhibition of acetaldehyde dehydrogenase
- Acamprosate (weak NMDA receptor antagonist): reduces cravings
- naltrexone
Give 5 complications of chronic alcohol abuse
- Liver disease: ALD, cirrhosis
- Wernicke-Korsakoff syndrome
- alcoholic cardiomyopathy
- increased risk of CVD - stroke, MI
- Pancreatitis
Why are alcoholics at risk of Wernicke-Korsakoff Syndrome
- Alcohol excess leads to thiamine (vitamin B1) deficiency.
- Thiamine deficiency leads to Wernicke’s encephalopathy and Korsakoff syndrome
Give 3 features of Wernicke’s encephalopathy
- Confusion and disorientation
- Oculomotor dysfunction - nystagmus, lateral rectus palsy
- gait ataxia
Describe the presentation of Korsakoff syndrome
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
Give 5 features of substance misuse from ICD-10 criteria
- acute intoxication
- hazardous use
- tolerance to substance
- withdrawal
- prioritising over commitments
- compulsion to take
3 or more for > 1 month
Give 4 features of opioid misuse
- rhinorrhoea
- needle track marks
- drowsiness
- pinpoint pupils
- watering eyes
How is an opioid overdose managed
IV/IM naloxone
Give 4 complications of opioid misuse
- viral infections - HIV, hep B/C
- bacterial infections - infective endocarditis, septic arthritis
- VTE
- respiratory depression and death
How is opioid dependence managed
- specialist drug dependence clinics
- detoxification: methadone (full agonist) or buprenorphine (partial agonist)
- Naltrexone - help prevent relapse
How is nicotine dependence managed
- nicotine replacement therapy - patches + gum/inhalor/lozenge
- bupropion (reduce pleasure)
- varenicline (reduce cravings)
