Addictive Behaviours Flashcards
What is addiction?
Primary, chronic disease of brain reward, motivation, memory and related circulatory
What is an alcoholic?
- Someone whose problematic pattern of alcohol use leads to clinically significant impairment or distress
What are the UK guidelines for alcohol consumption?
- Alcohol intake limited to 14 units per week for men and women
- 1 unit = 10ml = 8g pure alcohol
=> Units = volume x ABV
=> If you do drink as much as 14 units per week, it is best to spread this over 3 days
What are the risk factors of alcohol addiction?
- Exceeding weekly alcohol limit
- Parent with alcohol use disorder
- Depression, anxiety or schizophrenia
- Peer pressure
- Low self-esteem
- High levels of stress
What are the symptoms of alcohol addiction?
Can be categorised as:
- Behavioural
- Physical
=> Behavioural symptoms:
- Drinking alone
- Having high tolerance
- Violence/anger when asked about their drinking
- Lack of personal hygiene
- Missing work or school because of drinking
- Making excuses to drink
- Giving up important activities because of alcohol
=> Physical symptoms:
- Alcohol cravings
- Withdrawal symptoms
- Tremors
- Lapses in memory
- Illness (eg alcohol ketoacidosis or cirrhosis)
What is the pathophysiology of Alcoholism?
- GABA is an inhibitory neurotransmitter
- Glutamate is an excitatory neurotransmitter
- Ethanol is the main molecule in alcohol
- Acts as a GABA agonist and Glutamate antagonist
What are the affects of alcohol on different parts of the brain? => Nucleus Accumbens & Amygdala => Cerebral Cortex => Prefrontal Cortex => Cerebellum => Hypothalamus & pituitary gland => Medulla
=> Nucleus Accumbens & Amygdala:
- Induces pleasant and rewarding feelings
=> Cerebral Cortex:
- Slows everything down, making thinking and speaking difficult
=> Prefrontal Cortex:
- Behavioural inhibition
=> Cerebellum:
- Loss of co-ordination
=> Hypothalamus & pituitary gland:
- Increased sexual arousal but decreased ability to engage
=> Medulla:
- Slows breathing, lowers body temp and increases sleepiness
What are the different theories behind Alcohol Tolerance?
=> GABA, Glutamate and Dopamine receptors become less sensitive to alcohol
=> Neurones lose receptors
What are the symptoms of Alcohol withdrawal?
- Symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
- Peak incidence at 36 hours
- Peak incidence of delirium tremens 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
What are the investigations in suspected Alcoholics?
=> Bloods
- Increased GGT
- Increased ALT
- Increased MCV
- AST:ALT > 2
- Decreased urea and platelets
=> TWEAR Screening questions:
Alcohol Tolerance increased? - 2
Worried about drinking? - 2
Use of alcohol as eye-opener in morning? - 1
Amnesia after alcohol? - 1
Ever felt need to cut down on drinking? - 1
Score ≥ 2 suggests alcohol problem
What is the management of Alcohol Withdrawal?
- First line benzodiazepine - Chlordiazepoxide
- Lorazepam preferred in those with hepatic failure
=> Methods of prevention:
- Alcohol free beers
- Group therapy
- Suggest graceful ways of declining alcohol consumption
What is the addictive component of cigarettes?
Nicotine
How do you calculate smoking pack years?
1 pack year = 20 cigarettes per day for one year
What are the clinical features of Nicotine addiction?
- Cravings
- Snacking and weight gain
- Sleep disturbance
- Persistent cough
- Flu like symptoms
- Irritability
- Constipation
- Impaired concentration
What is the main management of smoking addiction?
Nicotine replacement therapy
=> Forms of Nicotine replacement therapy:
- Nicotine gum
- Transdermal nicotine patches
- E-cigarettes
- Varenicline (PO selective Nicotine receptor partial agonist)
- Buproprion (Only consider if all else fails. Contraindicated in epilepsy)
