Alcohol and Drug addiction

Question 1

What are the symptoms of (alcohol) intoxication?

Answer 1

Impaired attention and judgements
Unsteadiness
Flushing
Nystagmus
Mood instability
Disinhibition
Slurring
Stupor
Unconsciousness

Question 2

Define “harmful use”

Answer 2

pattern of use causing damage to physical or mental health. Use >1 month or repeatedly over 12 months

Question 3

What features constitute “dependence” on a substance?

Answer 3

Cravings/compulsions to take
- Difficulty controlling use
- Primacy
- Increased tolerance
- Physiological withdrawal on reduction/cessation
- Persistence despite harmful consequences

Question 4

Describe the features of alcohol withdrawal

Answer 4

STAND mnemonic

Seizures
Tremor and weakness
Anxiety/Agitation
Nausea and vomiting
Death

Question 5

What is delirium trements?

Answer 5

An acute alcohol withdrawal state that comes on 24-72 hours after alcohol is stopped
Hyperadrenergic state
–> Medical emergency

Question 6

Describe the features of delirium tremens

Answer 6

Features of alcohol withdrawal PLUS altered mental status:

• confusion
• altered level of consciousness
• sleepiness
• tremor
• agitation
• hallucinations
• delusions

Question 7

What is the mortality rate of delirium tremens?

Answer 7

5%

Question 8

How can delirium tremens be fatal?

Answer 8

Cardiovascular collapse
Infection
Hyperthermia
Seizures
Self-injury

Question 9

Give four problems caused by alcohol

Answer 9

• Liver disease (and other physical health problems)
• Lover (relationships)
• Livelihood – ability to work
• Legal aspects

Question 10

Give two neurological conditions linked to alcoholism. What causes these?

Answer 10

Wernicke’s encephalopathy
Korsakoff’s psychosis

–> Thiamine deficiency

Question 11

What is the main difference between Wernicke’s encephalopathy and Korsakoff’s psychosis?

Answer 11

Wernicke’s is reversible whereas Korsakoff’s is irreversible

Question 12

Describe the CAGE screening tool for alcoholism

Answer 12

2 or more = likely alcohol problem

• Have you tried to Cut down?
• Have you felt Annoyed by people criticising your drinking?
• Have you felt Guilty about drinking?
• Have you felt the need to have an Eye-opener?

Question 13

Give four screening tools available to screen for alcoholism

Answer 13

CAGE
AUDIT (Alcohol Use Disorders Identification Test)
FAST
PAT (Paddington Alcohol Test)

Question 14

What treatment is used to prevent Wernicke-Korsakoff syndrome?

Answer 14

Thiamine

Question 15

Which drugs can be used to manage alcohol withdrawal?

Answer 15

Benzodiazepines, commonly Chlordiazepoxide

Question 16

What is Disulfiram?

Answer 16

An aversion/deterrent medication used to help reduce alcohol consumption

Question 17

Give three examples of anti-craving medications

Answer 17

 Acamprosate (Campral)
 Naltrexone, Nalmefene – long acting opioid antagonists
 (Baclofen)

Question 18

How long does it take for fatty liver to return to normal after abstinence?

Answer 18

Up to 6 weeks

Question 19

What percentage of patients with fatty liver will go on to develop cirrhosis?

Answer 19

20%

Question 20

What is the most common precipitant of decompensated liver disease?

Answer 20

Infection

Question 21

Give three manifestations of decompensated liver disease

Answer 21

GI bleed
Encephalopathy
Ascites

Question 22

Among cirrhosis patients, what is the mortality rate from hepatocellular cancer?

Answer 22

20 - 25%

Question 23

Define tolerance

Answer 23

Reduced responsiveness to a drug caused by previous administration

Question 24

Give four examples of drugs which people develop tolerance to

Answer 24

Alcohol
Opioids
Barbiturates
Benzodiazepines

Question 25

What is the difference between “dispositional tolerance” and “pharmacodynamic tolerance”?

Answer 25

Dispositional: less drug reaches the active site

Pharmacodynamic: drug has less action at the active site

Question 26

What causes dependence on a substance?

Answer 26

Tolerance means that the substance is required to be in the normal state
This leads to withdrawal
People become dependent to avoid withdrawal effects

Question 27

What is withdrawal phenomena?

Answer 27

Usually the reverse of the acute effect of the drug

Question 28

Which parts of the brain are involved in the reward pathway?

Answer 28

Neurones project from the ventral tegmental area to the nucleus accumbens & prefrontal cortex
When VTA neurones are stimulated they release dopamine is released

Question 29

What causes the psychological component of addiction (i.e. cravings)

Answer 29

Reward centres

Question 30

Give four drugs which act on the reward centres of the brain and describe their effects

Answer 30

Heroin - increases firing rate of dopaminergic neurones
Amphetamine - increases dopamine release
Cocaine - inhibits dopamine uptake
Alcohol