Alcohol and Drugs

Question 1

What is the definition of tolerance?

Answer 1

1. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
   OR
2. Markedly diminished effect with continued use of the same amount of the substance.

Question 2

What are the different types of substance use disorders?

Answer 2

1. Alcohol use disorder
2. Alcohol intoxication
3. Alcohol withdrawal
4. Substance use disorder (specify which substance)
5. Substance intoxication (specify which substance)
6. Substance withdrawal (specify which substance)

Question 3

What are the features of alcohol withdrawal?

Answer 3

1. Autonomic hyperactivity (tachycardia, sweating)
2. Increasing hand tremors
3. Hallucinations (usually visual or tactile)
4. Nausea or vomiting
5. Insomnia
6. Psychomotor agitation
7. Generalised tonic-clonic seizures
8. Anxiety

Question 4

What are Prochaska and DiClemente’s stages of change?

Answer 4

1. Precontemplation (I don’t have a problem)
2. Contemplation (May I have a problem?)
3. Determination (I do have a problem and I want to do something about it)
4. Action (I am doing something about my problem)
5. Maintenance (I am maintaining my change)
6. Relapse –> Precontemplation

Question 5

What is the CAGE screening test for alcohol/substance dependence?

Answer 5

Cut down: Have you ever wanted to cut down your drinking?
Annoyed: Have you felt annoyed when people bring up or criticise your drinking?
Guilt: Have you ever felt guilty about your drinking?
Eye opener: Have you ever needed a drink on waking?

Question 6

How do you treat alcohol or substance use disorders?

Answer 6

Biological:
- Alcohol: naltrexone (opioid antagonist) - reduces cravings and highs from alcohol or disulfiram (inhibits aldehyde dehydrogenase) - makes you feel terrible. But note risk of CV collapse or seizure if severe use
- Methadone for opioid addiction
Psychological:
- 12 step programmes
- Alcoholics/narcotics anonymous/group therapy
- CBT
- Counselling
- Motivational interviewing
Social:
- Education around substance risk/risky behaviours that may come with substance use
- Family therapy/couples therapy
- Family involvement in detoxification process

Question 7

How do you manage alcohol withdrawal?

Answer 7

1. Benzodiazepines - use CIWAr score
2. Pabrinex
3. Thiamine (200mg IV/IM) for at least 3 days

Question 8

What percentage of people with alcohol withdrawal develop delirium tremens?

Answer 8

1-2% of people with alcohol use disorder

Question 9

What causes Wernicke’s encephalopathy and Korsakoff’s syndrome?

Answer 9

Wernicke’s is an acute reversible condition caused by severe thiamine deficiency.

Korsakoff’s syndrome is caused by chronic thiamine deficiency

Question 10

What is the classic triad of Wernicke’s encephalopathy?

Answer 10

1. Gait ataxia
2. Confusion
3. Oculomotor dysfunction