Alcohol and substance abuse 2 Flashcards
What is harm reduction?
Needle distribution and exchange program
Advice about safer injecting practice
Naloxone to take home to reverse opiate OD
Substitute prescribing- methadone
Assessment /treatment of comorbid illness
Education about safe sex
What are the stages of change?
Pre-contemplation- no intention of changing behaviour, may be unaware of problem
Contemplation- aware of problem but no commitment to change
Preparation- intent on taking action, convinced that change is good and believes the change can be made
Action- actively modifying behaviour
Maintenance- sustained change occurs, new behaviour replaces old one (transitional stage, can relapse)
Relapse- falls back into old patterns of behaviour (cycle begins again)
Upward spiral- each time they go through he cycle, learn from each relapse
What are positive and negative prognostic factors for change?
Positive: Motivated to change Supportive relationships In employment Treated comorbid mental illness Involved in AA services Negative: Undecided about change Unstable accommodation/homeless Absence of pro-social relationships Unemployment Primacy - limited life outside substance Repeated treatment failures Cognitive impairmen
What occurs in motivational interviewing?
Develop discrepancy
Express empathy
Support self-efficacy
Roll with resistance
What is the biological management of alcohol misuse?
Disulfiram- used to deter from alcohol abuse
Causes irreversible inhibition of ALDH, causing a build-up of acetaldehyde when alcohol
is consumed
Causes flushing, headache, tachycardia, N+V within 20 mins
Acamprosate- reduces cravings for alcohol
Enhances GABA transmission in the brain
Variable course, many relapses
Highly functional adults show >65% 1 year abstinence rate following treatment
What is the biological management for opiate detoxification?
Symptomatic medication - non-opiate medications can alleviate symptoms of opiate withdrawal
Lofexidine- alpha-adrenergic agonists to reduce sympathetic outflow
Loperamide and metoclopramide- diarrhoea, N+V
Substitute prescribing:
Methadone is a long acting synthetic opioid that has a 24 hour half life scan be used
once daily
Need to confirm dependence by a urine drug screen, as severe respiratory
depression may result if patient is not tolerant
Aim to slowly reduce dose
Buprenorphine: partial opiate agonist
Treat opiate dependence
Taken OD sublingually
Reducing dose to avoid withdrawal syndrome
What is the biological management for other illicit drugs?
Benzodiazepines:
Need to avoid withdrawal symptoms - convert from short acting benzo to long acting Reduce dose slowly by a few amounts each week
Cocaine and amphetamines:
These can be stopped abruptly
Antidepressants may help the depressed mood following withdrawal Benzos or antipsychotics help psychotic symptoms
What are the harmful effects fo heroin?
Nausea and vomiting, constipation, respiratory depression and loss of consciousness (with risk of aspiration)
Intravenous use adds the risk of local abscesses, cellulitis, osteomyelitis, bacterial endocarditis, septicaemia and transmission of viral infections including Hepatitis B, C and HIV.
Opiate dependency develops after weeks of regular use
What are the harmful effects of cocaine?
Acute: Cardiovascular: tachycardia, hypertension and generalised vasoconstriction Acute anxiety, panic attacks, impaired judgement Chronic: Necrosis of nasal septum and sinuses CKD secondary to hypertension Use in pregnancy: increased risk of miscarriage and placental abruption Psychiatric complications Withdrawal: dysphoria and anxiety fatigue and difficulty concentrating craving for cocaine muscle aches and tremors Resolve in less than a fortnight
What are the harmful effects of cannabis?
Increased heart rate
Dizziness
Increased appetite
Increased risk of respiratory disease and other smoking-related pathology
provoke acute anxiety, panic attacks. Some users may develop acute psychotic symptoms.
Chronic harmful use may cause dysthymia, reduced motivation and anxiety disorders
Increased risk of developing schizophrenia
What are the harmful effects of MDMA?
Acute:
Jaw clenching and teeth grinding
Nausea
Blurred vision
Increased body temperature leading to dehydration
Come down effects, 12-48 hours after
Chronic effects:
Develop tolerance, dependence doesn’t occur
Depressions and anxiety are associated with chronic use
What are the harmful effects of LSD?
Acute:
Dilated pupils, tachycardia and hypertension
Perceptual distortions and high risk behaviour
Delusions and hallucinations
Chronic:
Not associated with psychological dependence or withdrawal
Chronic psychotic illness and anxiety disorders
What re the harmful effects of benzodiazepines?
Intoxication, drowsiness, dizziness, blurred vision, impaired concentration/coordination
Hypotension and respiratory depression
Chronic:
Impaired memory and concentration
Depression
Tolerance and dependence within 3-6 weeks of regular use
Unpleasant withdrawal (agitation, anxiety and insomnia). Complicated by seizures, delirium and psychosis
Withdrawl often requires medical management and may be fatal
What are the objective signs in opioid withdrawal?
Epiphoria (eyes watering), rhinorrhoea, agitation, perspiration, piloerection, tachycardia, vomiting, shivering, yawning and dilated pupils
