Alcohol and substance misuse Flashcards
What is the ICD-10 criteria for substance misuse
Acute intoxication
Harmful use
Dependence syndrome
Withdrawal state
Psychotic disorder
Amnesic syndrome
Residual disorder (flashbacks)
What are the clinical features of substance misuse
Physical
- Death, infection, endocarditis, VTE
Psychological
- Cravings, anxiety, cognitive disturbance, drug-induced psychosis
Social
- Crime, imprisonment, homelessness, prostitution
Ask about TRAP
- Type, route, amount, pattern
What investigations are needed for substance misuse
Bloods
- HIV/Hep screen, normal bloods, drug levels
Urine drug test
ECG
Consider ECHO
What is the management of substance misuse
Hep B immunisation
Motivational interviewing
CBT
Contingency management (incentives for positive behaviour)
Social support
Self-help groups
Consider DVLA guidance
What is the management of opioid dependence
Methadone
- Detoxification and maintenance
IV naloxone
- Antidote for opioid overuse
What is binge drinking
Drinking double the recommended level per day, in one session
What is harmful alcohol use
Drinking above safe levels
Evidence of alcohol-related problems
What is the pathophysiology of alcohol abuse
Pleasurable and stimulant effects due to dopamine
When withdrawn, get CNS hyper-excitability
What are the risk factors for alcohol abuse
Male
Young adult
Genetics
Antisocial behaviour
Lack of facial blushing
Life stressors
What are the symptoms of alcohol intoxication
Slurred speech
Labile affect
Impaired judgement
Poor co-ordination
Hypoglycaemia
Stupor
Coma
What are the symptoms of alcohol dependence
Subjective awareness
Avoidance
Withdrawal symptoms
Drink-seeking behaviour
Reinstatement
Increased tolerance
Narrowing of drinking repertoire
What are the symptoms of alcohol withdrawal
Malaise
Tremor
Nausea
Insomnia
Transient hallucinations
Autonomic hyperactivity
Usually at 6-12 hours of abstinence
What is delirium tremens
24 hrs - 1 week after alcohol cessation
Dehydration and electrolyte disturbance
Presentation
- Cognitive impairment, vivid hallucinations, paranoid delusions, marked tremor, autonomic arousal
Treatment
- Large dose benzodiazepines
- Haloperidol
- IV pabrinex
What investigations are needed for alcohol abuse
Bloods
- FBC, U&Es, LFTs, blood alcohol levels, MCV, B12/folate, TFTs, amylase, hepatitis serology, glucose
Questionnaires
Consider CT head/ECG
What is the management of alcohol abuse based on the bio-psycho-social model
Biological
- Chlordiazepoxide detox regime + thiamine
- Disulfiram/nalterexone, acamprosate
- Treat medical and psychiatric complications
Psychological
- Motivational interviewing
- CBT
- Environment-based therapies
Social
- AA, social support
