Alcohol and substance misuse Flashcards
One unit of alcohol
10ml or 8g of pure alcohol
Low risk alcohol consumption
‘Safe drinking’ - unlikely to be associated with harm
M <14 units/week
Hazardous drinking
Intake likely to increase risk of alcohol related harm
M 22-50 u/w
F 15-35 u/w
Harmful drinking
‘Alcohol misuse’ a pattern of drinking associated with alcohol related harm
Males >50 u/w
Females >35 u/w
Alcohol dependence
Three or more of:
Strong desire or compulsion to drink
Difficulty in controlling the onset or termination of drinking or the levels of alcohol use
Withdrawal on cessation of alcohol or its use to avoid withdrawal symptoms
Increasing tolerance
Progressive neglect of other interests
Persistent use of alcohol despite awareness and clear evidence of the harm it is causing
Complications of alcohol use
Death Hospital admission Domestic accidents/death Domestic fire Workplace accidents Homicides Domestic violence
Intoxication phenomena
eg lability of mood, memory black-outs, belligerence
Alcohol withdrawal phenomena
Occur when alcohol suddenly stopped or significantly reduced
First symptoms 8-12hours after last drink, delirium may occur within one 2-3 days
Mild: tremor, nausea, sweating, insomnia, mood disturbance, restlessness, agitation, anxiety, fear, tinnitus, cramps, noise sensitivity
Severe: seizures (12-48h); Delirium Tremens - acute confusional state, 3 days after last drink, lasting up to 7 days. Disorientation, visual hallucinations, agitation, fearfulness, sweating and tremors. Significant mortality rate
Also depression, anxiety and psychotic illnesses
Just that they often co-exist
May trigger and illness or may be a sign of pre-existing illness
Alcoholic hallucinations
Auditory hallucinations occurring in clear consciousness
During heavy drinking or withdrawal
Morbid jealousy (Othello syndrome)
Delusion that partner is unfaithful
May result in domestic violence or death of the partner
Alcoholic dementia
Specific cognitive deficits
May or may not be accompanied by non-progressive impairment of intellectual capacity
Wernecke’s encephalopathy
Thiamine deficiency → haemorrhage in the mammillary bodies of posterior hypothalamus and nearby midline structures
Opthalmoplegia
Ataxia
Confusional state
Reversed to a large extent by administration of thiamine
Korsakoff’s syndrome
Thiamine deficiency → haemorrhage into the mammillary bodies of posterior hypothalamus and nearby midline structures
Profound short term memory loss with preservation of other intellectual capacities
Gaps in short term memory filled in by confabulation
Resolution less predictable
Physical disorders from alcohol overuse
GI: Hepatitis, pancreatitis, cirrhosis, Mallory-Weiss tears
CVS: hypertension, alcoholic cardiomyopathy
CNS: seizures, peripheral neuropathy, cerebellar degeneration, dementia, myopathy
Others: malnutrition, vit deficiency, fetal damage
CAGE
Do you feel you need to Cut down?
Do you ever get Annoyed at people criticising your drinking?
Do you every feel Guilty about the amount you drink?
Do you use alcohol as an Eye opener in the morning?
Questions to ask about drinking if concerned
Consumption over previous 3 months: typical day, frequency, max/day
Morning drinking to stop shakes/previous failed attempts to stop
Alcohol related physical, emotional and social problems
Lab investigations: gamma GT, LFTs, MCV
Cannabis
Smoked
Profound sense of relaxation and mild euphoria
Mild paranoid ideation
?acute confusional state with delusions and hallucinations
Stimulants (amphetamines, MDMA)
Orally or IV (amphetamine)
Elevation of mood, increased alertness and physical activity
Rapid tolerance
Amphetamine pyschosis - florid, schizophrenia like illness. Usually subsides in a week but can persist for months
Sedatives (benzos, esp temazepam)
Hypnotic and anxiolytic
Tolerance, dependence and withdrawal
Hallucinogens (LSD, magic mushrooms)
Orally
Heightened perceptions, vivid imagery, illusions, hallucinations, state of euphoria
‘Bad trip’ - terrifying hallucinations and delusions
Regular use may lead to flashbacks to bad trips and emotional damage
Cocaine
Smoked, snorted, IV
CNS stimulation
Sense of euphoria
Cravings, tolerance and psychological dependency
Chronic use can lead to paranoid psychosis
Formication - feeling of bugs under the skin
Opiates
Smoked, IV
Euphoria, detachment, wellbeing, analgesia
Rapidly fatal in overdose
Tolerance and dependence
Withdrawal: restlessness, insomnia, piloerection, pupillary dilatation, nasal discharge, sweating, vomiting, diarrhoea, abdo pain, hyperaethesia, paraesthesia and cramps
Harmful effects of drug use
Drug effects
Social problems related to the drug use
Method of administration → infections eg. tetanus, abscesses, endocarditis, hep B/C/D, HIV, septicaemia
Non-infective medical problems: track marks, thrombophlebitis, venous thrombosis, arterial insufficiency, resp failure, pulmonary oedema, polyarteritis nodosa, pulmonary hypertension, PE, psychosis, depression, neuropathy, brain damage
