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Alcohol and Substance Misuse Flashcards

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1
Q

How common is alcohol excess?

A

37% of M and 29% of F in the UK frequently exceed the safe daily alcohol limits

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2
Q

What causes alcohol withdrawal symptoms?

A

decreased GABA and increased NMDA

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3
Q

What are some of the problems associated with alcohol use and dependence?

A
  • Psychiatric or physical illness increases the risk of alcohol use and dependence (or vice versa)
  • Alcohol dependence is linked to antisocial and borderline personality traits
  • Age of first drink is relevant to risk of dependence and harmful drinking
  • Cirrhosis F>M
  • Alcohol dependence increases risk of arrhythmias i.e. AF, cardiomyopathy and haemorrhagic stroke
  • Alcohol = commonest cause of chronic pancreatitis
  • Also increases risk of suicide
  • Common cause of seizures – be aware of this for detox
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4
Q

What is Wernicke’s encephalopathy/what are the symptoms?

A

acute confusion
oculomotor signs
ataxic gait

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5
Q

What is Korsakoff’s encephalopathy?

A
  • Anterograde (+/- retrograde) amnesia
  • Confabulation – false memories
  • Apathy
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6
Q

How is Wernickes treated? What are the outcomes?

A

untreated mortality - 15%
- 80% progress to Korsakoff’s
Pabrinex

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7
Q

How is Korsakoff’s treated? What are the outcomes?

A

May require OT input, home care etc.
Oral pabrinex usually sufficient
20% recover completely, 25% significant recovery

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8
Q

Describe alcohol related brain damage (ABRD)

A

Affects short-term memory, long-term recall and executive function
Cortical and subcortical atrophy and white matter loss on CT

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9
Q

How is alcohol misuse managed?

A
  • Outpatient or community detox is used unless: severe dependence, Hx of withdrawal seizures or delirium tremens, unsupportive home, previous failed detox.
  • Benzodiazepines can be given short term to relieve severe symptoms
  • Give thiamine B1 to prevent Wernicke’s Encephalopathy (Pabrinex if oral is inadequate)
  • Also multivitamins
  • Chlordiazepoxide (Librium) for initial detox and decreased seizure incidence
  • May need symptomatic relief i.e. Loperamide, anti-emetics
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10
Q

How does disulfiram (antabuse) work?

A

Causes unpleasant symptoms – vomiting, anxiety, flushing, palpitations etc. if alcohol consumed
C/I if Hx cardiorespiratory disease

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11
Q

How does acamprosate (cameral) work?

A

Reduces craving and relapse rates

Can use while drinking

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12
Q

How does naltrexone (nalorex) work?

A

Reduces cravings and pleasant effects of alcohol

“Sinclair Method”

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13
Q

Should you use antidepressants or benzos when treating alcohol misuse?

A

Only if treating comorbid psychiatric illness

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14
Q

What psychosocial interventions can be used?

A
  • Motivational interviewing
  • CBT
  • Group therapy
  • AA – 12 step programme
  • Social support
  • Primary prevention – alcohol cost increase is most effective
  • Drug and alcohol services
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15
Q

What is the recommended limit of alcohol consumption?

A

Not more than 14 units a week regularly

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16
Q

What is the ICD-10 criteria for diagnosing criteria of substance misuse?

A

TWO STEP

1 - specify the substance or class of the substance

examples - alcohol, opioids, cocaine, solvents

2 - specify the type of disorder 
acute intoxication,
harmful use, 
dependence syndrome,
withdrawal state (with/without delirium),
psychotic disorder,
amnestic disorder
17
Q

What is acute intoxication?

A
  • transient physical and mental abnormalities occurring shortly after administration and caused by the direct effects of the psychoactive substance
  • may cause disturbances in level of consciousness, cognition, perception affect, behaviour and or other physiological functions
  • effects are specific and characteristic of each substance
18
Q

How is harmful use defined?

A
  • the continuation of substance use despite evidence of damage to the user’s physical or mental health or to their social, occupational or familial well-being
  • damage may be denied or minimised by the individual concerned
19
Q

What is the withdrawal state?

A
  • Where there is physical dependence on a drug, abrupt cessation or partial withdrawal of the substance generally leads to withdrawal symptoms
  • Some drugs are not associated with withdrawal and some only mild withdrawal
  • Clinically significant withdrawal symptoms opiates, alcohol, benzodiazepines, cocaine and amphetamines
  • Withdrawal symptoms seizures, delirium, psychotic symptoms
20
Q

What is dependence syndrome?

A

Comprises a cluster of physiological, behavioural and cognitive phenomena relevant to a person’s relationship with a particular substance or a class of substance

21
Q

What are the core features of dependence syndrome?

6 features and descriptions

A

Primacy - the drug and need to obtain it become the most important thing in the person’s life

Continued use despite negative consequences - the user continues with substance use even when threatened with significant losses as a direct consequence of continued use

Loss of control of consumption - a subjective sense of inability to control or restrict further consumption once the drug is taken

Narrowing of the repertoire - user moves to taking a single drug in preference to all others

Rapid reinstatement of dependent use after abstinence

Tolerance and withdrawal

22
Q

What is tolerance?

A
  • Over time more of the drug must be taken to achieve the same intensity of pleasurable effects
  • Able to consume large quantities of specific substances while showing no or few signs of intoxication
23
Q

What is substance induced psychotic disorder?

A

• Individual presents with psychotic symptoms as a direct result of substance-induced neurotoxicity

24
Q

What percentage of men and women are dependent on alcohol?

A

9% men

4% women

25
Q

What is the most common cause of alcohol related death?

A

Alcoholic liver disease

26
Q

What are some BIO causes of alcohol dependence?

A

family of alcohol dependent pts have an increased risk

27
Q

What are some PSYCHOLOGICAL causes of alcohol dependence?

A

mental illness increased risk

stress, social anxiety, low self esteem are associated with alcohol misuse

28
Q

What are some SOCIAL causes of alcohol dependence?

A

heavy drinking is more common in MEN
morality is higher is more deprived class
RFs - social isolation, lack of spouse, profession - bartender, farmer, medics

29
Q

What medical problems can alcohol misuse cause?

A

See notes

cognitive impairment 
wernicke-korsakoff syndrome 
cerebellar degeneration 
increased susceptibility to infection 
CV - HTN, arrhythmias, CV events
Cirrhosis --> hepato-renal syndrome
CKD
Alcoholic liver disease 
Alcoholic hepatitis
Splenomegaly 
Mallory-weiss tears 
gastric erosions 
Erectile dysfunction 
sexual dysfunction
30
Q

What are some psychiatric complications of alcohol misuse?

A

Alcoholic hallucinosis
Alcohol related brain injury - cognitive impairment
Psych comorbidity - anxiety, suicide, schizophrenia
Pathological jealousy

31
Q

What are SOCIAL consequences of alcohol misuse?

A
  • Psychological harm to family members
  • Marital disharmony and divorce
  • Risky sexual activity
  • Domestic violence
  • Missed days of work and poor work performance
  • Financial and legal problems
32
Q

How common is illicit drug use?

A

lifetime prevalence is 36% in adults

33
Q

How is opiate detoxification carried out? BIO

A
  • Substitutes i.e. methadone, buprenorphine
  • Lofexidine
  • Loperamide, metoclopramide for symptomatic relief

Naloxone or Naltrexone in the community to decrease overdose risk

34
Q

What are the psychosocial aspects of opiate detoxification?

A 
•	Drug and Alcohol services
•	Narcotics Anonymous
•	Social support: housing, child care, finances, employment
•	Individual counselling
•	Motivational Interviewing
•	CBT 
•	Psychoeducation
Rehab
35
Q

What are the withdrawal symptoms of benzos?

A

hallucinations, convulsions delirium

36
Q

How is benzo withdrawal managed?

A

• Mx involves switching to a longer acting benzo and then reducing the dose slowly over a number of weeks

37
Q

What are the initial investigations carried out for substance misuse?

A
  • Bloods - MCV is best indicator of alcohol abuse, will be low even after 6 months of abstinence, FBC, TFTs
  • LFTs - GGT best indicator of alcohol abuse
  • U+Es
  • BM
  • Urine drug and alcohol screen
  • Breathalyse as necessary on admission
38
Q

Why is a physical exam important in substance misuse?

A
  • IVDU are at risk of abscesses, infected injection sites, DVTs, PEs, endocarditis etc.
  • SM patients are unlikely to present to GP regularly so they are at higher risk of undiagnosed physical conditions

Psych (7 decks)

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