Alcohol and substance misuse

Question 1

What are the criteria for substance dependence?

Answer 1

3+ in the last 12 months of:

1. Tolerance
2. Withdrawal symptoms when stopped
3. Using more or for longer than intended
4. Unsuccessful attempts to reduce use
5. Large amount of time spent on the habit
6. Prioritising the habit over other activities
7. Persistent use despite knowing harmful consequences

Question 2

What are the criteria for alcohol dependence according to ICD-10?

Answer 2

3+ in the last 12 months of:

1. Strong desire or compulsion to drink
2. Difficulty in controlling drinking
3. Withdrawal state or use of alcohol to avoid withdrawal
4. Tolerance
5. Neglect of alternative interests
6. Continued use despite harmful consequences

Question 3

What pharmacotherapy might be used in alcohol dependence?

Answer 3

Disulfiram - an aversive agent which produces unpleasant side effects if alcohol is drank
Acamprosate - anti-craving agent, useful to maintain abstinence

Question 4

What pharmacotherapy might be used in opiate dependence?

Answer 4

For heavy users: Methadone or bupenorphrine for maintenance

For those successfully detoxified: naltrexone (an opioid antagonist) can be used for relapse prevention

Question 5

How is alcohol withdrawal managed?

Answer 5

Chlordiazepoxide reducing regimen over 5-7 days

Question 6

What drug is used in reversal of a benzodiazepine overdose?

Answer 6

Flumenazil

Question 7

What is Wernicke’s encephalopathy?

Answer 7

Most dramatic neuropsychiatric complication of alcohol withdrawal. Occurs secondary to thiamine (B1) deficiency. It is characterised by ataxia, nystagmus, ophthalmoplegia and acute confusion

Question 8

What is Korsakoff’s psychosis?

Answer 8

Prominent impairment of recent and remote memory with preservation of immediate recall in the absence of generalised cognitive impairment. Confabulation is often a feature.

Question 9

What is delirium tremens?

Answer 9

A potentially fatal confusional state that occurs 1-7 days after the last alcoholic drink, peaking at 48 hours. It is characterised by tremor, clouding of consciousness, disorientation, agitation, hallucinations (characteristically of little people or animals). There may be autonomic instability, mood instability, illusions and convulsions. Managed with chlordiazepoxide/diazepam

Question 10

What drug is used in reversal of an opiate overdose?

Answer 10

Naloxone