Alcohol and Substance Misuse Flashcards by Amy Fielding

State the seven ICD10 categories of Substance Misuse

1 - Acute Intoxication
2 - Harmful Use (but no dependence)
3 - Dependence Syndrome 
4 - Withdrawal State
5 - Psychotic Disorder 
6 - Amnesic Syndrome 
7 - Residual Disorder (Personality disorder etc as a result of substance misuse)

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Describe the Biological Aetiology behind Substance Misuse

Genetics (variations in enzymes that metabolise drugs)
Neurochemical Abnormalities
Mesolimbic Dopaminergic Reward Pathway

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Substance Dependence requires more than three of the following symptoms over a period of 1 month

Strong Complisooon
Preoccupation with Substance Misuse
Withdrawal State
Tolerance
Persistent use despite harm

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Give three examples of Stimulant Drugs

Cocaine
Crack
Ecstasy

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Describe the psychological effects of Stimulant Drugs

Euphoria
Increased Energy
Grandiose
Aggression

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Describe the physical effects of Stimulant Drugs

Tachycardia
Hypertension
Arrhythmias

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Describe the withdrawal effects of Stimulant Drugs

Lethargy
Psychomotor Agitation
Craving
Increased Appetite
Insomnia

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Name two Hallucinogens

LSD

Magic Mushrooms

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Describe the psychological effects of Hallucinogenic Drugs

Anxiety
Illusions
Hallucinations
Derealisation/Depersonalisation

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Describe the physical effects of Hallucinogenic Drugs

Tachycardia
Palpitations
Sweating
Tremor

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Describe the psychological effects of Volatile Solvent Drugs

Aggression

Impaired attention and judgement

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Describe the physical effects of Volatile Solvent Drugs

Unsteady Gait
Diplopia
Nystagmus

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Describe the psychological effects of Anabolic Steroids

Euphoria
Depression
Aggression
Mood Swings

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Describe the physical effects of Anabolic Steroids

Increased muscle mass
Reduced fat
Acne
Reduced sperm count

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Give 5 potential consequences of Substance Misuse

Endocarditis
Drug Induced Psychosis
DVT
Crime
Homelessness

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Give an example of a Class A drug and the subsequent UK law

Cocaine

7 years prison for possession, up to life for supply

Give an example of a Class B drug and the subsequent UK law

Ketamine

5 years for possession, up to 14 years for supply

Give an example of a Class C drug and the subsequent UK law

Benzodiazepines

Up to 2y possession and 14y for supply

Name four investigations for a known substance abuser

Bloods - BBV, LFTs, U&Es
Urinalysis - Drug Metabolites
ECG - Arrhythmias
Echo - Endocarditis

Describe the management of Opioid Dependence

Detoxification and Maintenance- Methadone/Buprenorphine

Continued Abstinence (ie after detoxification) - Naltrexone

Overdose antidote = Naloxone

Describe four psychosocial interventions for Substance Misuse

Motivational interviewing and CBT

Contingency Management (changing specific behaviours by offering incentives for positive behaviours)

Supportive help with finance/housing/employment

Narcotics Anonymous

Define Alcohol Abuse

Consumption of alcohol at a level enough to cause physical psychiatric and social harm

Define Binge Drinking

Drinking twice over recommended level of alcohol per day in one session
>8 units for males
>6 units for females

Define Harmful Alcohol Use

Drinking above safe levels with evidence of alcohol related problems
>50 units per week for males and >35 units per week for females

Describe the biological effects of alcohol

Affects GABA causing Anxiolytic and Sedative effects Pleasurable and stimulant effect from dopaminergic pathway sensitises and leads to dependence Long term decreases GABA and increases Glutamate

Describe the psychological theories behind alcohol dependence

Social Learning Theory | Operant Conditioning Therapy

Describe the ICD10 criteria for Alcohol Intoxication

A - Clear evidence of psychoactive substance, Disturbance in consciousness/cognition/behaviour, Not accounted for by mental/medical disorder B - Evidence of dysfunctional behaviour, and one of unsteady gait/slurred speech/nystagmus/flushing

Describe the clinical features of Alcohol Dependence (SAW DRINk)

Subjective awareness of compulsion Avoidance of withdrawal symptoms by drinking Withdrawal symptoms Drink seeking behaviour predominates Reinstatement if drinking after failed abstinence Increase tolerance Narrowing of drinking repertoire (fixed times)

Describe the ICD10 criteria for Alcohol Withdrawal

A) General criteria for withdrawal state met (not accounted for by mental/medical disorders) B) 3 of Tremor/Sweating/N and V/ Tachycardia/ Headache/Insomnia/Transient Hallucinations Occurs 6-12hrs after abstinence

Give 5 long term manifestations of Alcoholism

``` Cirrhosis HCC Peptic Ulcers Pancreatitis Wernickes and Korsakoff ```

What is the CAGE questionnaire for Alcohol Abuse?

C - Have you ever felt you should CUT down on your drinking A- Have people ANNOYED you by criticising your drinking G - Have you ever felt GUILTY about your drinking E - Do you ever have a drink EARLY in the morning

Describe the expected MSE for an Alcohol Intoxicated patient

Appearance - Poor coordination, alcohol smell Speech - Slurred Mood - Elevated or depressed Thought - Variable Perception- Normal Cognition - Impaired judgement, reduced concentration Insight - Poor

Describe the expected MSE for an Alcohol Withdrawn patient

``` Appearance - Agitated, Sweaty Speech - Confused Mood - Anxious Thoughts - Paranoid Delusions Perception - Visual Hallucinations, Illusions Cognition - Delirium, Inattention Insight - Poor ```

Name three questionnaires for Alcohol Abuse

AUDIT (Alcohol Use Disorders Identification Test) SADQ (Severity of Alcohol Dependence Questionnaire) FAST screening tool

Describe the biological management of Alcohol withdrawal

High Dose Benzodiazepines used and tapered over 5-9 days | Thiamine Orally or IV as Pabrinex

Describe the long term Biological management of Alcohol Dependence

Disulfiram Acamprosate (reduces craving by enhancing GABA) Naltrexone

Describe the Psychological management of Alcohol Abuse

Motivational Interviewing CBT Environment based therapy

Motivational interviewing uses the Stages Of Change Model, describe it

1) Precontemplation 2) Contemplation 3) Determination 4) Action 5) Maintenance 6) Relapse

Describe the social management of Alcohol abuse

Alcoholics Anonymous