ALCOHOL AND SUBSTANCE USE

Question 1

List any six points that are included in the DSM-V Diagnostic Criteria for Alcohol Use Disorder

Answer 1

• Alcohol is often taken in larger amounts or over a longer period than was intended.
• There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
• A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or
  recover from its effects.
• Craving, or a strong desire or urge to use alcohol.
• Recurrent alcohol use resulting in a failure to fulfil major role obligations at work,
  school, or home.
• Important social, occupational, or recreational activities are given up or reduced
  because of alcohol use.
• Tolerance, A need for markedly increased amounts of alcohol to achieve intoxication or
  desired effect.
• Withdrawal,Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or
  avoid withdrawal symptoms.

Question 2

List any 4 substances that are screened for by the ASSIST screening tool.

Answer 2

• Alcohol
• cannabis
• cocaine
• tobacco
• opioids
• sedatives
• inhalants

Question 3

Give 2 examples of other commonly used screening tools.

Answer 3

• CAGE (Cut Down, Annoyed, Guilty, Eye-Opener)
• AUDIT (Alcohol Use Disorders Identification Test)
• DAST (Drug Abuse Screening Test)

Question 4

A 58-year-old man is brought into the emergency department following an automobile accident. His
blood alcohol level on admission is 280 mg/dL. He has been treated in the past for seizures related to
alcohol use disorder, and he confirms that he has been drinking heavily over the past month since losing
his job. What treatment should be given to this patient if he begins to go into alcohol withdrawal while
hospitalized? Motivate for your choice.

Answer 4

Lorazepam. Should this patient go into alcohol withdrawal, he will likely also have seizures associated
with it, given his past history. Benzodiazepines are used to treat seizures associated with alcohol
withdrawal. These drugs stimulate the GABA, receptors, causing a decrease in neuronal activity and
sedation. Acamprosate, naltrexone, and disulfiram may be considered at a later time to treat the alcohol
dependence but would not be useful in the acute withdrawal setting.

Question 5

Jabu is a 32-year-old man who is living with bipolar disorder type 1 with severe agitation. One night he
and his friends decided to go to a concert where they drank alcohol and smokes cannabis. That night
Jabu had also stopped taking is medication for 2 days and while at the concert he developed seizures
which are said to be due to stopping to take his benzos abruptly. What are the best ways to wean a
patient off benzodiazepines?

Answer 5

The best ways to take patients off Benzos is by substituting the drugs with another that doesn’t have as
greater risk for dependence as benzos, another measure involves having to reduce the dose of
the prescribed benzo slowly until it is safe enough to stop prescribing them to the patient. (1.5
marks)
Some benzodiazepines, notably alprazolam, appear to have a greater propensity for misuse and are
more dangerous in overdose (0.5 marks). A common approach is substituting these shorter half-life
drugs, such as alprazolam, with longer half-life drugs, such as diazepam (1 mark).