Alcohol + substance misuse Flashcards
Describe the neurocircuitry of the addiction cycle
1) binge + intoxication - basal ganglia - reward circuits in the brain are activated during intoxication
2) withdrawal + negative effect - extended amygdala - activation of emotional circuitry in brain results in negative mood and enhanced sensitivity to stress during withdrawal
3) preoccupation + anticipation - prefrontal cortex - decreased prefrontal functioning impairs the balance of desire and ability to abstain
Describe clearance of alcohol
eliminated at constant rate
predominantly hepatic
Diagnostic criteria for alcohol misuse problems
pattern: episode of harmful use, harmful pattern of use, dependence
impact: intoxication, withdrawal, alcohol-induced delirium, alcohol-induced psychosis, mood + anxiety disorders
Describe alcohol dependence
pattern of recurrent episodic use (>12mo) or continuous (daily/almost daily >3mo) with evidence of impaired regulation AND >2 of:
- impaired control over use (onset, frequency, intensity, duration, termination, context)
- increasing precedence of use over other aspects of life (maintaining health, daily activities + responsibilities) with use continuing/escalating despite harm)
- physiological neuroadaptation (tolerance or withdrawal)
Aetiology of alcohol dependence
unclear molecular mechanisms
interacts with neuronal membranes > increase fluidity > more specific changes in neurotransmitter release > characteristic pharmacological actions
pleasure = dopamine + opioids in mesolimbic forebrain
anxiolytic effects = brain GABA activity
List some forms of 1 unit of alcohol
half a pint of regular beer, lager or cider
half a small glass of wine
1 single measure of spirits
1 small glass of sherry
1 single measure of aperitifs
What screening tools can be used for alcohol use?
AUDIT
FAST
SADQ
What questions should be asked in an alcohol history?
describe a typical day’s drinking
what time is the first drink of the day?
when did daily drinking start?
presence of withdrawal symptoms in the morning or after abstinence
previous attempts at treatment
physical health problems
patient’s attitude towards drinking
Alcohol treatment approach
raise individual’s awareness + motivation to change
support + advice from AA
withdraw alcohol (detox) or controlled drinking
NICE:
- harmful drinking + mild dependence = high-intensity psychotherapy
- mod-severe = after successful withdrawal, consider acamprosate/naltrexone
- >15 units/day or 15-30 on SADQ = community-based assisted withdrawal (inpatient if safety concerns)
Psychological treatments for alcohol dependence
motivational interviewing
behavioural techniques (with partner and social network)
social and interpersonal skills
cue exposure and relapse prevention
CBRT (cognitive behavioural relationship therapy)
AA
What substances can be detected on urine drug screen?
amphetamines + analogues
opioids (codeine, morphine, dihydrocodeine)
methadone
buprenorphine + metabolites
cannabinoids
cannabis
Effects of cannabis
increased enjoyment of aesthetic experiences + distortion of time + space
red eyes, dry mouth, tachycardia, irritated airway
toxic confusional states, occasional psychosis
Cannabis withdrawal symptoms
generally mild
irritability
nausea
insomnia
anorexia
Pharmacological treatment of tobacco addiction
transdermal nicotine patches
nicotine gum
nicotine lozenges
nicotine inhalers
nicotine nasal spray
sublingual nicotine tablets
varenicline
e-cigarettes
Effect of MDMA (ecstasy)
stimulant + mild hallucinogen
mood: positive state (euphoria, sociability + intimacy, sensations of new insights + perceptions)
physical: loss of appetite, tachycardia, bruxism, sweating
