Clinical Assessment and Management of Substance Use Disorder Flashcards
What is the definition of a drug?
- Any psychoactive substance that affects the CNS and causes alteration in mood, behaviour, perception and conscioussness.
- Any substance other than those required to maintain normal health, that can modify the individual’s functions.
What is the definition of acute intoxication?
The pattern of reversible physical and mental abnormalities caused by direct effects of the substance.
What is the definition of ‘at risk use’?
- A pattern of substance use where the person is at increased risk of harming their physical or mental health.
- Not a discrete point but shades into normal consumption and harmful use.
- Not only absolute amounts but also situations e.g. driving.
What is the definition of harmful use?
- Continuation of the substance use despite evidence of damage to the user’s physical and mental health or to their social, occupational and familial wellbeing.
What is the definition of dependence?
- A state, psychological or physical resulting from use of psychoactive substance characterised by compulsion to continuously seek adn take the substance, to experience psychic effects or avoid discomfort of its absence.
What is the definition of physical dependence?
A state of physical disturbance when the drug is withdrawn.
What is the definition of tolerance?
A state of reduced responsiveness to the effects of the drug caused by its previous administration.
What is the definition of withdrawl?
- Physical withdrawls - can be fatal particularly in alcohol, seizures, death.
- Psychological withdrawl state of anhedonia characterised by dysphoria, irritability, emotional distress.
What are the functions of the dopamine pathway?
- Reward (motivation)
- Pleasure, euphoria
- Motor function (fine tuning)
- Compulsion
- Perseveration
What are the functions of the serotonin pathways?
- Mood
- Memory processing
- Sleep
- Cognition
What are the components of the assessment of addiction?
- Making a diagnosis
- History taking
- Collateral
- Biopsychosocial
- Formulation
- Screening tools
- Investigations
- Risk assessment
- Short term
- Long term recovery
What are the different disorders caused by substance use and addictive behaviours?
What are the core features of addictive behaviour?
- Salience (importance, dominance)
- Mood modification (rush and escape)
- Tolerance (escalation for effect, increasing intensity, recklessness, destructiveness).
- Withdrawl (unpleasant emotional / physical effects when engagement is prevented).
- Conflict (interpersonal, intrapsychic, loss of control)
- Relapse (repeated reversions to excess)
What are the 4 groups of the DSMV diagnostic criteria for substance use disorders?
- Impaired cotrol
- Risky use of substance
- Social impairment
- Pharmacological criteria
Describe the features of impaired control.
- Substance 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 substance use.
- A great deal of time is spent in activities necessary to obtain the substance, use the substance or recover from its effects.
- Craving, or a strong desire or urge to use the substance.
What are the 10 classes of drugs encompassed in DSMV?
What are the substances in the ICD10 classification?
Describe the formulation model of addiction.
- Predisposing
- Precipitating
- Perpetuating
- Presenting
- Protective
What are the stages of change in a patient with addiction?
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Precontemplation (unaware / unready)
- Intervention unlikely to succeed, give information about risks.
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Contemplation (aware / ambivalent)
- Offer advice and / or motivational work to move patient along.
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Preparation (planning)
- Set date, make plans, be specific, anticipate difficulties.
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Action (ready to go)
- Encourage, support, offer to follow-up.
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Maintenance (keeping it up)
- Reinforce success, advise on managing slips / relapse prevention.
