Clinical Management & Presentation Of Addiction

Question 1

What is the ICD 10 criteria of dependence syndrome?

Answer 1

3 or more in the last year
Tolerance

Question 2

What 6 things does a substance misuse history include?

Answer 2

Length of use
Amount of use (in g/ml)
Method of administration
Withdrawal symptoms
Overdoses
Motivation to change

Question 3

How do you calculate alcohol units?

Answer 3

% strength x ml / 1000

Question 4

How long does alcohol take to be absorbed? What transmitters does it affect?

Answer 4

60 mins
GABA-A enhanced and stimulates dopamine

Question 5

What are alcohol assessment tools?

Answer 5

CAGE screening- cut down, annoyed, guilty, eye opener
AUDIT

Question 6

What is alcohol withdrawal like?
What is the most serious threatening condition?
What do you treat it with?

Answer 6

More dangerous that opioids
Can die
Starts from about 6hrs
Hallucinations and delirium

Delirium tremens

Chlorediazepoxide

Question 7

What’s the difference between opiates and opioids?

Answer 7

Opiates- natural opioids
Opioids- synthetic

Question 8

What do opioids do?

Answer 8

Analgesic effects
Sense of euphoria
Regulate pain and mood

Question 9

What does an opioid overdose look like?

Answer 9

Tachycardia
Sweating
Dilated pupils
Tremor
Diarrhoea
Anxiety
Goose flesh skin
Choking
No breathing

Question 10

What are the three stages of abnormal drug and alcohol abuse?
What do they each mean?

Answer 10

Hazardous use- likely to cause a hazard if continued to be used at this level
Harmful use-actual damage to physical/mental health
Dependence/addiction
Dependence: biological tolerance to the substance
Addiction: compulsive use despite harmful consequences

Question 11

How does alcohol alter the balance of the brain’s inhibitory and excitatory system?
How does alcohol, opiates and nicotine affect the dopaminergic neurons?
How does the brain adapt to these changes?

Answer 11

Increases GABA-A receptor so therefore increases the inhibitory system
Decreases NMDA glutamate receptor so therefore decreases the excitatory system
Increases dopaminergic firing rate
Brain adapts by having a reduced sensitivity to GABA and upregulation of NMDA

Question 12

How does the brain’s change after alcohol dependence affect withdrawal symptoms
What drug is given to treat this?

Answer 12

Hyperexcitability = seizures, loss of balance
Benzodiazepine