Drug abuse

Question 1

What is the definition of drug dependence?

Answer 1

Acute intoxication – transient disturbance of behavior or perception from substance

Misuse – maladaptive and recurent use of substance leading to impairment or distress

Dependence –same features as alcohol dependence but with other drug

Question 2

What is the aetiology of drug dependence?

Answer 2

Multifactoria, neurobiological mechanism of conditioned response. Psych hx increases risk. Hard to estimate epidemiology due to illegality.

Question 3

What investigations would you do for drug dependence?

Answer 3

Drug screen, hepatitis, HIV, infection, urine drug.

Question 4

What is the management of drug dependence?

Answer 4

Psychological and social intervention

Pharmacological:

· Detoxify: help with lofeximide, loperamide, buscopan, BZD, metclopramide.

· Motivational interviewing

· Substitution therapy: methadone, buprenophrine -> prevent on top effect.

· Tx psych comorbidity

Question 5

What are the complications and prognosis of drug dependence?

Answer 5

Physical and psychiatric.

Question 6

What may you find in the history and examination of all drugs drug dependence?

Answer 6

Cannabis - B -> Relaxation/lethargy -> LT effect on concentration and LT memory

Cocaine - A -> Buzz, alert, confidence (30 min) -> LT heart problems, convulsion, nose

Crack – A -> high, 10 mins -> heart, addiciton, restelss -> LT confusion psychosis

Ecstasy – A -> altertness, intense energy, 3-6h -> LT nausea, sweat, liver/kidney.

GHB - Legal -> sedative euphoric -> LT sickness, stiff, fits, collapse, death with alcohol

Gas/glue/solvent - L -> dizzy, hallucinations, 15-45minutes, drowsiness -> LT instant death, nausea, blackout.

Heroin – A -> relax/drowsy/numb -> LT v addictive, tolerance, HIV risk.

Ket – Prescriotion -> hallucinations -> LT numb/breathing issues, ket bladder

LSD – A -> hallucinogenic -> Bad trip, intense paranoia, precipitation of schizophrenia

Mushrooms – A -> like LSD -> LT Stomach pain, sick, diahrrea

PCP – A -> euphoria, -> LT impaired consciousness and psychosis

Poppers -> head rush, headache LT dangerous for anaemia, glaucoma, heart problems. Fatal if swallowed – must only be inhaled form liquid bottle.

Speed -> amphetamines, stimulants, comedown precipitates depression