drug and alcohol abuse

Question 1

what is substance abuse?

Answer 1

According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), of the American Psychiatric Association,1,2 a diagnosis of sub- stance abuse requires the recurrent use of a substance over the past 12 months with subsequent adverse conse- quences (e.g., failure to ful ll a major role at work, school, or home; legal problems; persistent interpersonal problems) or placement of the affected person in high-risk physically hazardous situations.

Question 2

what is alcoholism?

Answer 2

Alcoholism is a term commonly used to describe a condition of substance abuse focused on consumption of alcohol. A more precise de nition, however, has been proposed by O’Conner: “a primary chronic disease with genetic, psychosocial, and environmental factors … often progressive and fatal … characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite future consequences, and distortions of thinking, most notably denial.”4

Question 3

what is the etiology of addiciton and dependence?

Answer 3

The neurobiology of addiction and dependence is complex and involves a unique set of variables. Disruption of the endogenous reward systems in the brain is a common feature of all of the major drugs of abuse; most of these drugs act by disrupting dopa- mine circuits in the brain.6 Acute changes increase synaptic dopamine and disrupt circuits that mediate motivation and drive, conditioned learning, and inhibi- tory controls. This enhancement of synaptic dopamine is particularly rewarding for persons with abnormally low density of the D2 dopamine receptor (D2DR).6 A complex neural circuitry underlies the valuation and pursuit of rewards3 (Figure 30-1). Although dopa- mine is the primary neurotransmitter involved in drug abuse and addiction, many other neurotransmitters are involved, depending on the drug of abuse (Figure 30-2). Evidence suggests that inherited genetic factors are involved in alcoholism. Psychological factors such as depression, self-medication (to relieve psychic distress), personality disorder, and poor coping skills appear to be involved in addictive behavior. Social factors that may be involved include interpersonal, cultural, and societal in uences.1

Question 4

what are organ systems that could be impaired by alcoholism

Answer 4

This includes a search for evidence of liver failure, gastrointestinal bleed- ing, cardiac arrhythmia, and glucose or electrolyte imbal- ance. Hemorrhage from esophageal varices and hepatic encephalopathy require immediate treatment. Ascites mandates measures to control uids and electrolytes; alcoholic hepatitis often is treated with glucocorticoids; and infection or sepsis is managed with antimicrobial agents. During this phase, the patient may refuse to accept the diagnosis and deny that a problem exists.4

Question 5

what symtpoms would prompt hyou to refer an alcoholic to the hopsital for treatment?

Answer 5

• Additional signs of withdrawal: Nausea, vomiting, anorexia, malaise, weight loss, tachycardia, anxiety, insomnia, hallucinations, disorientation, impaired attention and memory, extreme agitation and fever
• Physical findings include severe sweating, elevated blood pressure and tachycardia.
• Early signs of cirrhosis: jaundice, ascites, ankle edema, spider angiomas.

Question 6

what is brief intervention?

Answer 6

• Brief intervention is a technique to motivate individuals at risk of substance abuse and related health problems to change their behavior by helping them understand how their substance abuse puts them at risk.
• A general dentist may use the principle of brief intervention through motivational interviewing to help this patient:
o Engaging: Involve the client by sharing concerns provoked by the medical assessment, and talk to them about issues and hopes to establish a trusting relationship
o Focusing: Pointing out destructive patterns of alcohol use and help client narrow down habits or patterns they want to change
o Evoking: Discussing further problems that may be anticipated if alcohol use continues to help motivate change.
o Planning: Discussing the possibilities and successes of treatment to implement the changes they desire

Question 7

what part of brain invovled in substance abuse?

Answer 7

• Alcohol produces feelings of pleasure and reward, which motivates people to repeat behaviors. The limbic system contains the brain’s reward circuit - it links together a number of brain structures that control and regulate our ability to feel pleasure.