PSYCH Substance Use

Question 1

Alcohol Use Disorder/ Any substance use disorder template

Answer 1

ANY 2 of 11

A :
problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following:

A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

A markedly diminished effect with continued use of the same amount of alcohol.

11. Withdrawal, as manifested by either of the following:

The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal).

Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Question 2

Describe uncomplicated alcohol withdrawal

Answer 2

Uncomplicated
Happens for 85% of people
6-12 hrs after last drink - insomnia,
tremulousness, mild anxiety, gastrointestinal upset (nausea/vomiting), headache, diaphoresis, palpitations, anorexia anxiety, tremors, increased HR/BP.
- subsides within a week without treatment.

Question 3

Describe complicated alcohol withdrawal

Answer 3

15% of people with Alcohol Use Disorder
Alcoholic Withdrawal Seizures
- 24-48 hrs after last drink - Usually occurs with
severe, long-term use.
Alcoholic Hallucinosis
- 12-24 hrs of last drink - Typically lasts 1 week
but can become chronic.
Alcohol Withdrawal Delirium (Delirium tremens)
- 48-72 hrs after last drink - hallucinations (usually visual), disorientation,
tachycardia, hypertension, low grade fever, agitation, diaphoresis.
Who is at risk of complicated alcohol withdrawal?
- Older age
- Severity
drinking/tolerance
- Prior AW (“kindling”)
- Major medical/surgical
problems
- Sedative/hypnotic use
- Persistent drinking (eye
opener/sipping throughout the day, no days without alcohol)

Question 4

How to manage Alcohol Withdrawal

Answer 4

Nutritional supplementation and use Thiamine

Do a CIWA score
If CIWA > 8-10, start patient on
benzos, and if 10- 20 do standing doses with possible prns as well if > 15 (give 20 of diazepam q1hr until CIWA is < 10 for three successive measurements!)
* Usually, diazepam is the preferred drug for alcohol
withdrawal given its long half-life and ease of administration, however lorazepam or oxazepam is preferred if there is evidence of impaired liver function.

Question 5

Describe Opioid withdrawal

Answer 5

Begins to set in approximately 10 hrs after last dose with short- acting opioids (e.g. morphine, heroin)
- Minor = lacrimation, rhinorrhea, sweating, yawning, piloerection, hypertension, tachycardia
- Severe = hot/cold flashes, muscle/joint pain, nausea, vomiting, abdominal cramps
- Also, anxiety, restlessness, irritability, insomnia, decreased appetite