Smoking, Alcohol and Substance Misuse Flashcards
Difference between harmful and hazardous use of alcohol?
Harmful-pattern of drinking that has caused damage to physical or mental health (10% of the population)
Hazardous-regularly drinking more than 14 units per week
When is contingency management offered in the management of drug misuse?
this should be introduced to reduce illicit drug use and/or promote engagement with services for people receiving methadone maintenance treatment or who primarily misuse stimulants
emphasis on reinforcing positive behaviours e.g. incentive if negative drug screen test, and participation in health promoting interventions e.g. Hep B vaccination
Principles of contingency management for patients with drug misuse problems?
- offer incentives (vouchers or privileges e.g. take home methadone) contingent on each presentation of a drug-negative test
- frequency of screening-3 times a week for first 3 weeks, then twice a week for next 3 weeks, then once a week until stability achieved.
- if vouchers used start with monetary value of £2-increase with each additional continuous period of abstinence
- urinalysis=preferred testing method, oral fluid tests are an alternative
- to improve physical healthcare-consider material incentives e.g. shopping vouchers, to encourage harm reduction.
When should behavioural couples therapy be offered as a psychosocial intervention in managing drug misuse?
for those in close contact with a non-drug-misusing-partner and who present for treatment of opioid or stimulant misuse
should be at least 12 weekly sessions
What does the CAGE questionnaire screen for?
Alcohol dependence
Which smoking cessation treatment would be contraindicated in a patient with depression?
varenicline-partial nicotinic receptor agonist, main side effect=nausea
however out of NRT, buproprion and varenicline, varenicline has the greatest odds of smoking cessation
Medication that can be used to reduce cravings following alcohol cessation?
Acamprosate
How long does cocaine remain detectable in urine?
12-36hrs after use
How long do opiates including heroin and codeine remain detectable in urine for?
up to 3 days
How long is methadone detectable in urine for?
3-4 days as a single dose
7-9 days as a stable maintenance dose
How long can cannabis remain detectable in urine for?
up to 27 days with chronic heavy use
ICD-10 criteria for alcohol dependence syndrome?
3 or more of these symptoms:
strong desire to drink alcohol
difficulty controlling amount and levels of alcohol use
tolerance
continuing to drink despite knowing the harms
withdrawal sx or using alcohol to avoid these
neglecting alternative pleasures/interests
narrowing of personal repertoire of patterns of alcohol use
How long should people with alcohol dependence refrain from driving for?
12 months of abstinence
NOTE patients with alcohol dependence MUST notify the DVLA and refrain from driving
if persistent alcohol misuse must not drive for 6 months until drinking controlled or abstinence
Questionnaires to assess severity of alcohol dependence?
SOADQ-C-Severity of alcohol dependence questionnaire
LDQ-Leeds Dependence Questionnaire
Contraindications to using bupropion for smoking cessation?
epilepsy
pregnancy and breastfeeding
having an eating disorder is a relative contraindication
Sx and signs of opioid withdrawal?
agitation muscle aches diarrhoea vomiting dilated pupils sweating
Which questionnaire should be routinely used to screen for alcohol use disorders ?
AUDIT-alcohol use disorders identification test: low risk drinking-score 1-7 hazardous drinking-8-15 harmful drinking-16-19 possible alcohol dependence-20 or more
AUDIT-C can be used where time is limited
After what time period of not drinking does delirium tremens tend to occur?
after 3 days (72 hours) of abstinence or decreased drinking
Management in primary care of patients who misuse alcohol?
- offer a session of structured brief advice about alcohol consumption
- if pt does not respond to this then offer an extended brief intervention-up to 5 sessions
- for those with harmful drinking or mild alcohol dependence (pt not requiring referral to specialist service for supervised withdrawal) also consider offering a psychological intervention e.g. CBT
if person fails to respond to all of above consider referring to specialist alcohol treatment service
offer prophylactic PO thiamine to harmful or dependent drinkers if malnourished or at risk of malnourishment and/or decompensated liver disease and/or medically assisted alcohol withdrawal planned
What principle should brief advice for hazardous or harmful drinkers be based on?
FRAMES: feedback responsibility advice menu empathy self efficacy
How long to BZDs remain detectable in urine for?
short acting-1-3 days
long acting-1-2 weeks (up to 6 weeks)
Role of LFTs in patients taking methadone or buprenorphine substitution therapy?
-LFTs should be checked at initial assessment and then every 6-9 months whilst taking methadone or buprenorphine due to extensive metabolism of these substances by the liver.
Schedule for Hep B vaccination of patients dependent on opioids?
accelerated schedule-dose at 0, 7 and 21 days, with a booster at 1 year
should also be vaccinated against Hep A and tetanus
DVLA guidance for patients who are opioid dependent or persistently use opioids?
must inform the DVLA and STOP driving, person must be free of drug use for at least 1 year for group 1 and 3 years for group 2
same for cocaine
In patients who misuse opioids, BZDs or CNS stimulants, when should a report be made to the National Drug Treatment Monitoring System (NDTMS) in England?
when a person first starts treatment for drug misuse
consent should be sought, the information sent to them is kept confidential
What treatment can be given for symptoms of opioid withdrawal?
lofexidine-alpha agonist
Minimum duration of supervised consumption of opioid substitution therapy?
3 months
What is required for patients travelling abroad with 3 months or more supply of benzodiazepines?
a personal import/export license
this is needed for any patient carrying 3 months supply or more of schedule 1, 2, 3 or 4 part I drugs.
DVLA restrictions if patients misusing benzodiazepines?
group 1-must not drive and must inform DVLA, license can be revoked/refused for minimum of 1 year which must be free of dependence
2-license will be revoked/refused for minimum of 3 years
What must be checked prior to switching to diazepam as part of assisted withdrawal for BZD dependence?
hepatic function
How are BZDs withdrawn?
dose tapering with 5-10% reduction every 1-2 weeks, slower reduction at lower doses
diazepam conversion is recommended
DVLA guidance if misuse cannabis/amphetamines/LSD/ectasy?
group 1-must not drive for at least 6 months free from use of these substances
If prescribing a BZD or Z drug for management of short term insomnia (<4 weeks) how long can you prescribe the drug for?
no more than 2 weeks
Peak incidence of seizures after alcohol withdrawal?
36 hours
Duration of opioid detoxification in an inpatient/residential setting?
4 weeks
3 months if in the community
Starting dose of methadone?
10-30mg daily
If a patient misses their methadone (opioid agonist), when would a GP need to review their prescription?
if missed 3 or more consecutive days as at this time levels would be reduced and pt may need a lower dose
