Substanc Abuse Flashcards
Harmful use definition
Continuation of substance use despite evidence of damage to users physical or mental health or to social, emotional or financial well being
Tolerance definition
A state where the individual needs more of a substance to achieve the same effects/same amount produces less of an effect
- tissue tolerance-> receptor down steaming
- metabolic-> enzyme induction
- psychological
Dependence syndrome ICD 10 criteria
> =3
1) a strong desire to take substance
2) impaired control of substance taking
3) physiological withdrawal state
4) signs of tollerance
5) neglect of other interests
6) persistence despite harmful effects
Units of alcohol calculation
Units=volume of alcohol (ml) x ABV (%) / 1000
Men 3-4 pd
Women 2-3 pd
Epidemiology alcohol abuse
Prevelance 7% m 2% female
25% of a and e admissions
10% of psych admissions
Aetiology of alcohol abuse
Genetics -> 1st degree relative-> x7 increased risk -personality traits -biochemical susceptibility -down regulation of GABA Psychological -operant conditioning -psych conditions Social -life events -occupation -availability -social attitudes -chronic pain/illness
Physical complications of alcohol abuse
Fatty liver/alcoholic liver disease Gastritis/ulcers/varices Cancer Malnutrition Delirium tremens/seizures Haemorrhagic stroke Neuropathy IHD/arrhythmia/hypertension Hypoglycaemia/hyperlipidemia Anaemia Resp depression/aspiration pneumonia
Wernicke-korsakoff syndrome
Thiamine deficiency Wernickes-> acute brain damage -delirium -opthalmoplegia -ataxia Korsakoff syndrome -> chronic damage -amnesia syndrome -frontal lobe dysfunction -psychiatric symptoms
Psychiatric complications of alcohol abuse
Pathological intoxication Suicide and self harm Alcoholic hallucinosis-> auditory Amnesia Cognitive impairment Pathological jealousy Exacerbation of existing disorders
Social consequences of alcohol abuse
Absence from/poor attendance at work Legal problems Interpersonal problems Financial difficulty Vagrancy Homelessness
Alcohol withdrawal syndrome- uncomplicated
40% 6-8hrs after last drink Trmulousness Sweating N+V Mood disturbances Sensitive to sound Sleep disturbances Psychomotor agitation *perceptual disturbances *withdrawal seizures
Alcoholic withdrawal syndrome delirium tremens
5% 1-7 days after Clouding of conciousness Visual hallucinations and paranoid delusions Autonomic arousal Agitation 5-15% mortality -> benzo's, fluid and electrolytes, thiamine
CAGE questionnaire
C have you ever felt like you should cut down on your drinking?
A have people ever annoyed you by criticising your drinking?
G have you ever felt guilty about your drinking?
E have you ever needed and eye opener in the morning to steady your nerves?
Sedatives
Drowsiness Disinhibition Confusion Poor concentration Miosis Hypotension Withdrawal seizures
Stimulants
Amphetamine, cocaine, MDMA Alertness, hyperactivity, confidence, euphoria Impulsivity Irritability and aggression Hallucinations Subsequent dysphoria Mydriasis, tremor, hypertension, tachycardia, arrhythmias Sweating and fever Convulsions
Opioids
Heroin, methadone
Euphoria
Drowsiness
Apathy
Personality change
Miosis, nause, puritis, constipation, bradycardia, resp depression, coma
Tolerance developed quickly-> potential for accidental over dose
Withdrawal syndrome -> invokes physical illness
Hallucinogens
LSD, magic mushrooms Perceptual disturbances, euphoria, paranoia, suicidal and homicidal thoughts, psychosis Mydriasis, hypertension, tachycardia, Sweating and fever Tremor
Canabinoids
Canabis, hashish, hash oil
Euphoria, relaxation, psychosis
Impaired co ordination, nystagmus, dry mouth
Dissociative anaesthetics
Ketamine
Hallucinations, paranoid ideas, thought disorganisation, aggression
Mydriasis, tachycardia, hypertension
Solvents
Aerosols, glue, lighter fluid, petrol
Disinhibition, stimulation, euphoria, hallucinations, psychosis
Headache, nausea, slurred speech, muscle weakness
Damage to brain/bone marrow/liver/kidneys/myocardium
Sudden death
Management of substance/alcohol abuse biological
Lofexidine for opiate withdrawal
Treat withdrawal symptoms
Substitution therapy-> methadone, buprenorphine
Naltrexone blocks further euphoric effects of opiates
Management of substance/alcohol abuse psychological
Education Motivational interviewing CBT group therapy Set step by step goals
Management of substance/alcohol abuse social
Address perpetuating factors Family/peers Housing Prostitution Compliance Criminality
Acute intoxication definition
Pattern of reversible physical and mental abnormalities causes by direct effects of a substance
5 steps of motivational interviewing
1) establish rapport
2) elicit priorities to set an agenda
- > ask patient what is most important to them
3) facilitate change talk
- importance ruler-> help patient identify and discuss reasons for and against change
- confidence ruler-> help patient identify and discuss self perceived ability for accomplishing change
4) offer advice with patients permission
5) end with a plan
Aims of motivational interviewing
Guiding style rather than directing style Engage patients Clarify strengths and weaknesses Evoke their own motivations Prompt autonomy
