Substance Abuse 1 Flashcards by Zach Geddes

What is a drug?

Medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body

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Which group are most likely to misuse drugs?

Age 16-24

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What percentage of people have alcohol dependence?

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What is a substance use disorder?

cluster of cognitive, behavioural, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems

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What is addiction?

Chronic, primary, neurobiological condition influenced by genetic, psychosocial and environmental factors

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What are the risk factors for drug misuse and addiction?

Genetics- men more likely

Socioeconomic

Environmental:
Home, family, friends using drugs
Low-self esteem
Stress
Easy access to drugs
Peer pressure
Mental health problems
Early exposure
Physical and sexual abuse
Trauma
Homelessness

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What are the steps in the addiction cycle for recreational drugs?

Acute reinforcement/social drug taking

Escalating, binging, compulsive use

Dependence

Withdrawal

Protracted withdrawal

Recovery?

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What is the initiation and progression of drug use most associated with?

Initiation- social and environmental factors

Progression- neurobiological factors

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What are the steps in the pattern of addiction for opioids?

Intense initial intoxication

Development of tolerance

Escalation in intake

Profound dysphoria, physical discomfort and somatic withdrawal signs during abstinence

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What is the addiction pattern for alcohol?

Initial intoxication less than opiods

Binges

Severe emotional and somatic withdrawal syndrome

Intense craving for drug often driven by negative emotional states but also positive

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What areas of the brain are associated with the reward pathway?

Ventral Tegmental Area

Nucleus Accumbens

Prefrontal cortex

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What occurs in the reward pathway?

Activated by rewarding stimulus (food, water, sex)
-> information travels from the VTA then Nucleus accumbens then prefrontal cortex
-> dopamine mediated transmission allows feeling of pleasure

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What are the effects of different neurotransmitters on how we feel?

Increased dopamine- euphoria

Increased serotonin- increased contentment

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What are the elements in the psychodynamic theory of addiction?

2 critical
-> disordered emotions
-> disordered self- care

2 contributory
-> disordered self-esteem
-> disordered relationships

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What happens upon chronic exposure to drugs?

Reduced sensitivity of brain to reward system

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What is withdrawal?

Array of symptoms that follow sudden withdrawal of drug that patient had been physically dependent on

What is tolerance?

Users become less sensitive to the effects of a drug and require larger doses to achieve same effect previously produced by lower doses

-> different for different drugs

What are the different ways of classifying drugs?

Behavioural

Pharmacodynamic

Legal

What are the different types of behavioural classifications for drugs?

Stimulants- cocaine, amphetamines, nicotine

Opioids- bind to opiod receptors and produce analgesia

Sedative hypnotics- decrease arousal and have anti-anxiety, hypnosis, sleep effect

Antipsychotics- Haloperidol

Antidepressants- SSRIs

Psychedelics- mind altering

What are the different pharmacodynamic classifications of drugs? (describe effect on brain neurotransmission)

Stimulants- dopamine agonists

Opioids- opioid receptor agonists

Sedative hypnotics- directly/indirectly facilitate Y-aminobutryic acid

Antipsychotics- dopamine D2 receptor antagonists and serotonin 5-HT2 receptor antagonists

Antidepressants
- Serotonin/noradrenaline reuptake inhibitors

Psychedelics- facilitate serotonergic activity directly or indirectly increasing serotonin release

What is an offence under the misuse of drugs act 1971?

to unlawfully possess a controlled drug
to possess a controlled drug with intent to supply it
to unlawfully supply (sell/give/share) a controlled drug
to allow premises you occupy or manage to be used for the smoking or use of drugs

Which drugs are in different classes?

A (7 years)- cocaine, heroin, MDMA, LSD, methadone, crystal meth

B (5 years)- amphetamines, cannabis, codeine, ketamine

C (2 years in prison)- anabolic steroids, benzos, GHB

What are the risks of illicit drug use?

Increased risk of infections
-> TB
-> STIs
-> IV drug use- BBVs

What are the ways that recreational drugs are taken?

Oral – Alcohol, MDMA, Prescription Drugs
Transmucosal – Cocaine
Inhalation / Smoking - Cannabis
Intramuscular - Ketamine
Intravenous – Heroin

What are some of the possible injection related complications?

Cellulitis Abscess Thrombophlebitis Thrombosis Embolism DVT Muscoskeletal infection Endovascular issues

What are the ways the BBVs can be transmitted?

* Contaminated blood and blood products * Sharing of contaminated injecting equipment including needles, syringes, spoons, filters * Needle-stick injuries in health-care settings * Tattoos or piercing with contaminated equipment * Sharing of razors and toothbrushes in closed settings (HBV) * Mother-to-child transmission (MTCT) during pregnancy and delivery * Unprotected sex (HBV) , Rarely HCV * HCV is easily transmitted among individuals sharing injecting equipment

What are the social implications of drug use?

Death Suicides Assaults Drug related crime Need for drug treatment services -> fix room- supervised drug use (reduces public injecting, reduced needle sharing, improved uptake of addiction tx)

What are some of the effects of cannabis?

Euphoria Slowed thinking and rxn time Confusion Impaired coordination Cough/resp infections Impaired memory and learning Anxiety and panic attacks Tolerance Addiction

What issues could potential cause a fitness to practice meeting by GDC?

* Behaviours involving or associated with potential criminality eg * dealing, possessing or misusing drugs/illegal substances even if there are no legal proceedings * Becoming involved in criminal activity * Violent behaviour * Abusive behaviour * Sexual harassment * Theft including shoplifting * Gaining a criminal conviction or caution * Financial fraud

What do we recommend for alcohol intake?

14 units per week spread evenly over 3 days with alcohol free days (at least 2)

What is the figure for daily alcohol misuse?

Exceeded 5 units

What are the effects of alcohol?

CNS depressant Impaired judgement, concentration, coordination Aggression Higher doses: -> interference with cerebellar function -> Ataxia -> unconsciousness

What are the RF for alcoholism?

Armed forced Bachelors over 40 Bored housewives Commercial travellers Doctors entertainers Publicans in drinks industry

What are the signs of addiction?

Loss of reliability Mood changes Impaired driving Self-prescribing Deteriorating attitude and behaviour Personal/professional isolation Wastage of drugs Sloppy record keeping

What are the causes of stress in students?

Dislocation from family Relationships Time demands of study Finical issues Lack of sleep New environment

What are the physical effects of stress?

Increased HR Increased BP Palpitation Increase muscle tension- headaches, dizziness, jaw ache, insomnia Sweating/blushing- hands and feet

What are the mental effects of stress?

Small amounts- stimulation Too much- affects thinking -> confusion -> focussing on worries -> being preoccupied -> negative thinking -> difficulty making decisions

What are the emotional effects of stress?

Irritability Impatience Anger Frustration Fear/anxiety Self-doubt Panic Despondency Feeling inadequate/insecure Hopeless Depression

What should be done if you or colleague have addiction problem?

Put interests of patient first Consult senior colleague and ask for advice/support -> document encounter Consider whether you are safe to practice Engage with support groups and medical services