Substance Abuse 1 Flashcards
What is a drug?
Medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body
Which group are most likely to misuse drugs?
Age 16-24
What percentage of people have alcohol dependence?
4%
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
What is addiction?
Chronic, primary, neurobiological condition influenced by genetic, psychosocial and environmental factors
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
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?
What is the initiation and progression of drug use most associated with?
Initiation- social and environmental factors
Progression- neurobiological factors
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
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
What areas of the brain are associated with the reward pathway?
Ventral Tegmental Area
Nucleus Accumbens
Prefrontal cortex
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
What are the effects of different neurotransmitters on how we feel?
Increased dopamine- euphoria
Increased serotonin- increased contentment
What are the elements in the psychodynamic theory of addiction?
2 critical
-> disordered emotions
-> disordered self- care
2 contributory
-> disordered self-esteem
-> disordered relationships
What happens upon chronic exposure to drugs?
Reduced sensitivity of brain to reward system
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
