Substance abuse Flashcards
Define substance use disorder
Drug or alcohol use that causes physical, mental or social dysfunction
Define intoxication
dose-dependent, transient state following drug use
Define harmful drug use
pattern of use likely to cause physical or psychological damage
Define dependence
need to use a substance to feel or function normally, after a period of regular use
What are the features of dependence
A strong desire or sense of compulsion to use
Difficulty in controlling use.
A physiological withdrawal state when use has ceased or been reduced.
Evidence of tolerance.
Progressive neglect of alternative pleasures and interests.
Persistence with use despite clear evidence of overtly harmful consequences.
What is a dual diagnosis
the presence of substance use with a comorbid mental health problem
Define tolerance
Bigger doses are increasingly needed to get the same effect
Define withdrawal
Psychological state when the substance is stopped/decreased, causing:
- A characteristic withdrawal syndrome for that substance
- Substance use to prevent/relieve withdrawal symptoms
Define compulsion
Strong desire to use
Define loss of control
Difficulty controlling starting, stopping, or amount used
Define salience
Obtaining and using the substance becomes so important that other social priorities are neglected
What is the aetiology of substance use disorder
Genetic: 40-60% heritability, reduced D2 receptors
ACEs
Social theory
Operant conditioning
Classical conditioning
Motivational theory
Dopamine theory
What are the risk factors for substance use disorder
Adolescence
Male gender
Low parental socioeconomic group and educational achievement
Parental substance dependence
Ineffective parenting
Family breakdown
Childhood abuse
Occupations: publicans, journalists, doctors, military personnel, people in the entertainment industry
Co-morbid psychiatric disorders e.g. personality disorders, depression, BPAD, ADHD, psychosis, anxiety disorders
What is the 12 month and lifetime prevalence of substance use disorder
12 month: 3.8%
llifetime: 14.6%
What investigations should be done for suspected substance use disorder
Bedside: ECG, urine toxicology, saliva drug screen, hair samples
Bloods: FBC, MCV, vit B12, LFTs, U&Es, blood toxicology
What are the differentials for substance use disorder
Head injury
Subdural haematoma
Depression
Mania
Psychosis
Anxiety disorder
Personality disorder
Give examples of opioids (strongest to weakest)
Fentanyl
Heroin (diamorphine)
Buprenorphine
Methadone
Oxycodone
Morphine
Hydrocodone
dihydrocodeine
tramadol
Codeine
What is the MOA for opioids
Opioid receptor (µ/mu) agonist → dopaminergic mesolimbic stimulation → dopamine release into the nucleus accumbens → mmediate euphoria, diminished pain sensation, feelings of detachment):
What are the methods of ingestion for opioids
IV (mainlining)
IM
SC
smoked/ inhaled (‘chasing the dragon’)
snorted/sniffed
oral
What is the epidemiology for opioid use
Opioid dependence can develop within a relatively short period of continuous use (2-10 days)
More common in men than women
Most common 16-24yo
What are the symptoms of opioid intoxication
Intense rush or buzz, feelings of euphoria, warmth, and well being
Sedation, analgesia
Itching and scratching
Pinpoint pupils
N&V
Dizziness
Bradycardia
Respiratory depression
What are the symptoms of opioid withdrawal and when does it occur
6 hours post injection (peak 36-48h)
Watering eyes, Rhinorrhoea, sneezing, cough
Yawning
Clammy skin
Dilated pupils (mydriasis)
Abdominal cramps, nausea, vomiting, diarrhoea
Tremor
Sleep disorder, restlessness, anxiety, irritability
Goosebumps
Hypertension
What investigations should be done for suspected opioid intoxication/withdrawal
Bedside: Urine toxicology, naloxone trial, mouth swab tests, ECG
Bloods: hepB/C serology, HIV serology, LFTs, U&Es, TFTs, FBC
Other: CXR, AXR
What is the long-term management for opioid abuse
MDT approach: primary care, practice nurse, pharmacists, addiction specialists
seek patient’s consent for informing the National Drug Treatment Monitoring System
Bio
Substitution therapy
Psycho
Drugs and alcohol service (DALS)
Motivational interviewing
Social
Key worker appointment
Harm reduction
Health education
Narcotics anonymous or self-management and recovery training (SMART)
DVLA notification
Sleep hygiene
Diet