Substance abuse Flashcards
What are risk factors for drug abuse
Genetic
Environment
* socioeconomic factors
* surrounding by those who take drugs
* time of drug use (younger = higher risk)
* personality (low self esteem)
* availability of drugs
* coexisting mental help problems
* peer pressure
* physical and sexual abuse
* early exposure to drugs
* stress
What is the traditional theory on the pattern of addiction
- intense initial intoxiciation
- development of tolerance
- escalation in intake
- profound dysphoria, physical discomfort and somatic withdrawal
What is the ‘reward’ pathway
- when activated by rewarding stimulus, informationt ravels from the VTA to the nucelus accumbens and then up to the prefrontal cortex
- dopamine mediated transmission allows us to feel pleasure
How do drugs effect neurotransmitters
increased dopamina levels - euphoria
decreased levels of serotonin - decreased levels of contentment
Describe the psychodynamic theory
two critical elements - disordered emotions and disordered self care
two contributory elements - disordered self esteem and disordered relationships
What does prolonged exposure to drugs of abuse result in
addiction via reward pathway
chronic exposure reduces sensitivity of brain to reward system
What are features of drug dependance
- psychological - taking the drug knowing its harmful
- physical - symptoms if drug not taken
- withdrawal syndrome - symptoms following sudden withdrawal
- tolerance - repeated administration means they become less sensitive
What can drugs be divided into
- behavioural classification
- pharmacodynamic classification
- legal classification
How can drugs be classed based on behavioural features
- stimulants e.g cocaine
- opiods
- sedative
- anypsychotics
- antidepressants
- psychedelics
What are the risks of illicit drug use
- STI
- BBV
- TB
- smoking/alcohol risks
How can drugs be administered
- oral
- transmucosal
- inhalation
- smoking
- intramuscular
- IV
What are injection related complications from drug use
- cellulitis
- abscess
- thrombophlebitis
- thrombosis
- embolism
- DVT
What are the effects of cannabis
- euphoria
- slowed thinking and reaction time
- confusion
- impaired balance and coordination
- cough
- frequent resp infections
- impared memory and learning
- increased HR
- anxiety
- panic
What are the effects of alcohol
- CNS depressant
- judgement, concentration and coordination
- effects are dose related
- eventually interfere with cerebellar function
- cause ataxia and motor coordination
- ultimately unconsciousness
What are signs of substance misuse
- loss of reliability
- mood and behaviour changes - defensive and angry
- subjective symptoms
- requesting specific drugs
- progressive deterioration in personal appearance and hygiene
- tremor
- constricted pupils or dilated
- puncture marks, scars or pigmentation over veins
What are barriers to accessing dental services for drug misusers
- fear of judgement
- low priority of OH
- fear of dentists
- self medication
- chaotic lifestyle
- poor attendance compliance
- cost
What can help facilitate access for drug misusers
- key workers may be assigned if enrolled in addiction programmes
- key workers can encourage attendance and accompany px to appointments
What are the medical implications of drug misuse
- increased rates of infection
- general health neglect
- oral health neglect
- chronic liver disease in alcohol abuse - impaired drug metabolism and bleeding risk
- BBV
- infective endocarditis
- venous thromboses
What are drug misusers at risk of
- crime to fund addiction
- maxfax injuries
- sharing of needles - BBV
- family disruption
- no address
- prison
- risk of withdrawing
- chaotic lifestyle
Why may consent be an issue for this group
- issue for dependent px
- fluctuating capacity
- capacity unlikely when under the influence
- postpone tx
What are examples of alcohol related brian damage
korsakoffs syndrome
similar to dementia
How should we tx plan for these px
- assess px expectation
- stabilise mouth
- diet and OHI
- keep tx as simple as possible during active substance misuse - use ART and SDF
How can LA be impacted in cannabis misusers
LA with adrenaline can prolong acute tacychardia
What problems can LA pose for alcohol misusers
- liver problems
- lidocaine metabolzied in liver
- keep doses to minimum
- use articaine
- avoid IDB
