Substance Abuse Flashcards
What are the potential warning signs of substance abuse?
- Taking higher doses than advised or prescribed
- Running out of meds early (emergency supply etc)
- Regularly losing medication
- Requesting specific drugs
- Stealing or forging scripts
- Drug hoarding (fear of running out)
- Risky behaviours
- Reduced social function
How might someone who is using substances present?
- Intoxicated, sedated or withdrawal symptoms
- Unkempt appearance
- Mood swings or hostility
- Change in sleep patterns
- Avoiding drug testing
Non-pharmacological help for patients taking substances
- Harm reduction advice
- Peer support
- Drug diaries
- Mindfulness
- Counselling
- Therapy
- Physiotherapy
- Physical exercise
- Hobbies/activities
Why do people drink alcohol?
- Disinhibiting effects (dizzy etc)
- Taste
- Peer pressure
- Stress
- Anxiety and other mental health conditions
- To prevent withdrawal symptoms
What are the risks of long term high alcohol intake?
- Death
- Liver damage
- Cancer
- Accidents due to being drunk
- Mental health issues
- Gut problems e.g. bleeds
- Social problems (divorce etc)
- Brain damage
- Nerve damage
- Strokes
- Insomnia
- Heart disease
What is Wernicke- Korsakoff syndrome?
It is a neuropsychiatric disorder caused by thiamine deficiency. It presents as confusion, apathy, disorientation, vomiting and disturbed memory. It is found to occur in as many as 12.5% of chronic alcohol misusers.
How is Wernicke- korsakoff syndrome treated?
Acute treatment= Pabrinex (IM or IV daily for 3-5 days)
Maintenance= Oral thiamine (100mg-300mg daily spread out)
What is disulfiram (Antabuse)? -Clinical
- Makes the taker feel ill when alcohol is consumed.
- Used as an adversive therapy to alcohol.
What is disulfiram (Antabuse) and how does it work?
-Science
- It’s a prodrug that is activated in the liver.
- It prevents the conversion of acetaldehyde to acetic acid, and dopamine to adrenaline.
What is acamprosate (Campral)?
- Clinical
- A drug used after someone has stopped drinking large amounts of alcohol .
- It rebalances the chemicals in the brain which is thought to help prevent the urge to drink alcohol.
What is Naltrexone and how does it work?
- It is an opioid antagonist.
- It blocks the opioid receptors that modulate the release of dopamine in the brain, blocking the rewarding effects from alcohol and heroin
What is Nalmefene and how does it work?
- It is an opioid antagonist.
- It blocks the opioid receptors that modulate the release of dopamine in the brain, blocking the rewarding effects from alcohol and heroin
What is the recommended maximum units of alcohol in a week?
14 units
What are the physical advantages of reducing alcohol intake?
- Feeling better in the mornings
- More energy
- Improved skin
- Weight control
- Overall better functioning
- Better memory
- Lower risk of health problems
What are the non- physical benefits to reducing alcohol intake?
- Developing better relationships
- Improved self esteem
- More money
- More time available
When to refer someone who abuses alcohol to their GP?
- They express a desire to talk in depth with someone about alcohol
- They display alcohol dependence
- They show a high level of alcohol harm, physically or mentally
- A brief intervention isn’t appropriate
What are opiates?
Natural opioids e.g. heroin, morphine and codeine
What is the treatment process for opioid dependence?
- Assessment- to confirm dependence
2.Detoxification- titrate over several days to curb withdrawal symptoms - Maintenance- opioid substitute
- Gradual discontinuation- with support
Opioid withdrawal symptoms
- Runny nose
- Watering eyes
- Dilated pupils
- Yawning
- Nausea
- Vomiting
- Diarrhoea
- Muscle aches
- Restlessness
- Difficulty sleeping
Why/how is methadone used in opioid dependence?
- It is a full agonist
- It is an opioid substitute
- It has a longer half-life than diamorphine so suppresses withdrawal and craving
- Can be and is used ‘on top’
- Avoids opioid withdrawal
Why/how is buprenorphine used in opioid dependence?
- It is a partial agonist
- Has a longer half-life than methaone so suppresses withdrawal and craving
- Can’t be used ‘on top’
—Not absorbed orally (s/l, injection or rods)
Methadone advantages
- Established and familiar
- Good evidence base for methadone maintenance treatment
- Sedating
- Cheap
- Full agonist
- Variety of forms/routes
- Easy to supervise
- Orally absorbed
Buprenorphine advantages
- Can’t be used ‘on top’
- Safer in overdose
- Less stigmatised
- Easier to detox from
- Less sedating
- Better outcomes for new-borns
- Can’t be adulterated
Methadone disadvantages
- Easy to overdose
- Can use ‘on top’
- Leakage onto the streets occurs
- Stigmatised
- Syrup rots teeth
- Can accumulate in fatty tissue
- 3 days to steady state
- Long detox
- Avoids withdrawal but doesn’t stop craving
- Sedating
- Toxic for drug naïve adults or children
