Substance Abuse

Question 1

Dependence

Answer 1

≥3 of the following in 12 month period:

• tolerance
• withdrawal
• substance taken for longer or in larger amounts than expected
• persistent desire/failed efforts to cut down
• substance use is continued despite knowledge of adverse physical or psychological problems
• great deal of time/effort is spent on obtaining, using and recovering from the substance

Question 2

Withdrawal

Answer 2

Cessation of alcohol use that has been heavy and prolonged.
≥2 of the following, developing within several hours to a few days after the cessation (or reduction in) alcohol:
- autonomic activity
- increased hand tremor
- insomnia
- nausea or vomiting
- transient visual, tactile or auditory hallucinations or illusions
- psychomotor agitation
- anxiety
- generalised tonic-clonic seizures

Question 3

Alcohol Abuse

Management

Answer 3

Detoxification and management of withdrawals - naloxone
AA
Psychotherapy - family therapy
Withdrawal centres
Home detox (family help and community services)
Substitution programs - methodone (full agonist), buprenorphine (partial-agonist)
Abstinence programs - Naltrexone (decreases cravings by blocking the release of endogenous opioids/receptors)

Question 4

Alcohol Withdrawal

Pharmacological treatment

Answer 4

Benzodiazepines

Haloperidol for any psychotic features

Question 5

Barbituate Use

Signs and Symptoms

Answer 5

Nystagmus
Ataxia
Slurred and slowed speech
Clouding of consciousness
Slow and shallow breathing
Poor coordination

Question 6

Opiate Use

Signs and Symptoms

Answer 6

Bilateral miosis
Increased anxiety 
Psychosis 
Depression and irritability
Increased HR and BP

Question 7

Amphetamine Use

Signs and Symptoms

Answer 7

Tachycardia
Excitable and irritable
Paranoid delusions
Increased temperature
Dry mouth
Dilated pupils

Question 8

Cocaine Use

Signs and Symptoms

Answer 8

Dilated pupils
Runny nose/nose bleeds
Tachycardic
Euphoric
Overconfidence

Question 9

Alcohol dependence

Management

Answer 9

Naltrexone