Substance abuse

Question 1

types of substances

Answer 1

stimulants: cocaine, meth, ecstasy
depressants: alcohol, BZD, opiates
hallucinogens: LSD
cannabis
solvents
legal/novel highs

Question 2

diagnostic criteria (ICD-10)

Answer 2

1) class/type of substnce
2) disorder type: acute intoxication (Reversible, direct effect), harmful use/abuse, dependence, w/d +/- delirium, psychosis, amnesia, other mental/behavioural

Question 3

depressants

Answer 3

heroin: euphoria, relax, miosis, sedation, nausea, twitch
BZD: sedation, amnesia, mm relax, anxiolytic, hypnosis

Question 4

dependence syndrome

w/d and tolerance top features

requires tolerance (e.g. ADD not addictive)

Answer 4

12 month period; 3 of:
compulsion: sense/perception
control: sense/perception, inabiltiy to stop
w/d: Sx, or taking to avoid Sx
tolerance: ^dose or less effect
preoccupation/priority
persistence: despite harm
rapid reinstatement: attempted abstinence

Question 5

alcohol - stats and units

Answer 5

unit = vol (L) x ABV; 14/w, 2 days free

M7% F2% dependence; 25% ED Ax (1m), 10% psych Ax
21% teetotal last year, 15% binge drink, ^’problem drinkers’
F: genetic dependence risk, and more physical complicatiosn

Question 6

alcohol - aetiology

Answer 6

genetics: FDR 4-7x; asian ADH
NT: GABA, DA, 5HT, glutamate upregulation
pain, chronic illness

positive and negative reinforcment, modelling (peers/media)
social: stressors, access, attitudes

Question 7

alcohol - physical complications

Answer 7

hepatic/GI: liver diseases, gastritis, ulcers, varices, pancreatitis, cancer
CVS/blood: anaemia (MCV)
endocrine: hypoglycaemia
neuro: neuropathy, ceb, seizure, injury
other: accidents, hypothermia, resp depp, asp pn., infection

Question 8

alcohol - psych complications

bidirectional
dual diagnosis (co-exist)

Answer 8

intoxication: confusion, disinhibition, depression; 10-15%
SI and DSH; DT; amnesia (15%), WKS
cognitive impairement (Dementia), Othello delusion, hallucinosis (audio, sober)
exacerbate pre-existing

Question 9

alcohol withdrawal syndrome

Answer 9

up to 40%; 6-8h after last drink, peaks 10-30h

SANS: anxiety, agitation, tachyC, sweating N/V, tremor
toxic cortisol - risk of DT
Rx: BZD

Question 10

Delirium Tremens

emergency (usually IP)

Answer 10

1-3 days abstinence; 5% of AWS; UnRx mort 15%

• cloudy consciousness, visual halls, paranoid delusion, SANS
• DDx: injury, infection, hypoG
• Rx: chlordiazepoxide (BZD), fluids/electrolytes, parenteral B1 ASAP

Question 11

Wernicke and Korsakoffs

Answer 11

Wernicke: emergency, B1 deficiency, Mamillary body risk

• confusion, ataxia, ocular; neuropathy, nystagmus
• Rx: IV thiamine
• 20% recover, 10% die (BS/hypothal hge), 70% Korsakoff

Korsakoff: recent memory, confabulation; other functions normal

Question 12

alcohol - social complications

Answer 12

family/marriage
employment, finance, homeless
accidents
crime, driving

Question 13

alcohol assessment

Answer 13

CAGE: cut, annoyed, guilt, eye-opener

history: TWAT, dependence, PPH/PMH, DH (common), SH, collateral
exam: physical + w/d signs
investigations: MCV (^, specific), anaemia, ALP, GGT (sensitive)

Question 14

stages of drug use

Answer 14

experimental: cigs, cannabis, solvents
recreational: clubbing
harmful/abuse
dependence: physical, psychological (craving, behaviour)

Question 15

drug classes

Answer 15

A: ecstasy, LSD, MMshroom, heroin, morphine, methadone, cocaine
B: meth, barbiturates, cannabis
C: BZD, ket, GHB

Question 16

opioid withdrawal

Answer 16

rapid tolerance and loss - OD risk
Sx: craving, restless, insomnia, mm pain, tachyC, midriasis, rhinorrhoea, ANS, GI
Rx: alpha-agonists e.g. Lofexidine

Question 17

general management

Answer 17

goals: stop/reduce harm/social; motivation;
-controlled, non problematic, non-dependent use
stages of change: pre/contemplation/prep/action/maintenance
MI (5 steps): rapport/agenda/change talk/advise/plan
-change talk: importance and confidence scales

Question 18

alcohol management

20-50% abstinent 1y later

Answer 18

B: detox (BZD, 5-10d); acamprosate (craving), disulfiram (antabuse), naltrexone (pleasure less)
-controlled vs. abstinence

P: AA, CBT, FIT, social skills training (decline), assertiveness, harm reduction
S: headings

Question 19

MHA and substance misuse

Answer 19

can not use MHA to override capacity regarding treating substances

Question 20

stimulants - effects

Answer 20

cocaine: energy, alert, confident, euphoria, impulsive, judgement, less sleep
- chronic: depression, panic, paranoia, saddle-nose
- SE: formication, crash, anx, HTN, arryth

meth: cocaine, but longer and slower
-tachy/arrhy, pyrexia, psychosis/mood/anx
MDMA: rush euphoria, intimacy, perception
-gurning, lost appe, vitals, dehydration, ?memory

Question 21

LSD, solvents, and cannabis effects

Answer 21

LSD: trip, detached, synaesthesia, visual halls, wonder
-tox, flashback, anx, depp, psychosis

cannabis: joy, relax, perception, munchies
- memory, schizo, concentration, tobacco

solvents: euphoria, visual , slurred/blurry, ataxia
- brain/organ damage, cardiac arrest

Question 22

RF

Answer 22

personal: abuse, disrupted family, education issues, conduct/antisocial PD, impulsive, sensation-seeking
social: deprivation, culture, unemployment

Question 23

BZD w/d (wean off over months; 2mg/wk)

Answer 23

rapid tolerance (fixed 6/52, can start 2/52)

anxiety, irritable, tremor, insomnia, perception, seizure, depression, delirium

o/d: resp depp, coma, death