Substance Abuse Disorders

Question 1

What is the definition of Substance Use Disorder?

Answer 1

A pattern of use leading to clinically significant impairment or distress, manifested by 2 or more criteria in 1 year.

Question 2

Name two criteria for Substance Use Disorder.

Answer 2

1. Taken in larger amounts or longer than intended
2. Desire or unsuccessful efforts to cut down.
3. Craving or strong desire for stimulant

Question 3

What is Alcohol Abuse Disorder?

Answer 3

A recurrent pattern of harmful alcohol drinking resulting in mental and physical health problems.

Question 4

What is the lifetime prevalence of Alcohol Abuse Disorder in males and females?

Answer 4

20% in males and 8% in females.

Question 5

List the “CAGE” screening questions for Alcohol Abuse Disorder.

Answer 5

Cut down - Ever felt the need to cut down?
Annoyed - Ever felt annoyed by criticism of drinking?
Guilty - Felt guilty abouy your drinking?
Eye-opener - Drinking first thing in the AM?

Question 6

What is the pathophysiology of Alcohol Abuse Disorder?

Answer 6

1. Reward pathway activated by alcohol consumption mediated by dopaminergic pathways.
2. Repeated excessive alcohol consumption sensitises this pathway leading to dependence
3. Long term exposure results in adaptive changes in the brain & alteration in NTs: including down regulation of GABA & upregulation of Glutamate (NDMA) & increased NA activity.
4. Excessive ETOH results in neuroinflammation & leads to myelin disruptions & white matter loss

Question 7

What are some symptoms of Acute Alcohol Intoxication?

Answer 7

Slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma.

Question 8

What is Alcohol Withdrawal?

Answer 8

A set of characteristic symptoms that occur following a reduction in alcohol use after a period of excess.

Question 9

What are the treatment options for Alcohol Withdrawal?

Answer 9

Supportive care, antiemetics, thiamine supplementation, benzodiazepines (diazepam).

Question 10

What is Wernicke-Korsakoff Syndrome?

Answer 10

Thiamine deficiency common in malnourished alcoholics, leading to biochemical damage to the CNS.

Question 11

What are the symptoms of Wernicke’s Encephalopathy?

Answer 11

Triad of symptoms:
1. Ophthalmoplegia
2. Changes in mental state (confusion)
3. Ataxic gait

Question 12

What is Korsakoff’s Syndrome?

Answer 12

Acute onset of severe memory impairment without any dysfunction in intellectual abilities. (A manifestation of Wernicke’s)
- Damage is primarily in the thalamus and mammillary bodies

Question 13

List three symptoms of Korsakoff’s Syndrome.

Answer 13

1. Anterograde amnesia
2. Retrograde amnesia
3. Confabulation
4. Lack of insight

Question 14

What are some risk factors for Alcohol Abuse Disorder?

Answer 14

Low socioeconomic status, peer pressure, familial association, mental illness, indigenous status, genetics, environment, personality, opportunity, childhood trauma, family modeling.

Question 15

What is the Alcohol Use Disorder Identification Test (AUDIT)?

Answer 15

A screening tool used to identify alcohol use disorder.

Question 16

What are the stages of change in overcoming substance abuse?

Answer 16

Pre-contemplation, contemplation, preparation, action, maintenance, termination.

Question 17

Define: Acute Intoxication

Answer 17

A transient condition following the administration of alcohol or other psychoactive substance, resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses as a result of the drug

Question 18

Define: Drug misuse

Answer 18

Misuse of prescription medications used for mood alteration or intoxication. May involve medication changing hands from pt to which it was prescribed

Question 19

Define: Substance Dependence

Answer 19

An adaptive state that develops from repeated drug administration, and which results in withdrawal upon cessation of drug use. These can be mild (caffeine) or even life threatening (for alcohol).

Question 20

Define: Substance
Addiction

Answer 20

Addiction is a psychological condition that describes a compulsion to take a drug or engage in other harmful behaviours.
People can be depended without being addicted. Pt can have symptoms of withdrawal + dependence without the psychological cravings