Substance Abuse Disorders Flashcards
Defn of substance misuse?
Use of a substance in excess, or in a different way to its prescribed or intended use
Defn of hazardous substance use?
A pattern of substance use that increases someone’s risk of harmful consequences to themselves
Defn of harmful substance use?
Pattern of misuse that damages individual’s physical or mental health
Substance use disorder defn according to DSM-V?
A maladaptive pattern of substance use, leading to impairment or distress, manifesting itself in any of the following:
- Role failure: fails to fulfill important obligations at school, home or work
- Risky drug taking: uses in a manner that is physically hazardous
- Run-ins with the law: legal problems
- Relationship problems: social or interpersonal problems
Intoxication defn
When the substance is used and the user is “under the influence” of the substance –> reversible
Tolerance defn
The body adapts to the effects of a substance, and higher doses are needed to achieve the same initial effect (“chasing the dragon”)
Withdrawal defn
An indicator of tolerance, effects can be the opposite of intoxication symptoms. Manifests as abnormal physical or psychological features that follow the abrupt discontinuation of a drug of dependance
Detoxification defn
Process of using medicines to reduce the level of tolerance gradually and safely, to relieve withdrawal symptoms
Classes of substances of abuse
- Psychedelics
- Stimulants
- Depressants
Signs of cannabis intoxication
CNS: Euphoria, anxiety, impaired short-term memory, poor judgment and co-ordination
Physical: Red eyes, dry mouth, increased appetite, tachycardia, hypotension
Severe intoxication: Ataxia, sedation, poor concentration, slurred speech
What is amotivational syndrome?
Syndrome associated with chronic cannabis use: users show apathy, dullness, diminished goal-directed activities
Cannabis withdrawal
Restlessness, insomnia, anxiety, aggression, anorexia, muscle tremors
Similar to, but much less severe than alcohol, opioid, benzodiazepine withdrawal
Management of cannabis withdrawal
Detoxification is unnecessary
Treat uncomfortable symptoms with diazepam 5mg PO tds tapered down over a few days
Cannabis-induced psychiatric effects
- Acute ‘toxic’ responses: panic, anxiety, depression, psychosis
- Withdrawal syndromes
- Cannabis-induced psychotic disorder
- Amotivational syndrome
- Effects on pre-existing mental illness
Symptoms of tik use
Rush of intense arousal, euphoria, increased energy, excessive speech, increased libido, reduced appetite
Symptoms of tik withdrawal
“Crash”, agitated, exhaustion, insomnia, hyperphagia
Withdrawal syndrome can have a very long course
From day 45-120 can experience symptoms of depression, anxiety, lethargy, insomnia, drug cravings
Management of tik withdrawal
Doesn’t normally require detoxification
Support, empathic counseling, occasionally medically manage symptoms
Intensive long-term outpatient rehabilitation
If they have SIPD, treat with atypical antipsychotics
Psychiatric complications of tik use
- SIPD
- Anxiety disorder
- MDD
- Sleep disorder
- Sexual dysfunction
- Intoxication delirium
- Cognitive impairment
DSM-V criteria for alcohol use disorder
At least 2 of the following, within a 12 month period:
- Alcohol often taken in large amounts
- Persistent desire/unnecessary effort to cut down
- Great deal of time spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects
- Craving/strong desire to use alcohol
- Recurrent alcohol use leads to failure to fulfil major obligations at work, school or home
- Continued use despite recurrent social or interpersonal problems caused/exacerbated by effects of alcohol
- Give up/reduce important activities because of alcohol
- Recurrent use in situations in which it is physically hazardous
- Use continued despite knowledge of having a persistent physical or psychological problem due to alcohol
- Tolerance: either need increased amounts to reach desired effect, or diminished effect with continued use
- Withdrawal: either characteristic withdrawal syndrome, or alcohol or a closely related substance (e.g. benzo) taken to relieve or avoid withdrawal symptoms
DSM-V criteria for alcohol use disorder (less wordy)
At least 2 within 12 month period:
- Use alcohol in large amounts
- Unable to cut down
- Time spent using, getting or recovering from use
- Craving for alcohol
- Use leads to failure to meet obligations
- Continued use despite it causing problems
- Reduce activities because of alcohol
- Use when physically hazardous
- Continued use despite known harms
- Tolerance
- Withdrawal
Alcohol intoxication: low dose
- Disinhibited –> risky behaviour
- Talkative
- Outgoing
- Belligerent
- Emotional
Alcohol intoxication: high dose
- CNS depressant
- Impaired judgment
- Slurred speech
- Staggering gait
Alcohol poisoning
- Respiratory depression
- Coma
- Death
Uncomplicated alcohol withdrawal
- Anxiety
- Agitation
- Nausea/vomiting
- Insomnia
- Cravings
