Substance and alcohol misuse Flashcards
Factors leading to substance dependence
Precipitating factor e.g parent drug use, peer pressure
Takes substance
Positive reinforcement - from peers, drug or mesolimbic system
Dependence
What is dependence
At least 3 of following over 1 month:
Compulsion to have substance
Preoccupation with substance use
Withdrawal when substance use stopped or reduced
Impaired ability to control substance taking behaviour
Tolerance (more substance needed for desired effect)
Persistent use despite harmful effects
Management of substance abuse
Screen for BBV Motivational interviewing Incentives for abstaining from substance use Help social circumstances Self help groups
What is maintenance and detoxification
Maintenance - aim is harm minimisation
Detoxification - drug eliminated safely so that withdrawal symptoms are avoided
Pharmacological management for opioid dependence
1st line: methadone
For detox and maintenance: buprenorphine
For overdose: naloxone
Recommended maximum alcohol intake
14 units per week
What is hazardous, harmful and binge drinking
Hazardous - above safe levels without alcohol related problems
Harmful - above safe levels with alcohol replaced problems
Binge - over twice recommended levels per day
Edward and Gross criteria for alcohol dependence
RAW DRIP Relief drinking Awareness of compulsion to drink Withdrawal symptoms Drink seeking behaviour Reinstatement after attempted abstinence Increased alcohol tolerance Pattern of drinking is fixed I.e one type of alcohol, same time
What is delirium tremens
Withdrawal delirium peaks at 72 hours Characterised by: Cognitive impairment Perceptual abnormalities - illusion or hallucination Paranoid delusion Marked tremor Autonomic arousal
Treatment for alcohol withdrawal
Chlordiazepoxide
Thiamine
What is CAGE
A questionnaire to screen for alcohol dependence
Ever wanted to Cut down on drinking?
Has anyone Annoyed you by criticising your drinking?
Have you ever felt Guilty about drinking?
Ever had an Eye opener?
What is Wernicke’s encephalopathy
Acute encephalopathy due to thiamine deficiency, presenting with: Confusion Ataxia Opthalmoplegia Can progress to Korsakoff psychosis
What is Korsakoff’s psychosis
Profound irreversible short term amnesia with confabulation (filling gaps in memory with imaginary events)
Management of alcohol dependence
BIOPSYCHOSOCIAL MODEL
Treat withdrawal Address social issues Alcoholics Anonymous Motivational interviewing Disulfiram DVLA
