Substance dependance and misuse

Question 1

What are the risk factors for susstance dependance?

Answer 1

Lower socioeconomic group
Genetic factors
Childhood experiences e.g. abandonment, abuse
Adolescent experiences e.g. family breakdown
Environmental experiences e.g. availability of substance

Question 2

What is the pattern of developing substance misuse?

Answer 2

Casual use into regular use through to compulsion

Question 3

What are some of the key features of dependance syndrome?

Answer 3

Salience (change in life priorities to drug seeking behaviour)
Tolerance
Impaired control of consumption
Returning to previous behaviour following absinence
Withdrawl syndrome (anticipate and avoiding withdrawls)

Question 4

What biological changes occur in addiction

Answer 4

There is neuro adaptation in the pre frontal corte that overrides normal judgement

Question 5

What are some of the common defence mechanisms in addiction?

Answer 5

Most commonly denial
Rationalisiation (I drink to sleep)
Passive aggression
Humour

Question 6

What is the states of change model?

Answer 6

Allows you to understand motivation for addiction and tailor treatment

Question 7

Are hallucinations present in alcoholism?

Answer 7

Yes they can commonly occur in alcoholics

Question 8

What is wernicke korsakoff’s syndrome caused by?

Answer 8

This is caused by Thiamine deficiency which causes haemorrhages in the mammary bodies and floor of the third ventricle

Question 9

What is korsakoff’s psychosis?

Answer 9

Following Wernickes if patients survive they can develop korsakoff’s psychosis which is anterograde loss of short term memory

Question 10

What is delerium tremens and what is it a feature of?

Answer 10

This is a triad of symptoms:
-Delerium
-Hallucinations
-tremor
Typically occurs following severe alcohol withdrawl

Question 11

What is typically used to treat alcohol withdrawl symptoms?

Answer 11

Treated with Chlordiazepoxide or diazepam

Question 12

What nutrients should alcohol withdrawl patients be given?

Answer 12

Iv pabrinex to treat thiamine deficiency

Question 13

What interventions should be used once alcoholics are off alcohol to stop them going back on it?

Answer 13

Psychosocial interventions:

• Brief interventions
• Cognitive behavioural therapies

Question 14

What are some of the signs and symptoms of opiate overdose?

Answer 14

It causes resp depression
Pinpoint unreactive pupils
Decreased sympathetic activity (low BP)
Bradycardia
Severe drowsiness

Question 15

How do you treat opiate overdose?

Answer 15

Naloxone

Question 16

How long does withdrawl from opiates take? When is it worst?

Answer 16

It begins after 4-12 hours and peaks at 48-72 hours

Takes 7-10 days altogether

Question 17

What are the symptoms of opiate withdrawl?

Answer 17

Muscle aches, vomiting, diarrhoea, agitation, sweating, insomnia

Question 18

What medication is typically used for opiate withdrawl?

Answer 18

Methadone dose can be titirated according to the withdrawl symtpoms
Buscopam can be used abdominal cramps and benzodiazepine can be used for other symptoms

Question 19

What is the antidote to benzodiazepine overdose and how does this work?

Answer 19

Flumazenil, it works by competitivly inhibits benzodiazepines at the GABA binding site

Question 20

How do benzodiazepines work?

Answer 20

They bind to GABA and reduce the excitability of neurones in the brain. This is because they increase GABA activity and this is an inhibitory neurotransmitter

Question 21

Broadly how do ectasy, cocaine and MDMA work?

Answer 21

Amphetamines that increase sympathetic activity in the brain

Question 22

What can be used to help with amphetamine dependance?

Answer 22

Antidepressants