Substance Misuse

Question 1

What is a drug?

Answer 1

A medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body

Question 2

What is addiction?

Answer 2

Chronic, primary, neurobiological condition influenced by genetic, phychosocial and environmental factors

Question 3

What are the risk factors involved in addiction?

Answer 3

• genetics
• environment
• stress
• conditioning effects

Question 4

What are the steps involved in addiction?

Answer 4

• acute reinforcement/social drug taking
• escalating/compulsive use/binge drinking
• dependence
• withdrawal
• protracted withdrawal
• (relapse)
• recovery?

Question 5

What are additional considerations when dealing with addiction?

Answer 5

• trauma history
• comormidity
• homelessness
• interactions with criminal justice system

Question 6

What is initiation of drug abuse more associated with?

Answer 6

Social and environmental factors

Question 7

What is the progression of substance disorder (addiction) more associated with?

Answer 7

Neurobiological factors

Question 8

Describe opioids pattern

Answer 8

• intense initial intoxication
• development of profound tolerance
• escalation in intake
• profound dysphoria, physical discomfort, and somatic withdrawal signs during abstinence

Question 9

Describe the pattern of alcohol

Answer 9

• initial intoxication less than opioids
• pattern characterised by binges
• emotional and somatic withdrawal syndrome
• intense craving for the drug often driven by negative or positive emotional states

Question 10

What are brain reward systems?

Answer 10

• important role in transition from occasional drug user to addiction
• neurobiological theory
• reward pathway

Question 11

What is the reward pathway?

Answer 11

• includes a number of areas of the brain including the ventral tegmental area (VTA), the nucleus accumbens and the prefrontal cortex
• when activated by a rewarding stimulus eg food, information travels from the VTA to the nucleus accumbens and then up the the prefrontal cortex
• dopamine mediated transmission allows us to feel pleasure

Question 12

What leads to euphoria?

Answer 12

Increased levels of dopamine

Question 13

What leads to a decrease in contentment level?

Answer 13

Decreased levels of serotonin

Question 14

What are the three factors in the psychiatric view on addiction?

Answer 14

• preoccupation/anticipation
• binge/intoxication
• withdrawal/negative effect

Question 15

What is the psychodynamic theory?

Answer 15

Two critical elements:
- disordered emotions and disordered self-care
Two contributory elements:
- disordered self esteem and disordered relationships

Question 16

Describe the effects of prolonged exposure to drugs

Answer 16

• addiction through reward pathway
• chronic exposure leads to reduced sensitivity of the brain to reward systems
• as addiction evolves there appears to be greater role of habituation and compulsion of conditioning and environmental stimulii

Question 17

What are the factors involved in drug dependence?

Answer 17

• psychological dependence
• physical dependence
• withdrawal syndrome
• tolerance

Question 18

What are the three classifications of drugs?

Answer 18

• behavioural
• pharmacodynamic
• legal

Question 19

What are the risks of illicit drug use?

Answer 19

• increased risk of infections eg TB/sexually transmitted/IVDU
• health and social issues related to alcohol and smoking

Question 20

How are drugs taken (with examples)?

Answer 20

• oral eg alcohol
• transmucosal eg cocaine
• inhaled/smoked eg cannabis
• intramuscular eg ketamine
• intravenous eg heroin

Question 21

What are complications with injections?

Answer 21

• cellulitis
• abscess
• thrombophlebitis

Question 22

Discuss STIs and drug use

Answer 22

• high rates of STIs among DUs
• independent risk factors for HIV
• trade sex for drugs
• unprotected

Question 23

Discuss blood borne viruses and drug use

Answer 23

HIV/Hep B/Hep C (most common)
- contaminated injection equipment
- health care needle stick injuries
- tattoos and piercings
- sharing razors and toothbrushes
- mother to child transmission in pregnancy
- unprotected sex

Question 24

What is a fix room?

Answer 24

• site provided to allow for supervised drug use
• reduces public injecting
• reduces needle sharing
• improved uptake of addiction treatment

Question 25

What are the effects of cannabis?

Answer 25

• euphoria
• slow reaction time
• confusion
• cough
• anxiety
• tolerance

Question 26

What is the advised amount of alcohol?

Answer 26

14 units/week with 2 alcohol free days

Question 27

What are the effects of alcohol?

Answer 27

• CNS depressant
• affects judgement and concentration
• affects coordination
• aggressive
• effects are dose related
• eventually interferes with cerebella’s function
• finally unconsciousness

Question 28

What are public health interventions with drugs?

Answer 28

• ## smoking packaging made ugly

Question 29

What are the physical effects of stress?

Answer 29

• increased HR
• increased BP
• palpitations
• muscle tension
• headaches

Question 30

What are the mental effects of stress?

Answer 30

• affects thinking ability
• thoughts become jumbled and confused
• focus on worrying

Question 31

What are the emotional effects of stress?

Answer 31

• irritability
• impatience
• unhappiness

Question 32

What should you do as a dentist if you have an addiction problem?

Answer 32

• interest of patients comes first
• senior college for advice
• if you are the college document the encounter
• are you safe to practice
• support groups eg British doctors/dentists groups
• engage with medical services