Substance Misuse Flashcards

1
Q

What is a drug?

A

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

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2
Q

What is addiction?

A

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

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3
Q

What are the risk factors involved in addiction?

A
  • genetics
  • environment
  • stress
  • conditioning effects
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4
Q

What are the steps involved in addiction?

A
  • acute reinforcement/social drug taking
  • escalating/compulsive use/binge drinking
  • dependence
  • withdrawal
  • protracted withdrawal
  • (relapse)
  • recovery?
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5
Q

What are additional considerations when dealing with addiction?

A
  • trauma history
  • comormidity
  • homelessness
  • interactions with criminal justice system
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6
Q

What is initiation of drug abuse more associated with?

A

Social and environmental factors

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7
Q

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

A

Neurobiological factors

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8
Q

Describe opioids pattern

A
  • intense initial intoxication
  • development of profound tolerance
  • escalation in intake
  • profound dysphoria, physical discomfort, and somatic withdrawal signs during abstinence
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9
Q

Describe the pattern of alcohol

A
  • 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
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10
Q

What are brain reward systems?

A
  • important role in transition from occasional drug user to addiction
  • neurobiological theory
  • reward pathway
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11
Q

What is the reward pathway?

A
  • 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
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12
Q

What leads to euphoria?

A

Increased levels of dopamine

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13
Q

What leads to a decrease in contentment level?

A

Decreased levels of serotonin

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14
Q

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

A
  • preoccupation/anticipation
  • binge/intoxication
  • withdrawal/negative effect
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15
Q

What is the psychodynamic theory?

A

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

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16
Q

Describe the effects of prolonged exposure to drugs

A
  • 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
17
Q

What are the factors involved in drug dependence?

A
  • psychological dependence
  • physical dependence
  • withdrawal syndrome
  • tolerance
18
Q

What are the three classifications of drugs?

A
  • behavioural
  • pharmacodynamic
  • legal
19
Q

What are the risks of illicit drug use?

A
  • increased risk of infections eg TB/sexually transmitted/IVDU
  • health and social issues related to alcohol and smoking
20
Q

How are drugs taken (with examples)?

A
  • oral eg alcohol
  • transmucosal eg cocaine
  • inhaled/smoked eg cannabis
  • intramuscular eg ketamine
  • intravenous eg heroin
21
Q

What are complications with injections?

A
  • cellulitis
  • abscess
  • thrombophlebitis
22
Q

Discuss STIs and drug use

A
  • high rates of STIs among DUs
  • independent risk factors for HIV
  • trade sex for drugs
  • unprotected
23
Q

Discuss blood borne viruses and drug use

A

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

24
Q

What is a fix room?

A
  • site provided to allow for supervised drug use
  • reduces public injecting
  • reduces needle sharing
  • improved uptake of addiction treatment
25
What are the effects of cannabis?
- euphoria - slow reaction time - confusion - cough - anxiety - tolerance
26
What is the advised amount of alcohol?
14 units/week with 2 alcohol free days
27
What are the effects of alcohol?
- CNS depressant - affects judgement and concentration - affects coordination - aggressive - effects are dose related - eventually interferes with cerebella’s function - finally unconsciousness
28
What are public health interventions with drugs?
- smoking packaging made ugly -
29
What are the physical effects of stress?
- increased HR - increased BP - palpitations - muscle tension - headaches
30
What are the mental effects of stress?
- affects thinking ability - thoughts become jumbled and confused - focus on worrying
31
What are the emotional effects of stress?
- irritability - impatience - unhappiness
32
What should you do as a dentist if you have an addiction problem?
- 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