Substance misuse

Question 1

Common substances which are misused

Answer 1

Opioids

Cannabinoids

Stimulants

Sedative-hypnotics

Hallucinogens

Volatile solvents

Anabolic steroids

Question 2

Delirium tremens

Answer 2

Withdrawal delirium that develops between 24 hours and one week after alcohol cessation

Characterised by cognitive impairment, vivid perceptual abnormalities, paranoid delusions, marked tremor & autonomic arousal

Medical treatment - large doses of benzodiazepines, haloperidol for any psychotic features & IV Pabrinex

Question 3

Wernicke’s encephalopathy

Answer 3

Acute encephalopathy due to thiamine deficiency

Present with delirium, nystagmus, ophthalmoplegia, hypothermia and ataxia

Requires urgent treatment with parenteral thiamine

May progress to Korsakoff’s psychosis

Question 4

Korsakoff’s psychosis

Answer 4

Profound, irreversible short-term memory loss with confabulation (the unconscious filling of gaps in memory with imaginary events) and disorientation to time

Question 5

Alcohol withdrawal mx

Answer 5

Alcohol detoxification regime - controlled withdrawal

High dose benzodiazepines given initially & dose is tapered down over 5-9 days

Thiamine is also given to prevent Wernicke’s encephalopathy

Question 6

Alcohol dependence (long term) mx

Answer 6

Pharmacological therapies:

• disulfiram: works by causing a build-up of acetaldehyde on consumption of alcohol, causing unpleasant symptoms
• acamprosate: reduces craving by enhancing GABA transmission
• naltrexone: blocks opioid receptors in the body, thus reducing the pleasurable effects of alcohol

Motivational interviewing - guides the person into wanting to change

CBT

Alcoholics anonymous