Substance misuse Flashcards
What is an addiction?
Chronic, primary, neurological condition influence by genetic, psychosocial and environmental factors which causes a compulsion to do something or partake in something.
What are common risk factors for drug misuse and addiction?
Genetic factors
Socioeconomic factors
Young having first drug or alcohol
Co-existing mental problems
Peer pressure
Physical and sexual abuse
Low self esteem
Stress
Adverse childhood events
poor role models
Low educational aspiration
What are the different theories with regards to initiation of drug abuse and the continuation of addiction?
Initiation is due to social and environmental factors but the ongoing addiction is due to neurobiological factors.
What is the traditional theory of patterns of addiction?
Intense initial intoxication
Development of profound tolerance
Escalation in intake
Profound dysphoria, physical discomfort and somatic withdrawal signs during abstinence
How is the reward pathway in the brain related to addictions?
Brain activated by rewarding stimulus
Information travels from the VTA to the Nucleus Accumbens and then to the prefrontal cortex.
Dopamine is transmitted- feel pleasure.
- drug use can cause increased levels of dopamine (Euphoria) or decreased levels of serotonin (decreased contentment).
Prolonged exposure to drugs of abuse results in addiction through rewards pathway.
Chronic exposure reduced the sensitivity of the brain tor reward systems.
What is dependence?
Can be psychological or physical.
Psychological- an overriding compulsion to take the drug even in the certain knowledge that it is harmful.
Physical- sudden drug withdrawal is followed by a withdrawal syndrome, which leads the person to take the drug again in order to avoid the withdrawal symptoms.
What is tolerance?
Repeated administration of a drug, which makes the user become less sensitive to the effects of the drug and over time, larger doses to achieve the same effects previously produced at lower doses.
What types of drugs exist?
Stimulants
Anti-depressants
Anti-psychotics
Opioids
Psychedelics
What mechanism of action does Haloperidol have?
Anti-psychotic medication- D2 receptor antagonist in the brain.
Give an example of SSRIs.
Sertraline
Citalopram
Fluoxetine
What are some of the general issues with illicit drug use?
Increased risk of infection- TB, BBV (Hep B, Hep C), sexually shared infections, HIV.
Injection related complications
- Cellulitis
- Abscess
- Thrombophlebitis
Embolism
Deep vein thrombosis
Musculoskeletal infection
Endovascular complications
Bacteraemia leads to septicaemia- bacteria lodge in small vessels in any organ.
Chronic liver disease
How are blood borne viruses transmitted?
Contaminated blood and blood products
Sharing of contaminated injecting equipment
Needle stick injuries
Tattoos or piercings with contaminated equipment
Mother to child transmission during pregnancy and delivery
Unprotected sex
What does PWID mean?
People who inject drugs
What has Glasgow implemented, that could help with the current drug epidemic?
Drug consumption rooms
Heroin assisted treatment
These are healthcare settings, which provide safe and clean environment for the consumption of drugs under supervision of medically trained staff with clean and safe injecting equipment.
What are the effects of Cannabis?
Euphoria
Slow thinking and reaction time
Confusion
Impaired balance and co-ordination
Cough
Respiratory infections
Impaired memory and learning
Panic
Anxiety
What is the safe limit of alcohol?
14 units per week, at least 2 alcohol free days
What are the signs of addiction?
Mood changes
Loss of reliability
Impaired driving
Complaints about deteriorating attitude and behaviour
Isolation
Requesting specific drugs
Progressive deterioration in personal appearance and hygiene
Tremors
Constricted or dated pupils
Puncture marks, scare of pigmentation over veins
What is the role of the GDP with regards to addictions?
Recognise substance abuse
Deliver emergency dental treatment within that period
Comprehensive care
Signpost to addiction services
Referral to hospital services
Maintain dental health during rehabilitation
Have empathy and awareness of potentially manipulative behaviour
Realistic treatment planning
What barriers are present for those with addictions?
Fear of judgement
Chaotic lifestyle
Low priority of oral health
Fear of dentists
Poor attendance and compliance
Cost
Aggressive and unpredictable behaviour
How would you ask someone if they used drugs?
Ask about alcohol, smoking and if there is any elicit drug use.
If they say no and you are still suspicious. Word it in a way that says you need to know to make sure that whatever you do is safe because you could harm the patient if you don’t know.
Aren’t there to judge, just want to make sure that when you’re treating them that you’re doing it safely.
What dental related issues might be present?
Gross caries
Periodontal disease
NCTSL- erosion, attrition
Hyposalivation
Poor oral hygiene
Poor denture hygiene
Opportunistic infections
Trauma
Oral cancer
Poor diet
Mucosal lesions of malignant potential.
Parafunction
LA with adrenaline may be an issue
- use articaine in alcohol addicts
- Want someone to be free of cannabis for a few days before using LA with adrenaline because it can prolong acute Tachycardia.
IV sedation contraindicated- can have a synergistic effect on sedative agent.
- venous access may also be difficult.
May request prescription for things when it is not appropriate.
Issues with capacity and consent
If someone is an alcoholic, what should you keep in mind?
Morning appointments better- least likely to be under the influence.
Not suitable for IV sedation
Avoid GA- may be resistant to GA, risk of vomiting.
Patients on disulfiram may have a psychotic reaction with metronidazole.
Bleeding risk and be mindful of drug metabolism- liver effects.
Consider articaine for LA
Avoid metronidazole.
What oral side effects exist for alcohol?
Erosion- palatal
Attrition
Parafunction- muscular hypertrophy
Sialosis
Golossitis
Increased risk of oral cancer
Advanced caries
Periodontal disease
Angular Cheilitis
What effect does heroin have?
Opioid
Causes users to feel euphoric for several hours and then a sedative state occurs, CNS depression and analgesia.
