Substance misuse

Question 1

Description

Answer 1

Use of a drug in amounts or methods that are harmful to the individual or to others
Most often used drugs
-alcohol, amphetamines
-barbiturates, BZ
-cannabis, cocaine
-hallucinogens
-opioids

Question 2

Epidemiology of alcohol use disorders
Aetiology of alcohol use disorders
Pathophysiology of alcohol use disorders

Answer 2

Male bias
20-36% prevalence in primary care
Greatest prevalence in resource poor countries

Multifactorial biopsychosocial etiology

Pleasurable effects of alcohol stimulated by dopaminergic pathway
Repeated excessive ingestion sensitises the pathway
-GABA downregulated
-Glutamate upregulated
Discontinuation leaves excitatory state unopposed resulting in DT, SNS signs, hallucinations, nausea

Question 3

What are the signs and symptoms of alcohol use disorder

Answer 3

Symptoms of withdrawal

• nausea
• anxiety, irritability
• shaking, sweating

Symptoms of alcoholism

• strong desire or cravings
• inability to stop drinking or get through everyday activities without a drink
• hiding drinking activities

Abdo exam

• jaundiced, hepatomegaly or cirrhosis
• cachexic, ascities

Neuro exam
-Wernicke’s encephalopathy (ataxia, eye instability, confusion, memory problems) => URGENT ADMISSION

Question 4

How would you screen for alcoholism

Answer 4

CAGE

• Concerned about your own drinking habits
• Apparent to others that there is a problem
• Guilt about your drinking
• Eye openers first thing in the morning?

AUDIT questionnaire to assess severity and likelihood of alcohol miuse

CIWA to assess the severity of withdrawal symptoms

Question 5

What investigations would you do for alcohol use disorder?

Answer 5

Assess impact of alcohol on body
FBCs and U&Es

LFTs and liver screen

• if liver impacted => high
• low albumin, high INR

Question 6

How would you manage alcohol use disorders?

Answer 6

If in primary care, mild => motivational interviewing and lifestyle advice
-CBT

If in primary care, moderate or severe withdrawal symptoms => refer to specialist care
-Pabrinex and BZ to address withdrawal symptoms

Question 7

What is the prognosis for alcohol use disorders?

What are the complications of alcohol use disorders?

Answer 7

Brief intervention can benefit patients greatly
Relapse is common but ongoing episodic treatment is beneficial

ALD, cirrhosis
Nutritional disorders => Wernicke-Korsakoff
DT, seizures
Esophageal varices