Substance Misuse and Addiction Flashcards
what are the UK guidelines of drinking
men and women
- 14 units a week spread over 3 days
what is considered increased and higher risk drinking
increased risk
- 15 to 35 units per week
higher risk
- over 35 units per week
what is the definition of harmful use of alcohol
A pattern of psychoactive substance use that is causing damage to health. The damage may be physical or mental
what is alcohol dependence syndrome
Strong desire or sense of compulsion to take drug
Difficulty in controlling use of substance in terms of onset, termination or level of use
Physiological withdrawal state
Evidence of tolerance
Progressive neglect of other pleasures /interests because of use /effects of substance
Persistence with use despite clear evidence of harmful consequences
what does alcohol do in the brain
inhibits the action of excitatory NMDA-glutamate controlled ion channels
- chronic use leads to up regulation of receptors
Alcohol potentiates the actions of inhibitory GABA type A controlled ion channels
what does alcohol withdrawal lead to
excess glutamate activity (toxic to the nerve cell) and reduced GABA activity
what does acute alcohol withdrawal lead to
CNS excitability and neurotoxicity
what are the Sx of alcohol withdrawal syndrome
first Sx occur within hours and peak at 24-48 hours
restlessness, tremor, sweating, anxiety, n+v, loss of appetite and insomnia
tachycardia
systolic hypertension
what is the time line for alcohol withdrawal Sx
Sx = 6-12 hours
Seizures = 36 hours
Delirium tremens = 72 hours
how long do Sx last in alcohol withdrawal
5-7 days
what is features of delirium tremens
peak onset with 2 days of abstinence
often presents insidiously with night time confusion
Sx of delirium tremens
Confusion Disorientation Agitation Hypertension Fever Visual and auditory hallucinations Paranoid ideation.
what is used during alcohol withdrawal
Benzodiazepines = Diazepam or Chlordiazepoxide
Thiamine
what is used in alcohol relapse prevention
Naltrexone
Disulfiram (antabuse)
Acamprosate
what are S.E. of Disulfiram
flushed skin, tachycardia, n+v, arrhythmias and hypotension
what is the criteria of dependence
A strong desire to take the substance
Difficulties in controlling substance use
A physiological withdrawal state
Tolerance - need a higher ‘dose’ to achieve the same effect
Neglect of alternative pleasures
Persistence despite evidence of harm
what is the reward pathway
mesolimbic pathway:
VTA»_space; nucleus accumbens»_space; prefrontal cortex»_space; release of dopamine
what receptors are decreased by addiction
Dopamine D2 receptors
what happens due to repeated dopamine release in addition
dopamine receptors down regulated»_space; Threshold for rewards during abstinence is thus increased
what part of the brain is our key creator of motivation to act
orbito-frontal cortex
what is the role of the pre-frontal cortex
Helps intention guide behaviour
Modulates the powerful effects of the reward pathway
Sets goals, focuses attention
Makes sound decisions
Keeps emotions and impulses under control to achieve long term goals
what does addictive drugs do to the prefrontal cortex
disrupts normal dopamine-related learning in the PFC
what are the effects of dopamine release
Ability to update information within the PFC
Ability to select new goals
The ability to avoid compulsive repetition of a behaviour
what parts of the brain are responsible for learning
Striatum – habit learning
Hippocampus – declarative learning
what is one of the last parts of the brain to fully mature
prefrontal cortex
- is vulnerable whilst developing
what is the medical intervention for opiate withdrawal
Methadone OR Buprenorphine OR Diamorphine
what can be added with buprenorphine
Naloxone
what is used in opiate overdose
Naloxone
what effects does cocaine have on the brain
serotonin, norepeniphrine, dopamine reuptake inhibitor
what effects does amphetamine have on the brain
dopamine, norepinephrine release
what effects does MDMA have on the brain
serotonin, norepinephrine, dopamine release
what are negative effects of stimulants
increased BP, chest pain, agitation, sweating, headaches, insomnia
Jaw clenching, nausea, vomiting, paranoia, hallucinations
Craving, dependency
