Substance Misuse and Alcohol Abuse Flashcards
Define “substance misuse”
Maladaptive and recurrent use of a substance, leading to significant functional impairment
Define “acute intoxication”
Transient disturbance of consciousness/cognition/behaviour as a direct effect of a substance
Define “harmful use”
Recurrent misuse resulting in bio/psycho/social consequences, but not dependence
Define “dependence”
Prolonged, compulsive substance misuse leading to addiction, tolerance and withdrawal symptoms
What are the key features of dependence?
“CANT STOP”:
- Compulsion
- Aware of risks but persists anyway
- Neglect of other activities
- Tolerance
- Stopping causes withdrawal
- Time preoccupied with substance
- Out of control use
- Persistent, futile wish to stop
Define “withdrawal state”
Physical and/or psychological effects from complete/partial cessation of a substance, after prolonged/repeated use
Define “substance-induced psychosis”
Psychosis occurs within 2 weeks of substance use and persists for at least 48 hours
Define “residual disorder”
Symptoms which persist long-term despite abstinence e.g. PD, affective disorder, dementia
List some aetiological factors in substance misuse
- Genetics
- Life stressors
- Parental drug use
- Cultural acceptability
- Psych hx
- Availability of drug
What are the 2 major perpetuating factors in drug misuse?
- Biological reward - activation of mesolimbic pathway
- Social - peer pressure
List some important questions to ask during a drug abuse hx
- Type, Route, Administration, Pattern
- Impact on life?
- Tried to stop?
- Drug always on mind?
List 3 important investigations for someone with substance misuse
- Blood borne viruses
- LFTs and clotting
- ECG
Outline the general management of substance misuse
- Hep B jab
- Movitational interviewing/CBT
- Support with housing/employment etc
- Narcotics Anonymous
- Allocate keyworker
What pharmacological options are there for someone addicted to opiates?
- Methadone - detox and maintenance
- Buprenorphine (2nd line) - detox and maintenance
- Naltrexone - continued abstinence
Define “alcohol abuse”
Consumption of alcohol at a level sufficient to cause physical, psychiatric and/or social harm
Define “binge drinking”
> 2x the recommended daily alcohol intake in 1 session.
i.e. >4 units in a session
Define “harmful drinking”
Drinking above safe levels, with evidence of alcohol-related problems
How do you calculate the number of units?
How many units is 500ml of 4% beer?
No of units = vol in L x % alcohol
so 2 units
How quickly does a standard person metabolise alcohol?
1 unit metabolised per hour
List 3 RFs for alcohol abuse
- Male
- Young
- Stressors
- Antisocial PD
Why does alcohol withdrawal lead to CNS hyperexcitability?
- Down-regulation of (inhibitory) GABA, and up-regulation of (excitatory) glutamate
What are the two major effects of alcohol on the brain, and which NTs are involved?
- Pleasure - dopamine
- Anxiolytic/sedative - GABA
What are the clinical features of alcohol dependence?
“SAWDRIN(k)”
- Subjective awareness of compulsion to drink
- Avoidance of withdrawal symptoms by further drinking
- Withdrawal symptoms
- Drink-seeking behaviour
- Reinstatement of drinking after attempted abstinence
- Increased alcohol tolerance
- Narrowing of drinking repertoire - same drink, time, place
List some features of alcohol withdrawal
Malaise, tremor, nausea, insomnia, hallucinations.
Starts 6 - 12 hrs post-abstinence, peaks at 36 hours.
What is delirium tremens?
Hyperadrenergic state caused by severe reaction to alcohol withdrawal
What are the key clinical features of delirium tremens?
- Cognitive impairment
- Hallucinations
- Paranoid delusions
- Marked tremor
- Autonomic arousal
How should you treat delirium tremens?
- Large dose of BZDs
- Haloperidol if psychotic
- Pabrinex
What is Wernicke’s encephalopathy?
Acute encephalopathy due to thiamine deficiency, most often (but not always) secondary to alcohol abuse.
What are the key clinical features of Wernicke’s encephalopathy?
“6th HAND”
- 6th nerve palsy
- Hypothermia
- Ataxia
- Nystagmus
- Delirium
What is the pathophysiology of Wernicke’s encephalopathy?
Multiple mini haemorrhages in mamillary bodies
How should you manage Wernicke’s encephalopathy?
IV thiamine (Pabrinex) DO NOT give any carbohydrate until this is done - i.e. no dextrose fluids
What may Wernicke’s encephalopathy progress to?
Korsakoff’s psychosis
What is Korsakoff’s psychosis?
Profound, irreversible short-term memory loss with confabulation (making stuff up to fill in gaps)
How would you manage Korsakoff’s psychosis?
Oral thiamine to prevent further problems, but damage irreversible
Outline some things you would cover in an alcohol history
- CAGE screening tool
- Drinking quantity and pattern across average week
- Tolerance/withdrawal
- Impact on life
List 5 bloods you would do in alcohol abuse
- FBC
- LFTs
- Clotting
- MCV - raised
- Vitamin B12
- Amylase
How would you initially begin the process of getting someone off alcohol?
Alcohol detox regime - high dose BZDs, tapered from days 5 - 9, and thiamine - oral or IV
How would you manage alcohol dependence long-term?
- Pharmacological
- Motivational interviewing/CBT
- AA
