Substance use Flashcards
Diagnoses possible with substance related and addictive disorders
Substance use disorders Substance intoxication Substance withdrawal Substance induced ->psychotic ->Bipolar ->depressive ->anxiety ->OCD ->sleep ->sexual dysfunction ->delirium ->neurocognitive
Define harmful use
Pattern/quantity of substance use which causes adverse effects, without dependance
- > Love
- > Livelihood
- > Liver
- > Law
Define hazardous use
Use that places person at risk of adverse effects without dependance
Use disorder criteria
Pattern of use leading to clinically significant impairment or distress with 2 of following w/i 12 months
- Larger/longer than intended
- +Effort/desire to cut back
- +Time spent in activities to obtain/use/recover
- Craving
- Recurrent use resulting in failure to fulfill roles
- Use despite negative consequences on social/interpersonal
- Important social/occupational/recreational activities givem up
- Recurrent use in dangerous situations
- Use despite knowledge of the recurrent physical/psychological problems
- Tolerance
- >Needing more for intoxication/desired effect
- >Diminished effect with same amount - Withdrawal
- >Withdrawal syndrome of substance
- >Substance taken to avoid withdrawal
Calculating units of alcohol
1 UNIT OF ALCOHOL (10ml pure alcohol) = 1⁄2 pint of beer (248ml) (3.5% ABV) or 1 small glass of wine (125ml) (8% ABV) or 1 measure of spirits (25ml) (40% ABV)
Calculating units of alcohol
You can calculate units by multiplying alcohol by
volume (in%) with volume (in litres),
e.g. ABV x vol = units
For instance, a pint (568ml) of 5.3% ABV continental
lager would contain 5.3 x 0.568 = 3 units
Differential
- There is a primary psychiatric illness and patient is using substance
- Symptoms entirely due to substance and no primary psychiatric illness
- Psychiatric problems are due to a combination
Features (4) suggesting substance-related psychiatric illness
- Symptoms known to be caused by substance
- Temporal relationship between use of substance and development of symptoms
- Recovery of symptoms on cessation of substance use
- No other explanation
History
CAGE and AUDIT Substances used Pattern Features of dependance Symptoms and relationship to substance, recovery of symptoms on cessation of substance use, temporal relationship Consequences->family, relationships, law, work, psychiatric health PHx psychiatric/substance use Gambling Family history MSE Suicidality Insight
CAGE
- Have you ever felt you ought to Cut down on your
drinking? - Have people ever Annoyed you by criticizing your
drinking? - Have you ever felt Guilty about your drinking?
- Have you ever needed an ‘Eye-opener’ (a drink first
thing in the morning to steady your nerves or get rid
of a hangover)?
Examination
Should focus on:
1. Evidence of acute use or intoxication (e.g. pupil constriction with opiate use; incoordination and slurred
speech with alcohol use).
2. Signs of withdrawal (e.g. tremulousness, sweating,
nausea and vomiting, tachycardia and pupil dilatation
with alcohol withdrawal).
3. Immediate and short-term medical complications of
substance use (e.g. head injury following alcohol intoxication, infection caused by intravenous drug use).
4. Long-term medical complications (e.g. alcoholrelated
liver disease, hepatitis B or C or HIV infection
with intravenous drug use).
Investigations
Depends on presentation, but may include UDS->essential FBC UEC LFTs Clotting/PLTs ECG Hepatitis serology HIV CT/imaging
Etiology of dependance
Socio-cultural->price, acceptability and availability
Pharmacology of the drug->pleasurable effects, rapid oset
Individual characteristics
Learning and conditioning
Individual characteristics predisposing to dependance
Disturbed ego function Concurrent psychiatric illness Genetic->+sensitivity to neurotransmitter Upbringing: poor coping strategies Personality: at risk children ->parental use ->impaired peer relationships ->poor academic ->limited problem solving skills ->poor impulse control ->negative mood states
Mechanism of learning and conditioning in relation to substance use
Behaviour maintained by consequences
1. Can ameliorate noxious/aversive states:
pain, anxiety, depression
2. Positive reinforcement
3. Alleviates disturbed effects of withdrawal
4. in withdrawal: the behaviours/environment that
was associated w. the addiction can trigger
withdrawal/craving. Example: watching someone use
or light a lighter etc.
5. Paraphernalia and behaviour becomes secondary reinforcements ++activity in limbic system
