Substance use & Addiction Flashcards
what is the typical course of alcohol/drug use, harmful use and addiction?
recreational use, no difficulties
want/need becomes increasingly regular use (harmful use)
need - spiralling dependence (addiction)
what is harmful use of drugs/alcohol?
actual damage caused to mental/physical health in the absence of diagnosis of dependence syndrome
what is dependence?
strong desire or compulsion to take drug
difficulties in controlling taking drug - onset, termination, levels of use
physiological withdrawal state when stopped/reduced
evidence of tolerance
progressive neglect of alternative interests
persisting with substance use despite evidence of consequences
what drug causes the most harm in the UK?
alcohol in both harm to users and harm to others
what is addiction vs dependence?
addiction is compulsive drug use despite harmful consequences (all impacts of drug use)
dependence is a physical and biological adaption to a substance
what factors affect addiction?
social, environmental factors
specific drug factors
personal factors (genetic, personality etc)
how does alcohol acutely affect brain chemistry?
blocks NMDA receptor (blocks excitatory)
therefore impaired memory
boosts GABA-A receptor (boosts inhibitory)
therefore anxiolysis, sedation
how does alcohol chronically affect brain chemistry?
upregulation of excitatory system to adapt to NMDA receptor being blocked chronically
reduced function in inhibitory system as GABA-A switches subunits to be less sensitive to alcohol
how do you treat alcohol withdrawal?
benzodiazepines to boost GABA function
how does alcohol withdrawal affect brain chemistry?
NMDA receptor upregulated, increase of Ca2+ leading to hyperexcitability (seizures) cell death
how is addiction reinforced?
reward deficiency - positive reinforcement
overcoming adverse state e.g anxiety/withdrawal - negative reinforcement
impulsivity and compulsivity
what is the reward pathway in the brain?
ventral striatum dopamine system
how do cocaine and amphetamines impact dopamine rewards?
block reuptake - prolonged effect of dopamine
amp also enhances dopamine release
how can reinforcing brain responses be predicted?
levels of D2 receptors in the brain
higher D2 leads to less pleasurable responses
what change in brain chemistry makes some addicts more likely to relapse?
blunted response to anticipation of reward in ventral striatum
what regions of the brain are involved in bingeing/intoxication?
thalamus, dorsal striatum
what regions of the brain are inolved in withdrawal?
brainstem, hypothalamus
what regions of the brain are involved in craving?
hippocampus, insula, prefrontal cortex, basolateral amygdala
how does reinforcement change over the course of addiction?
change from positive to negative reinforcement - avoiding bad effects so aggression, fear when unable to access it
what regions are targets for addiction withdrawal drugs?
reward system: dopamine and mu opioid
stress system: kappa opioid, noradrenaline and CRF
amygdala
what are the brain chemistry changes to compulsions from voluntary to habitual drug use?
transition from striatal control over drug taking
ventral to dorsal striatum
both to form habits
memory in hippocampus drives cravings
what drugs are used to support alcohol withdrawal?
benzodiazapines
what drugs are used to support abstinence and neuroprotection in alcoholism?
acamprosate
what drugs are used to modulate reward system in alcoholism and block heroin use in opioid addicts?
naltrexone
what are questions to test the signs of harmful use/dependency in alcoholism?
CAGE - cut down, angry, guilty, eye opener
how do you perform a mental state examination?
appearance + behaviour speech mood thoughts perceptions cognition insight
what is the clinical opiate withdrawal scale? COWS
heart rate sweating restlessness pupil size bone/joint aches runny nose/tears GI upset tremor (outstretched hands) yawning anxiety/irritability goosebumps
what are the ICD-10 requirements for dependency syndrome?
3+ in past year:
strong desire/sense of compulsion
difficulties in controlling behaviour around substance
physical withdrawal
tolerance
neglect of interests/pleasures/social life
persisting with use despite harmful effects
what are the ICD-10 requirements for harmful use classification?
a pattern of substance use causing damage to health
adverse social consequences
bingeing
no other diagnosis e.g dependency syndrome
what assessments are done for alcohol ab/use?
note history of seizures, delirium tremens, psychosis, haematemesis, melaena
examine for jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT
investigations: fibroscan/ultrasound, bloods (LFTs, GGT, lipids, U&E, amylase), breathalyser, urine drug screen
what assessments are done for opioid ab/use?
examination for collapsed veins/track marks, endocarditis, skin abscesses, hep/HIV, pneumonia
investigations: bloods (LFTs, U&E, GGT, glucose), breathalyser, urine drug screen, sexual health screening/BBV
what are the immediate effects of alcohol?
CNS - impaired reaction time, motor coord/sedation, coma, death
stomach - nausea, inflammation, bleeding
skin - flushing, sweating, heat loss and hypothermia, formation of broken capillaries
sexual - reduced erection response in men, reduced vaginal secretion in women
what are the chronic effects of alcohol?
CNS - damaged/destroyed brain cells, reduced brain size, impaired memory, limb sensation loss
cardiovascular - weakened muscle, high BP, irregular heartbeat, risk of stroke
immune system - less resistance to disease
digestive - cirrhosis, stomach/pancreas inflammation, risk of lip/mouth/larynx/eosophagus/liver/rectal/stomach/pancreatic cancers, kidney failure, obesity, nutrient deficiencies
reproductive - menstrual irregularities, impotence and testicular atrophy
bone - risk of osteoporosis, risk of fractures and falls
what are the minor effects of alcohol withdrawal?
tremulousness diaphoresis fever anxiety agitation nausea/vomiting/retching
when do alcohol withdrawal symptoms often start?
onset after 6hrs from last drink
what is DT in alcohol withdrawal?
delirium tremens
what is delirium tremens?
auditory/visual hallucinations, confusion, hypertension, agitation, tachycardia, fever, tremor in hands and body
medical emergency - mortality 15-20%
what are the effects of opioids?
analgesic effect
sense of euphoria
what are the symptoms of an opioid overdose?
not moving/cant be woken slow/not breathing choking/gargling/snoring tiny pupils clammy or cold skin blue lips+nails
how is an opioid overdose managed?
naloxone injection/nasal spray
repeat if no response after 3 mins
recovery position
