substance use and addiction

Question 1

define addiction

Answer 1

compulsive drug use despite harmful consequences, characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, (depending on the drug) tolerance and withdrawal.

Question 2

define dependence

Answer 2

refers to a physical adaptation to a substance
Tolerance/withdrawal

Question 3

what is the criteria for hazardous use, how does this differ from harmful use?

Answer 3

hazardous use is using too much, likely to cause harm if continues at this level e.g. drinking 4 pints a day, harmful use means that the hazardous use is having a physical, psychological or social impact e.g. missing work due to hangovers

Question 4

what are the 6 steps of dependence syndrome as set out by ICD-10?

Answer 4

1. a strong desire or sense of compulsion to take the substance
2. difficulties in controlling substance taking behaviour in terms of its onset, termination, or levels of use
3. a physiological withdrawal state when substance use has stopped or been reduced
4. evidence of tolerance: need to take more to get same effect
5. progressive neglect of alternative interests
6. persisting with substance use despite clear evidence of overtly harmful consequences

Question 5

what difference in epidemiology in the UK is seen between alcohol problems and drug problems?

Answer 5

alcohol problems are widespread. drug use is widespread but dependence is concentrated

Question 6

How does duration for brain entry affect addiction?

Answer 6

faster brain entry = more ‘rush’ and more addiction e.g crack has a faster brain entry than cocaine

Question 7

what are the three main elements that contribute to drug addiction?

Answer 7

social and environmental factors
personal factors such as genetics and personality traits
drug factors: how addictive the substance is

Question 8

which brain system is affected by alcohol?

Answer 8

Alcohol alters the balance between brain’s inhibitory (GABA-
A) and excitatory (glutamate) system

Question 9

how is the excitatory and inhibitory system of the brain affected by alcohol? (acute)

Answer 9

blocks the excitatory system and enhances activity of benzodiazepene and GABA coupling so more efficient at inhibitory activity

Question 10

how is the excitatory and inhibitory system of the brain affected by alcohol in the presence of alcohol? (chronic)

Answer 10

Upregulation of excitatory system, more NMDA receptors.
Reduced function in inhibitory system - tolerance:GABA-A receptor:
Switch in subunits to make less sensitive to alcohol

Question 11

how is the excitatory and inhibitory system of the brain affected by alcohol in the absence of alcohol? (chronic)

Answer 11

withdrawal state:
Upregulation of excitatory system: NMDA receptor increase in Ca2+ if toxic leads to hyperexcitability (seizures) and cell death (atrophy). Reduced function of inhibitory system

Question 12

How can a reduced inhibitory brain system caused by chronic alcohol use be treated?

Answer 12

benzodiazepines to boost GABA function

Question 13

what are the three main models of addiction?

Answer 13

reward deficiency (positive reinforcement). overcoming adverse state (negative reinforcement). Impulsivity/ compulsivity (lack of control)

Question 14

natural rewards such as food and sex, aswell as drugs of abuse increase levels of what chemical and where?

Answer 14

dopamine in the ventral striatum

Question 15

what is the dopamine pathway often referred to as?

Answer 15

pleasure-reward-motivation system

Question 16

what is the key modulator in the dopamine pathway?

Answer 16

opioid system
– particularly mu opioid that
mediates pleasurable effects (eg
of alcohol, ‘endorphin ‘rush’);
others include GABA-B, cannabinoids,
glutamate etc that are targets
for treatment

Question 17

What effect does cocaine and amphetamines have on dopamine levels and how?

Answer 17

block reuptake of dopamine resulting in accumulation in the synapse

Question 18

what affect do amphetamines have on dopamine release

Answer 18

enhance release

Question 19

What parts of the brain are affected by withdrawal/ negative affect?

Answer 19

Amygdala and brainstem

Question 20

What neurological structures are involved in the voluntary to habitual and compulsive drug use?

Answer 20

Pro frontal cortex: striata control over drug taking
Ventral (lambic/ emotional) through dorsal striatum

Question 21

Why is alcohol withdrawal more dangerous than opiate withdrawal?

Answer 21

Worsening pattern of symptoms, hallucinations can occur at any time, Delirium tremens can set in which is a medical emergency

Question 22

What is delirium tremens (DT) and how is is treat?

Answer 22

Auditory and visual hallucinations, confusion and disorientation, hypertension, agitation and tachycardia with severe tremor. Admission for at least 24 hours and given benzodiazepines

Question 23

What medication is commonly used in hospital for acute detoxification of alcohol withdrawal in order to prevent complications?

Answer 23

Chlorodiazepoxide

Question 24

What is the difference between ICD10 and ICD11?

Answer 24

11 has a harmful use category to denote single episodes of harmful use from a pattern of harmful use

Question 25

Outline the effects of opioids

Answer 25

Relieve pain - analgesic effect
Sense of euphoria

Question 26

Opioid receptors mu, delta and kappa are effected by opioid agonists or antagonists?

Answer 26

Both:
Agonists - heroin, methadone, fentanyl
Partial agonists - buprenorphine
Antagonists - naltrexone

Question 27

What is the difference between opiates and opioids?

Answer 27

Opiates refer to natural opioids such as morphine and codeine. Opioids refers to all natural, semisynthetic and synthetic opioids

Question 28

List three examples of natural opiates?

Answer 28

Opium, morphine and codeine

Question 29

List three types of synthetic opioids

Answer 29

Fentanyl, methadone, tramadol

Question 30

List three examples of semi-synthetic opioids

Answer 30

Heroin, hydrocodone, oxycodone

Question 31

What’s are the signs of an opiate overdose?

Answer 31

Not moving/ cant be woken. Slow or no breathing, choking or gurgling sounds, tiny pupils, clammy or cold skin, blue lips and blue nails

Question 32

What medications are given for alcohol abstinence?

Answer 32

Acamprosate, disulfiram, naltrexone

Question 33

What medications are given for opioid abstinence?

Answer 33

Methadone, buprenorphine

Question 34

What is the difference between ICD10 and ICD11 in terms of harmful use?

Answer 34

Distinction between substance dependence and harmful use is preserved
However a new category is made to denote single episode of harmful use from a pattern of harmful use
Harmful use also now includes the harm to health of others

Question 35

What is the difference between the diagnostic criteria of ICD10 and ICD11 for dependancy?

Answer 35

The former 6 diagnostic criteria for dependence have been bundled into 3 pairs – fulfilment of one criterion is sufficient

1.Impaired control over substance use (i.e. onset, frequency, intensity, duration, termination, context)

2.Increasing precedence of substance use over other aspects of life (e.g. repeated relationship disruption, occupational or scholastic consequences, negative impact on health)

3.Physiological features indicative of neuroadaptation to the substance, (e.g. tolerance, withdrawal, use of pharmacologically similar substances to prevent or alleviate withdrawal symptoms.

Question 36

Per the ICD 11 diagnostic criteria for dependecy, when can a diagnosis be made?

Answer 36

oThe features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if use is continuous (daily or almost daily) for at least 3 months

Question 37

Which enzyme is responsible for the oxidisation of ethanol?

Answer 37

Alcohol dehydrogenase and then acetaldehyde dehydrogenase

Question 38

What is CAGE screening?

Answer 38

Have you ever felt you needed to Cut down on your drinking?
2.Have people Annoyed you by criticizing your drinking?
3.Have you ever felt Guilty about drinking?
4.Have you ever felt you needed a drink first thing in the morning (Eye-opener)

Question 39

What investigations are conducted in an alcohol assessment for liver damage?

Answer 39

Liver Fibro scan / Ultrasound
Bloods (LFT, GGT, Lipids, U&E, amylase)
Breathalyser
Urine Drug Screen

Question 40

Outline the four stages of liver damage

Answer 40

Healthy liver
Fatty liver
Liver fibrosis
Cirrhosis