Substance Use Disorders and Dual Diagnosis

Question 1

What defines a substance use/addictive disorder?

Answer 1

• 2 or more of the following in 12 months
  
  • Impaired control (4 criteria): larger amounts/longer time than intended, persistent want to cut down, spending great deal of time obtaining/using/dealing with effects of substance, craving
  • Social impairment (3 criteria): failure to fulfil work/school/home obligations, continued use despite social/interpersonal problems, social/occupational/recreational activities given up or reduced
  • Risky use (2 criteria): use in physically hazardous situations, use despite knowledge that substance use exacerbates an ongoing physical or mental condition
  • Pharmacological criteria (2 criteria): tolerance, withdrawal

Question 2

What would be some important history elements to cover during a substance use history?

Answer 2

• Demographics - age, employment, marital status, financial status, children, living arrangements
• Presenting problem - why now, what for, which drugs, loss of control, harms, why do want to keep using
• Assessment for detox - recent substance use (quantity, route, duration/regularity, tolerance, withdrawal or recent attempts at same)
• Medical and psychiatric problems - relationship with substances, risk to self/dependants
• Patient motivation - Prochaska-Diclemente motivational stage, resources available to patient
• Drugs, alcohol and gambling (DAG)

Question 3

What is the difference between addiction and dependence?

Answer 3

• Dependence - physical (tolerance, withdrawal) and psychological (craving, salience, loss of control), use despite harmful effects
• Addiction - compulsive, continued use despite consequences

Question 4

When do alcohol withdrawal symptoms peak? What are they?

Answer 4

• Peak symptoms in days 2-4, but may last up to 7 days
• Neuro: agitation, restlessness, anxiety, sleep disturbance, confusion, disorientation, perceptual disturbances, seizures within first 48 hours
• Cardio: tachycardia, hypertension
• GIT: vomiting and diarrhoea

Question 5

When do seizures tend to occur in alcohol withdrawal?

Answer 5

Within the first 48 hours

Question 6

What tend to be the features of opioid withdrawal?

Answer 6

• Parasympathetic: sweats, yawning, lacrimation, rhinorrhoea
• Neuro: restlessness, irritability, anxiety, sleeplessness
• Sympathetic: dilated pupils, goosebumps
• GIT: nausea, vomiting, diarrhoea
• Musculoskeletal: myalgia, arthralgia
• Hallucinations/seizures not a feature