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Substance misuse categories
- - Intoxication
- - Harmful use
- - Dependency
- - Withdrawal
Features of dependency
(8, or 6 bigger)
- 1.a Compulsion
- 1.b Difficult controlling use - starting, stopping, or amounts used
- 3. Withdrawal - physiological withdrawal state
- a) characteristic withdrawal state
- b) substance use to prevent/relieve withdrawal symptoms
- 4.a. Continued used despite harm
- 4.b. Salience (primacy)
- 5. Narrowing of repertoire
6. Reinstatement after ab
Neurological models: all drug uses affect/
Dopaminergic 'reward' pathway in the barin.
Cocain and amphetamine block dopamine reuptake. Alcohol and opiates also increase dopamine.
Alcohol 'flush reaction'
Ethanol is metabolised to acetaldehyde, by aldehyde dehydrogenase.
East Asian, a variant enzyme -> acetaldehyde accumulates, causing flushing, palpitations and nausea.
Calculate exact alcohol content
units = (volume of drink in mL x % alcohol)/1000
Levels of alcohol consumption: safe and harmful
- - women: 2-3/day, 14/w
- - men: 3-4/day, 21/w
- - women: >6, >35
- - men: > 8, >50
Withdrawal of alcohol
ALcohol is a CNS depressant, stimulate GABA inhibitory system to reduce brain excitability.
Suddenly stop drinking -> neural pathway become hyper-excitable and seizures
DDx for alcohol and drugs
- 1. Organic
- (not to assume: confusion, ataxia, or psychotic symptoms are solely due to s misuse;
- Beware: head injury, subdural haematoma)
- 2. Psychiatric illness: primary or comorbid
- dual diagnosis
- - depression/mania
- - functional psychosis
- - anxiety disorder
- personality disorder
Distinguish subtance misuse from psychiatric prob
- - Which problem came first?
- - Do the psychiatric symptoms 'fit' with known symptoms of that substance?
- - Have psy symptoms continued after abstinence?
- - Is there a FHx or prev diag?
Pharm mx of alcohol
1. Detoxication of alcohol
- - Long acting benzodiazepines
- - Thiamine
- - Disulfiram (mimic flush reaction)
Opiates (heroin, morphine, codein): notable
1. intoxication px
4. substitute prescribing
- 1. pinpoint pupils
- 2. 'runs' (diarrhoea, vomitting, lacrimation, and rhinorhoea)
- 3. Naloxone - opiate antagonist
- 4. Methadone (full agonist) & buprenorphine (partial agonist)
- 5. Naltrexone - opiate antagonist
Cocaine users may experience
Formication - sensation of insects crawling on/below skin, also known as cocaine bugs
Snorting cocaine causes?
Cocaine is a powerful vasoconstrictor and snorting it damages the nasal mucosa, causing necrosis and septal perforation.
Treated with flumazenil, a benzo anatagonist