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39 terms

Alcohol and drug abuse

STUDY
PLAY
Prevalence of patients in primary care that have a problem related to alcohol use
20%
Prevalence of hospital in-patients with a history of alcohol abuse or alcohol dependence
25-40%
Low-risk drinking (men)
Total of 12 in the entire week
Single occasion no more than 4
Days each week when you don't drink alcohol
No alcohol when driving, when a health problem could be made worse, when alcohol could interact with a medication
Low-risk drinking (women)
Total of 9 in the entire week
Single occasion no more than 3
Days each week when you don't drink alcohol
No alcohol when pregnant, driving, when a health problem could be made worse, when alcohol could interact with a medication
Percent of men who meet criteria for alcohol/illicit drug dependence
4%
Percent of women who meet criteria for alcohol/illicit drug dependence
2%
Addiction
A primary, chronic disease characterized by impaired control over the use of a psychoactive substance or behaviour
Clinically the manifestations occur along biological, social and spiritual dimensions
Like other chronic diseases, it can be progressive, relapsing and fatal
Common features are change in mood, relief from negative emotions, provision of pleasure
Preoccupation with the use of substances or ritualistic behaviour
Continuted use of substances and/or engagement in behaviour despite adverse physical, psychological and/or social consequences
Substance abuse
Maladaptive pattern of use leading to clinically significant distress - at least one of:
-Failure to fulfill major role obligations at work, school or home
-Use in situations where it is physically hazardous
-Recurrent substance-related legal problems
-Continued use despite social or interpersonal problems caused by the effects of substance use
Substance dependence
Maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by 3 or more of the following over a 12 month period:
-Tolerance
-Withdrawal
-Taken in larger amounts over a longer period of time
-Persistent desire or unsuccessful efforts to cut down or control substance use
-Great deal of time is spent in activities necessary to obtain substances, use substances, or recover from their effects
-Important activities are given up or reduced because of alcohol
-Substance use is continued despite knowledge of having a problem is likely have been caused or exacerbated by it
3 Cs of addiction
Loss of control
Compulsion to use or preoccupation with using or craving
Continued use despite consequences
When to screen for substance dependence or abuse
At annual physical
Pregnancy
When a patient presents with any symptom which could be related to drug or alcohol use
CAGE screening tool
Felt you should Cut down?
Feel Annoyed by people criticizing you about your drinking?
Felt bad or Guilty about drinking?
Ever had an Eye-opener drink?
TACE
For pregnancy
T - tolerance (how many drinks until you are drunk? +ve if >2)
A - annoyed by people criticizing your drinking?
C - felt like you should Cut down?
E - eyeopener to steady nerves
Inquiries about drug use
Don't make assumptions based on age.
Ask about marijuana, cocaine/crack, valium, T3s and other opiates
E, Meth
Gambling
Taking a consumption history
Frequency and quantity
Drug use
Pattern of use
Consequence of use
Obstacles to admitting dependence
Denial, minimalization, rationalization (delusional?)
Lying
Shame, guilt, fear
Blackouts and dementia (collateral information useful)
Symptoms of substance abuse
Gastritis, ulcers, GI bleeds, pancreatitis, liver disease
Heachages, codeine dependence, peripheral neuropathy, seizures
Trauma
Hypertension, palpitations due to tachycardia or arrhymia, cardiomyopathy, endocarditis, MI
Anaemia
Pneumonia, chronic cough or rhinitis (cocaine)
Menstrual irregularities
Psychiatric symptoms
Anxiety
Depression
Insomnia
Hallucinations (from withdrawal)
Flashbacks
Dementia
Paranoia (cocaine at met-amphetamines)
Substance abuse cycles
Euphoric when using, but withdrawn when going through withdrawal.
Use to escape life problems, but then leads to more problems and can't quit
Determining comorbid psychiatric disorders
Best assessed when at least 3-4 weeks abstinent
Prevalence of comorbid conditions with alcoholism
37% people with SA had current or previous psych disorder
21% lifetime prevalence drug disorder
Prevalence of comorbid conditions with drug disorder
53% prevalence of psych disorder
47% lifetime prevalence of alcohol disorder
Signs of substance abuse
Track marks, abscess at injection site
Damaged nasal cartilage
Skin excoriations with met-amphetamines
Signs of liver disease
Signs of withdrawal
Signs of mild alcohol withdrawal
Agitation, tremor, tachycarida, hypertension, nausea, elevated temp and sweating
Onset within a few hours of last drink peak at 24-36 hours
Moderate alcohol withdrawal
More severe symptoms of sympathetic NS activity plus seizures (onset 7-48 hours, occur in 5-15%)
alcoholic hallucinosis (onset 24 hours - several days, 3-10%
Severe alcohol withdrawal
Delirium tremens. Occurs in up to 5%. Onset 3-4 days
Severe sympathetic system hyperactivity plus agitation, disorientation, confusion and hallucinations
Alcohol withdrawal mortality rate
1-5%, up to 10% for those with severe
Treating alcohol withdrawal
Daizepam
Lorazepam
Symptoms monitored hourly, treatment given according to severity
Thiamine 100 mg to prevent Wernike-Korsakoff syndrome
Haloperidol (for psychosis)
Thiamine
Must be given prior to any glucose
BZD withdrawal
Tremour, anxiety, insomnia, tachycardia
Severe - seizure, psychosis
Treating BZD withdrawal
Gradual tapering off with long-acting BZD - Diazepam or clonazepam (reduce by 10-25% per week)
Opiate withdrawal
Headache, nausea, vomiting, cramps and diarrhea
Bone pain
Chills, sweats, piloerection
Anxiety, emotional liability, craving
Not fatal!
Treating opiate withdrawal
Tapering does of long-acting opiate
Methadone maintenance long term
Stimulant withdrawal
Fatigue, hypersomnia, agitation, depression, increased appetite, drug craving
Stimulant withdrawal treatment
Emotional support, avoidance of triggers for cravings, antidepressants
Treatment for SA
Rehab programs are effective
-Motivational enhancement therapy, CBT
-Long term programs
Treating alcoholism
Naltrexone
Buspirone
SSRIs
Antabuse
Acomprosale
Acamorsate
Shows reduced rate of relapse, better tolerated than naltrexone (fewer side effects)
Use of SSRIs
Might just be treating comorbid depression