Addiction

Question 1

Why is chronic stress a risk factor for addiction?

Answer 1

Dampening of dopaminergic activity through down regulation of dopamine receptors; this encourages exposure to highly rewarding behaviours.

Question 2

State the 6 ICD-10 criteria for dependence

Answer 2

1) Strong desire
2) Difficulties with control
3) Physiological withdrawal
4) Tolerance
5) Neglect of alternative pleasures
6) Persistence despite obvious evidence of harm

Question 3

Describe negative reinforcement

Answer 3

Getting rid of the bad feeling that presents when they have not taken the drug or undertaken the activity.

Question 4

When are people at greatest risk of OD?

Answer 4

Following a period of abstinence

Question 5

Why are adolescences at a greater risk of addiction?

Answer 5

Reward pathway is fully developed, whereas their frontal lobe (involved in executive functioning and reasoning) is underdeveloped.

Question 6

What questions are involved in the CAGE questionnaire?

Answer 6

C) Have you every felt you should CUT down on your drinking?
A) Have people ANNOYED you by criticising your drinking?
G) Have you ever felt bad or GUILTY about your drinking?
E) Have you ever had an EYE opener?

Question 7

Brief interventions follow a FRAMES approach; what does each letter stand for?

Answer 7

Feedback - review problems experienced because of alcohol.
Responsibility - patient is responsible for change.
Advice - advise reduction or abstinence.
Menu - provide options for changing behaviour.
Empathy - use empathetic approach.
Self-efficacy - encourage optimism about changing behaviour.

Question 8

Physiologically describe acute alcohol withdrawal

Answer 8

Excess glutamate activity and reduced GABA activity, leading to CNS excitability and neurotoxicity.

Question 9

Which medications can be useful in the management of acute alcohol with withdrawal?

Answer 9

BZDs - particularly long acting agents (e.g. diazepam, chlordiazepoxide).
Thiamine - acts as prophylaxis against Wernicke’s encephalopathy.