Addiction Disorders

Question 1

What is the ICD-10’s criteria for dependence?

Answer 1

Strong desire
Difficulties controlling
Withdrawal
Tolerance
Neglect of alternative pleasures
Persistence despite harm

Question 2

What is the main neurotransmitter in the mesolimbic (reward) pathway?

Answer 2

Dopamine

Question 3

What effect does drug abuse have on the mesolimbic pathway?

Answer 3

Stimulation

Question 4

Why do certain drugs (cocaine, nicotine etc.) cause addiction?

Answer 4

As they cause a massive increase in dopamine which the brain craves

Question 5

What effect does repeated substance taking have on dopamine receptors?

Answer 5

Downregulation

Question 6

What is the role of the pre-frontal cortex in terms of the mesolimbic pathway?

Answer 6

It controls it and allows us to make sound decisions

Question 7

The prefrontal cortex is one the earliest developed areas of the brain. True/false?

Answer 7

False - one of the last

Question 8

The earlier/later the age of drug experimentation the longer the drug relationship

Answer 8

Earlier

Question 9

What role does the hippocampus and amygdala play in addiction?

Answer 9

They help the brain to learn drug associations and cue craving feelings

Question 10

Why can acute stress cause seeking of addictive substance?

Answer 10

As it triggers the release of dopamine

Question 11

Why is heroin so addictive?

Answer 11

Rapid onset of action

Short half-life

Question 12

Heroin is morphine/diamorphine

Answer 12

Diamorphine

Question 13

What are the two main ways to take heroin?

Answer 13

Intravenous

Smoking

Question 14

Give some of the effects of heroin

Answer 14

Euphoria
Analgesia
Respiratory depression
Constipation
Bradycardia
Pupillary constriction

Question 15

What is the half-life of heroin?

Answer 15

6-8 hours

Question 16

Give some of the withdrawal symptoms of heroin

Answer 16

Dysphoria/cravings
Agitations
Tachycardia
Piloerection
Diarrhoea
Pupillary dilation

Question 17

Over half of the individuals who have died from heroin overdose lived in the 20% most deprived areas in Scotland. True/false?

Answer 17

True

Question 18

What drugs are increasing in involvement in drug related deaths?

Answer 18

Gabapentin

Pregabalin

Question 19

Diazepam presence in drug related death has decreased while etizolam presence has increased. True/false?

Answer 19

True

Question 20

What is involved in opiate substitution therapy?

Answer 20

Replacing a short acting opiate with a long acting opiate

Question 21

What drugs are used in opiate substitution therapy?

Answer 21

Buprenorphine

Methadone

Question 22

Give some of the pros of OST

Answer 22

Reduced mortality rate

Reduced HIV risk

Question 23

Give some of the cons of OST

Answer 23

Daily chemist visits

Stigma

Question 24

Is methadone given as a tablet or a liquid?

Answer 24

Liquid

Question 25

What occurs in opiate detoxification?

Answer 25

Giving patients a reducing dose of the drug until they are not on any at all

Question 26

What are the main negatives of opiate detoxification?

Answer 26

High mortality risk | High relapse rate

Question 27

What psychosocial interventions can be done for opiate misuse?

Answer 27

Rewarding positive behaviour | Behavioural couples therapy

Question 28

What is involved in heroin assisted treatment?

Answer 28

Allowing patients to safely inject heroin while also taking methadone

Question 29

How do you calculate units of alcohol?

Answer 29

(%ABV x volume) / 10

Question 30

What is defined as higher risk drinking?

Answer 30

Regularly consuming above 15 units per week

Question 31

What biological marker is most commonly raised in alcoholism?

Answer 31

MCV

Question 32

When should a patient be referred for specialist treatment in alcoholism?

Answer 32

Showing signs of moderate/severe dependence Failed to benefit from previous advice Showing signs of severe alcohol-related impairment

Question 33

Alcohol withdrawal causes excess GABA activity and reduced glutamate activity. True/false?

Answer 33

False - excess glutamate activity and reduced GABA activity

Question 34

Give some of the symptoms of delirium tremens

Answer 34

``` Confusion Disorientation Agitation Fever Hallucinations ```

Question 35

How should short term alcohol withdrawal be managed?

Answer 35

``` Benzodiazapines Vitamin supplementation (thiamine/pabrinex) ```

Question 36

What psychosocial therapy is recommended for relapse prevention?

Answer 36

CBT

Question 37

What drugs can be used to prevent alcohol relapse?

Answer 37

Disulfiram (antebuse) Acamprosate Naltrexone

Question 38

What is the effect of drinking alcohol on disulfiram?

Answer 38

``` Flushed skin Tachycardia N + V Arrhythmias Hypotension ```

Question 39

What is the effect of acamprosate?

Answer 39

It reduces cravings