Addictive Behaviour Flashcards
What is Acute Intoxication?
The administration of alcohol and other psychoactive substances, resulting in the disturbances of consciousness, cognition, perception, affect or behaviour. It is dose-dependent and time-limited.
What is Harmful Use?
A pattern of psychoactive substance use that is causing actual damage to the mental and physical health of the user.
What is Dependence Syndrome?
A cluster of physiological, behavioural and cognitive symptoms in which the use of a substance takes on higher priority than the other behaviours that once had greater value.
What is Dependence Syndrome? (6)
3+ from :
- Craving;
- Difficulty in Controlling Substance Use (Onset, Termination, Level of Use);
- Withdrawal;
- Tolerance;
- Progressive Neglect of Alternative Pleasures/Interests;
- Persistent Use Despite Clear Evidence of Harmful Consequences.
What is Physical Dependence?
A state of physiological adaptation of the body to a presence of a drug; the drug is used t prevent withdrawal symptoms and/or there is tolerance.
What is Psychological Dependence?
Dependence on a psychoactive substance provides relief from tension or emotional discomfort.
What is Tolerance?
A decreasing response to repeated constant doses of a drug or the need for increased doses to maintain a constant response.
What is Withdrawal?
A substance-specific substance-induced disorder that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication.
What is Craving?
A strong desire/sense of compulsion to take the substance.
Give 4 reasons why a person might use alcohol/illicit drugs and why people might indulge in risky behaviour.
- Genetic Predisposition (25-50% in Alcohol Dependence).
- Occupation.
- Social Background.
- Psychiatric Illness (indulge in risky behaviour).
What are the safe limits for consumption of alcohol? (4)
- <14 Units per week.
- Spread over 3+ Days.
- Risk of Diseases increases with any amount of alcohol on a regular basis.
- Several Drink-Free days.
Why is Alcohol teratogenic in pregnancy? (2)
- Nutritional Deficiency.
2. Foetal Alcohol Spectrum Disorders.
How do you calculate Alcohol Units?
(ABV/1000) x mL.
What is the difference between Abuse and Addiction?
Abuse = Drinking harms a person's work or social life. Addiction = Dependence Syndrome.
Describe the pharmacodynamics of Alcohol consumption. (4)
- Potentiates transmission through GABA (Inhibitory) Receptors = Sluggish movement and slurred speech.
- Inhibits NMDA (Glutamatergic - Excitatory) Receptors.
- Imbalance of Inhibitory > Excitatory.
- Increases Dopamine levels in the mesolimbic dopaminergic system.
Describe the pharmacokinetics of Alcohol consumption.
A = depends on concentration gradient between gut and blood, vascularity and food (slows). D = soluble in water > fat so more dilute in men (proportionally more water) and crosses BBB quicker. M = Ethanol Clearance - 0 Order (Rate of Clearance is independent of concentration). E = Urine, Exhalation, Metabolic Conversion.
What causes Ethanol-Induced Hypoglycaemia? (6)
- Ethanol is converted by hepatic ADH into Acetaldehyde.
- NAD is converted into NADH by ADH simultaneously.
- Acetaldehyde is converted by ALDH into Acetate.
- NAD is again converted into NADH too.
- NADH inhibits gluconeogenesis (preventing oxidation of Lactate to Pyruvate) because Lactate Dehydrogenase requires NAD.
- Ethanol decreases glucose concentration.
How is Acute Alcohol Intoxication managed (if severe)?
- ABC Approach.
- Hypoglycaemia - 50ml 50% Dextrose Infusion.
- Thiamine Administration.
- U&Es checked to guide fluid replacement.
Describe the pathophysiology of Alcohol Withdrawal.
Alcohol depresses CNS through potentiation of GABA and inhibition of NMDA-type receptors. If alcohol is removed, neural pathways become hyper-excitable e.g. seizures (Delirium Tremens).
How does Alcohol Withdrawal present?
Symptoms start at 6-12 hours (peak seizure incidence = 36 hours) :-
- Confusion ‘Sun-Downing’ Effect.
- Autonomic Hyperactivity.
- Visual/Tactile Hallucinations/Illusions.
What is the management of Alcohol Withdrawal?
1st Line = Long-Acting Benzodiazepine e.g. Chlordiazepoxide, Diazepam or Lorazepam (Hepatic Failure) in a Reducing Dose Protocol.
Other = Carbamazepine.
