Alcohol and substance misuse

Question 1

One unit of alcohol

Answer 1

10ml or 8g of pure alcohol

Question 2

Low risk alcohol consumption

Answer 2

‘Safe drinking’ - unlikely to be associated with harm

M <14 units/week

Question 3

Hazardous drinking

Answer 3

Intake likely to increase risk of alcohol related harm
M 22-50 u/w
F 15-35 u/w

Question 4

Harmful drinking

Answer 4

‘Alcohol misuse’ a pattern of drinking associated with alcohol related harm
Males >50 u/w
Females >35 u/w

Question 5

Alcohol dependence

Answer 5

Three or more of:
Strong desire or compulsion to drink
Difficulty in controlling the onset or termination of drinking or the levels of alcohol use
Withdrawal on cessation of alcohol or its use to avoid withdrawal symptoms
Increasing tolerance
Progressive neglect of other interests
Persistent use of alcohol despite awareness and clear evidence of the harm it is causing

Question 6

Complications of alcohol use

Answer 6

Death
Hospital admission
Domestic accidents/death
Domestic fire
Workplace accidents
Homicides
Domestic violence

Question 7

Intoxication phenomena

Answer 7

eg lability of mood, memory black-outs, belligerence

Question 8

Alcohol withdrawal phenomena

Answer 8

Occur when alcohol suddenly stopped or significantly reduced
First symptoms 8-12hours after last drink, delirium may occur within one 2-3 days
Mild: tremor, nausea, sweating, insomnia, mood disturbance, restlessness, agitation, anxiety, fear, tinnitus, cramps, noise sensitivity
Severe: seizures (12-48h); Delirium Tremens - acute confusional state, 3 days after last drink, lasting up to 7 days. Disorientation, visual hallucinations, agitation, fearfulness, sweating and tremors. Significant mortality rate

Question 9

Also depression, anxiety and psychotic illnesses

Answer 9

Just that they often co-exist

May trigger and illness or may be a sign of pre-existing illness

Question 10

Alcoholic hallucinations

Answer 10

Auditory hallucinations occurring in clear consciousness

During heavy drinking or withdrawal

Question 11

Morbid jealousy (Othello syndrome)

Answer 11

Delusion that partner is unfaithful

May result in domestic violence or death of the partner

Question 12

Alcoholic dementia

Answer 12

Specific cognitive deficits

May or may not be accompanied by non-progressive impairment of intellectual capacity

Question 13

Wernecke’s encephalopathy

Answer 13

Thiamine deficiency → haemorrhage in the mammillary bodies of posterior hypothalamus and nearby midline structures
Opthalmoplegia
Ataxia
Confusional state
Reversed to a large extent by administration of thiamine

Question 14

Korsakoff’s syndrome

Answer 14

Thiamine deficiency → haemorrhage into the mammillary bodies of posterior hypothalamus and nearby midline structures
Profound short term memory loss with preservation of other intellectual capacities
Gaps in short term memory filled in by confabulation
Resolution less predictable

Question 15

Physical disorders from alcohol overuse

Answer 15

GI: Hepatitis, pancreatitis, cirrhosis, Mallory-Weiss tears
CVS: hypertension, alcoholic cardiomyopathy
CNS: seizures, peripheral neuropathy, cerebellar degeneration, dementia, myopathy
Others: malnutrition, vit deficiency, fetal damage

Question 16

CAGE

Answer 16

Do you feel you need to Cut down?
Do you ever get Annoyed at people criticising your drinking?
Do you every feel Guilty about the amount you drink?
Do you use alcohol as an Eye opener in the morning?

Question 17

Questions to ask about drinking if concerned

Answer 17

Consumption over previous 3 months: typical day, frequency, max/day
Morning drinking to stop shakes/previous failed attempts to stop
Alcohol related physical, emotional and social problems
Lab investigations: gamma GT, LFTs, MCV

Question 18

Cannabis

Answer 18

Smoked
Profound sense of relaxation and mild euphoria
Mild paranoid ideation
?acute confusional state with delusions and hallucinations

Question 19

Stimulants (amphetamines, MDMA)

Answer 19

Orally or IV (amphetamine)
Elevation of mood, increased alertness and physical activity
Rapid tolerance
Amphetamine pyschosis - florid, schizophrenia like illness. Usually subsides in a week but can persist for months

Question 20

Sedatives (benzos, esp temazepam)

Answer 20

Hypnotic and anxiolytic

Tolerance, dependence and withdrawal

Question 21

Hallucinogens (LSD, magic mushrooms)

Answer 21

Orally
Heightened perceptions, vivid imagery, illusions, hallucinations, state of euphoria
‘Bad trip’ - terrifying hallucinations and delusions
Regular use may lead to flashbacks to bad trips and emotional damage

Question 22

Cocaine

Answer 22

Smoked, snorted, IV
CNS stimulation
Sense of euphoria
Cravings, tolerance and psychological dependency
Chronic use can lead to paranoid psychosis
Formication - feeling of bugs under the skin

Question 23

Opiates

Answer 23

Smoked, IV
Euphoria, detachment, wellbeing, analgesia
Rapidly fatal in overdose
Tolerance and dependence
Withdrawal: restlessness, insomnia, piloerection, pupillary dilatation, nasal discharge, sweating, vomiting, diarrhoea, abdo pain, hyperaethesia, paraesthesia and cramps

Question 24

Harmful effects of drug use

Answer 24

Drug effects
Social problems related to the drug use
Method of administration → infections eg. tetanus, abscesses, endocarditis, hep B/C/D, HIV, septicaemia
Non-infective medical problems: track marks, thrombophlebitis, venous thrombosis, arterial insufficiency, resp failure, pulmonary oedema, polyarteritis nodosa, pulmonary hypertension, PE, psychosis, depression, neuropathy, brain damage