Substance Misuse Flashcards Preview

Toni's Psych > Substance Misuse > Flashcards

Flashcards in Substance Misuse Deck (61)
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What is harmful use?

A pattern of use likely to cause physical or psychological damage


What is dependency?

A cluster of physiological, behavioural and cognitive symptoms in which use of a substance takes on a much higher priority than other behaviours that once had grater value


What is withdrawal?

A transient state occurring while readjusting to lower levels of the drug in the body


What is the classical conditioning theory of dependence?

Cravings become conditioned to cues
So that a cue itself can trigger a craving and thus cause drug seeking behaviour


What is the operant conditioning theory of dependence?

Behaviours rewarded are repeated: positive reinforcement
Behaviours are repeated if they relieve unpleasant experiences: negative reinforcement


What are features of dependence?

Problems controlling use
Continued use despite harm
Reinstatement following abstinence
Narrowing of the repertoire


What is tolerance?

Larger doses required to gain the same effect experienced previously


What is compulsion?

Strong desire to use the substance


What is salience?

Obtaining and using the substance becomes so important that other interests are neglected


What is narrowing the repertoire?

Loss of variation in use of the substance?


What is the social learning theory of dependence?

AKA vicarious learning

We learn by copying behaviours of others
Substance misuse can result from peer pressure


What is the neurobiological model for addiction?

All drugs if abuse affect the dopaminergic reward pathway in the brain:
Ventral tegmental area -> prefrontal cortex and lambic system
Prefrontal cortex has a role in motivation + planning
Dopamine release in nucleus accumbens= sensation of pleasure


How do cocaine and amphetamines give pleasure?

Block dopamine reuptake
= increased synaptic dopamine levels


Aetiology of alcohol misuse

Some genetic susceptibility: supported by adoption studies
Occupation: stressful work + socially sanctioned drinking
Social background: difficult childhood, poor educational achievement
Psychiatric illness: assoc with personality disorders, mania, depression, and anxiety disorders


1 unit of alcohol:

1/2 pint normal beer
Small 125ml glass wine
One measure (25ml) spirit
One measure (50ml) fortified win

Units= vol in ml x % alcohol /1000


What are safe levels of alcohol consumption?

Women: 2-3/day, 14/week
Men: 3-4/day, 21/week


What are harmful levels of alcohol consumption?

Women: >6 /day, >35 /wk
Men: >8 /day, >50 / wk


Delerium tremens

48hrs into abstinence, lasts 3-4 days
Confusion, hallucinations, affective changes, gross tremor, autonomic disturbance, delusions
Mortality rate 5% (30% with sepsis)
Management: reducing benzodiazepine regime and parenteral thiamine, management of potentially fatal dehydration and electrolyte disturbance


What is Wernicke's encephalopathy

Due to acute thiamine (vit B1) deficiency
Confusion, ataxia, opthalmoplegia
Medical emergency!
Treat with parenteral thiamine


What is korsakoff's syndrome?

Cause by untreated Wernicke's encephalopathy
Irreversible antegrade amnesia
Can register new events but cannot recall them
Patients may confabulated to fill in gaps in memory


What is intoxication?

Transient state of emotional and behavioural change following drug use, dose dependent and time limited


How would you investigate a patient with apparent alcohol misuse?

FBC: macrocytic anaemia (incr MCV) due to B12 deficiency
LFTs: gammaGT rises with recent heavy alcohol use, raised transaminases indicate hepatocellular damage
UDS: if suspect drug misuse too
Hepatitis screen: if suspect IV drug use


What can a UDS: urine drug screen detect?

Amphetamine: 2 days
Heroin: 2 days
Cocaine: 5-7 days
Methadone: 7 days
Cannabis: up to 1 month


How do you assess a patients' motivation to change?

The stages of change model:
Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse
Identify support needed, set realistic goals e.g.
Short term: reduce consumption
Medium term: undergo detoxification
Long term: attend college


How is detoxification managed?

Planned = following period of preparation
Unplanned = e.g. after emergency hospital admission
Long-acting benzos: prevent withdrawal symptoms incl seizures + DT
Gradually withdrawn and stopped
Thiamine: parenteral prophylaxis


What methods are used to support relapse prevention?

Psychological: CBT + group therapy
Acamprosate, anti craving drug thought to act in midbrain
Disulfiram, mimics flush reaction to alcohol making consumption highly unpleasant


How does heroin give pleasure?

A mu opiate agonist it stimulates brain and spinal cord receptors usually acted on by endogenous endorphins


How is heroin taken?

Initially often smoked
IV injection: antecubital fossa -> feet, backs of hands, groin
Veins become damaged
Subcutaneous 'skin popping' or IM


What are local complications of IVDU?

DVT: femoral injection damages valves slowing venous return
Emboli: can cause gangrene and consequently amputation


What are systemic complications of IVDU?

Septicaemia: direct injection of bacteria or from abscess/cellulitis
Infective endocarditis: tricuspid valve
Blood borne infections: hepB, hepC, HIV
Increased risk of OD less dose titration than in smoking