Workshop 2 Flashcards
What are three drugs that have physical withdrawal?
Alcohol
Benzodiazepines
Opiates
What are the serious withdrawal symptoms?
Seizures -> high risk of death.
Agitation, confusion (alcohol).
Tremors, vomiting, abdominal pain, flu-like symptoms etc.
How risky is opiate withdrawal?
If the patient is otherwise well, the risk of death is small. If in older patients there is a higher risk of CV complications: MI.
Why does withdrawal sometimes last a long time?
It can take a very long time to restore the neurotransmitter imbalance.
Also some changes (receptor plasticity) might last longer.
Why can opiate withdrawal be particularly painful?
Opiate use/withdrawal causes changes in the pain pathway - heightened perceptions of pain and craving.
What % of people in drug and alcohol misue have a mental health disorder?
75%, what comes first?
Cannabis and alcohol withdrawal can cause acute ________ and ________ respectively.
Cannabis and alcohol withdrawal can cause acute psychosis and anxiety respectively.
What does substitution therapy for opiates consist of?
Methadone and buprenorphine licensed for SL/wafer although a lot can be lost via first pass.
What is HAT?
Heroin associated injection therapy. Diamorphine injections.
What is chlordiazepoxide?
BZ used in alcohol withdrawal; substitution and then withdrawal.
Long term high dose BZ use causes
Can cause cognitive impairment (>30mg OD for diazepam).
Why must patients sign up and agree to the risks of BZ substitution therapy?
Known to cause cognitive impairment if >30mg OD for diazepam.
Aversion therapy for alcohol consists of
Disulfiram
Mechanism of action of disulfiram
Inhibitor of acetaldehyde dehydrogenase enzyme which causes the effects of a hangover to be felt immediately.
What is the cycle of change?
- Pre-contemplation
- Contemplation
- Planning/preparation
- Action
- Maintenance
What is the first step of the cycle of change?
Pre-contemplation - no intention to change in the forseeable future.
Awareness/contemplation of risk is minimal.
What is the second step of the cycle of change?
Contemplation - aware of the risk, know it is something they should do at some point. Not really ready to change.
What is the third step of the cycle of change?
Planning/ preparation: very aware of the risk. Ready to change e.g. signing up for a treatment service. Picking a date and making a plan. Most difficult step for some people.
What is the fourth step of the cycle of change?
Action - actively engaging in modifying behaviour. Signing up for a behavioural change programme. Starting treatment programme for example.
What is the fifth and final step of the cycle of change?
Maintenance - The effort required to prevent relapse is high. Hard to stay motivated; the risk is very high or recent. This is an important stage not to be forgotten, due to receptor plasticity etc. the risk of relapse is very high. In the example of smoking, people go around the cycle 5-6x before they quit.
What is a lapse?
A lapse is not the same as a relapse but it’s a step towards a relapse. One off or short-term goes back to the behaviour that was originally changed. Can be a single episode or can trigger a relapse.
What can repeated relapse of alcohol abuse cause?
Evidence that alcohol withdrawal can cause cognitive impairment due to constant detox followed by relapse.
What is mindfulness?
Putting something to the front of someones mind and consciously considering it as someones behaviour. Often behaviours are unconscious and not much active thought is given to the behaviour.
Where does taking part in a needle exchange fit in the cycle of change?
Pre-contemplation, step 1.
