Addiction

Question 1

addiction ireland overview

Answer 1

• high levels of problematic drinking. 10.5% dependent, 40% Risk single occassionaly drinking (RSOD), 50% harmful/hazardous use
• physical illness, loss of productivity
• access to illicit and prescription drugs
• rapid internet development
• gambling

Question 2

the exhaustion cycle

Answer 2

1. burnout/stress
2. insomnia
3. daytime fatigue, loss of direction
4. recession
5. Binge eating, anxiety and depression
6. Excessive device use
7. Alcohol, drug use, internet, porn

Question 3

the protected environment

Answer 3

• restrict access
• boundaries
• medically assisted
• no technology
• reduction of stress
• often not welcomed!!

Question 4

Alcohol

Answer 4

• +/- other substances
• +/- comorbid process adiction
• hazardous use vs dependece
• medical. psychiatric or social complications arising
• mild 2-3 symptoms, moderate 4-5, severe 6 or more

Question 5

diagnosis of substance misuse

Answer 5

• taken in larger amounts than intended
• persistent desire or unsuccessful effots to cut down or control
• time spent obtaining or using
• craving
• failure to fulfill work, school, home obligations
• persistent in face of consequences
• recurrent use in situations in which it is physically hazardous
• persistence in face of pscyhological problems
• tolerance
• withdrawl

Question 6

physical problems associatied with alcohol use

Answer 6

1. cardiovascular
   - BP
   - pulse
   - heart failure in cardiomyopathy
   - arrhythmias
2. LIver - normal in many cases though
3. Musculoskeletal
4. Neurological
5. FBC. biochemistry, urea, creatinine
6. Ferritin, CRP
7. Coag screen

Question 7

alcohol intoxication

Answer 7

• life threatening condition
• differential diagnosis;
  1. overdose drugs, medical/surgical illness
• confusion, ataxia, coma
• monitoring - vital signs, temp, BP, PR, RR
• breath alcohol level
• urine plasma screen

Question 8

detoxification

Answer 8

• detox protocols using chlordiazepoxide
• protocols vary considerably in time required
• CIWA: scoring system used which objectifies severity of alcohol withdrawl
• avoid seizures, delirium tremens
• physical complications of withdrawl

Question 9

the confused patient - delirium tremens

Answer 9

• severe alcohol withdrawl - autonomic hyperactivity, severe anxiety, dehydration, electrolytes disturbance
• PLUS - clouding of consciousness, fluctuating mental state, confusion
• onset after last drink 48-72 hours
• generally preceded by alcohol withdrawl symptoms

Question 10

Wernicke encephalopathy

Answer 10

• medical emergency as it carries a 10-20% mortality without treatment
• elderly, severe dependence, poor nutrition, vomitting, underweight
• parenteral thiamine is the treatment
• classic triad: cerebellar ataxia, ocular abnormalities, global confusion state
• untreated or inadequartely treated Wernicke’s - korsakoffs psychosis

Question 11

stimulants

Answer 11

• cocaine
• crack cocaine
• Ectasy
• ketamine at low dose,
• party drugs
• MDMA (ecstasy)
• designer drugs - modafinil, ritalin
• methamphetamine

Question 12

stimulant use disorder

Answer 12

• paranoia, overvalued ideas, delusions, hallucinations, psychosis
• comorbid alcohol cocaine - cocaeythylene
  – cocaethylene is the by product of concurrent consumption of alcohol and cocaine as metabolized by the liver. Cocaethylene is largely considered a recreational drug in and of itself, with stimulant, euphoriant, anorectic, sympathomimetic and local anaesthetic properties. in most users, cocaethylene produces euphoria and has a longer duration of action than cocaine. Cocaethylene has a higher affinity for the dopamine transporter than does cocaine, but has a lower affinity for the serotonin and norepinephrine transporters. Study found thay cocaethylene “produced greater subjective ratings of ‘high’ in comparison with administration of cocaine or alcohol alone
• cardiac, cerebral vascular events
• social problems dealers

Question 13

Cannabis

Answer 13

-prevalence increasing in ireland
- CBD to THC ratio
- behavioural disturbance and psychosis
-

Question 14

Cannabis detoxification

Answer 14

• several weeks
• anger/agitation peak 2-3 weeks
• benzodiazepines, antipsychotics
• THC testing can be problematic
• smoking cessation may arise

Question 15

Gambling disorder

Answer 15

• unrealistic optimism
• risking something in the hope obtaining something greater
• significant social and health costs
• very hidden
• overt signs present late in gamblers career
• 1-5% population, much higher in adolescents
• not viewed as public health matter/crisis

Question 16

Gambling disorder DSM-5

Answer 16

1. needs to gamble with increasing amounts of money in order to achieve the desired excitement
2. is restless or irritable when attempting to cut down or stop gambling
3. has made repeated unsuccessful efforts to control, cut back or stop gambling
4. is often preoccupied with gambling (e.g having persistent thoughts of reliving past gambling experience, handicapping or planning the next venture, thinking of ways to get money with which to gamble
5. often gambles when feeling distressed (e.g helpless, guilty, anxious, depressed)
6. after losing money gambling, often returns another day to get even (“chasing” ones losses
7. lies to conceal the extent of involvement with gambling
8. Has jeopardized or lost a significant relationship, job, or education or career opportunity because of gambling
9. relies on others to provide money to relieve desperate financial situations caused by gambling