Substance Misuse

Question 1

what are the weekly low-risk drinking guidelines in ireland?

Answer 1

1. total consumption: men 17 SD, and women 11 SD
2. at least 2 or 3 alcohol free days per week
3. no more than 6 SD on one occasion

Question 2

1 SD = how much beer, spirit, and wine

Answer 2

1. 1/2 pint beer
2. single measure spirit
3. small glass wine

Question 3

formula for number of standard of drinks

Answer 3

number of standard drinks = (volume in mls x ABV%)/ 1000

Question 4

criteria for substance use disorder ?

Answer 4

desire/ drive to use substance + 2 of;
1. impaired control
2. increasing priority
3. physiological features
*cannot just be desire/ drive to use + physiological in the absence of impaired control or increasing priority (think opioids for cancer patient)

Question 5

duration of substance use to diagnose someone with substance use disorder?

Answer 5

usually period of at least 12 months (may be made if daily/ almost daily use over at least 3 months

Question 6

what is harmful use of substance ?

Answer 6

implies a pattern of alcohol use that causes either physical or mental damage to the user or others in the absence of dependence

Question 7

what is hazardous substance use?

Answer 7

implies a pattern of alcohol use that increases the risk of physical or mental damage to the use or others in the absence of dependence

Question 8

with regard to harmful use of substances, this harm can be caused by?

Answer 8

1. behaviour related to intoxication
2. direct or secondary toxic effects on body organs or systems
3. harmful route of administration
4. use of substance has resulted in behaviour leading to harm to the physical or mental health of others

Question 9

criteria for harmful use of substance ?

Answer 9

1. the pattern of use is evident over a period of at least 12 months (or at least 1 month if use is daily or almost daily)
2. does not include peer or cultural disapproval
3. does not include having a hangover
4. does not require dependence on the substance

Question 10

what categories relating to substance use does the ICD-11 identify

Answer 10

1. OCD (psychostimulant only)
2. psychotic disorder
3. mood disorder
4. anxiety disorder
5. delirium
6. impulse control disorder (psychostimulants only)

Question 11

what questions do you want to explore when taking a history of someone who may have a substance use disorder? (history of presenting complaint/ current history)

Answer 11

1. quantify the amount
   - how many days a week do you drink
   - how much do you drink during each drinking session
   - whats the most you might drink in one session
2. establish range of substance use:
   - what other substances do you use?
   - ask how much is used of each drug
   - asking how much money is spent weekly on each drug can be helpful
3. dependency/harmful use/ hazardous use
   - for each substance explore evidence of above criteria
   - family history
   - screening questions about depression/ anxiety/ psychosis/ medical problems/ relationship, legal, occupational problems secondary to substance use

Question 12

when taking a longitudinal history of substance use, what questions do you ask?

Answer 12

1. outline the chronology of events
   - when did you start to use the substance
   - how much were you using?/ how often?
   - how did use increase over time?
   - were there specific triggers?
2. establish when use became harmful/ dependence
   - evidence of tolerance over time
   - have there been periods of abstinence? why? how long did they last? what factors were involved in the relapse? is there evidence of ‘rapid reinstatement’ after a period of abstinence?
   - have there been periods of treatment? details?
   - evidence of withdrawls, DTs and medical complications