Substance Misuse

Question 1

What is acute intoxication?

Answer 1

Transient disturbances of consciousness, cognition, behaviour, perception, affect or behaviour following the administration of a psychoactive substance

Question 2

How is harmful use defined by ICD?

Answer 2

Damage to the individual’s health and adverse effects on family and society

Question 3

What is dependence?

Answer 3

Signs of dependence = CAN’T STOP. Usu associated with neglect of personal/ social / occupational activities.

• Compulsion to take substance
• Aware of harm but persists
• Neglect of other activities
• Tolerance
• Stopping leads to withdrawal
• Time preoccupied with substance
• Out of control use
• Persistent, futile wish to cut down

Question 4

What effect do drugs of abuse have on the brain?

Answer 4

All drugs of abuse activate the dopamine system in the mesolimbic reward pathway

Question 5

Management of substance misuse?

Answer 5

• residential rehab, community or hospital
• CBT, motivational interviewing
• contingency mx programs
• medication
• injection harm reduction strategies

Question 6

Early withdrawal symptoms of opiates?

Answer 6

Within 24-48h

• craving
• flu like Sx
• sweating
• yawning

Question 7

What are the later opiate withdrawal symptoms?

Answer 7

7-10d:

• Mydriasis (pupil dilation)
• abdo cramps / diarrhoea
• agitation, restlessness
• piloerection
• tachycardia

Question 8

Drugs used in opiate detoxification programs?

Answer 8

Methadone (opioid agonist) or buprenorphine (opioid partial agonist).
Less euphoriant and relatively long half life cf opioids of abuse.

Question 9

What is naltrexone?

Answer 9

Opioid antagonist. Blocks euphoric effects and sometimes used to prevent relapse.

Question 10

Signs of overdose opioids?

Answer 10

Miosis and respiratory depression.

Question 11

Drug mx opioid overdose?

Answer 11

Naloxone

Question 12

Effects of cocaine?

Answer 12

Restlessness, increased energy, abolition of fatigue, hunger. Resemble hypomania.

Question 13

Duration of cocaine effect?

Answer 13

~20mins

Question 14

What is post cocaine dysphoria?

Answer 14

Sleeplessness and intense depression; precedes withdrawal (depression, insomnia, craving).

Question 15

Effects of amphetamines?

Answer 15

-Euphoria
-Increased concentration and energy
-Mydriasis
-Tachycardia
-Hyperreflexia
Followed by: depression, fatigue, headache

Question 16

How does metamphetamine compare with amphetamines?

Answer 16

Chemically related but more potent, long lasting and harmful.

Question 17

Characteristic Physical sign of solvent misuse?

Answer 17

Red rash around mouth and nose

Question 18

Effects of chronic solvent misuse?

Answer 18

• Weight loss
• N/V
• Polyneuropathy
• Cognitive impairment

Question 19

Toxic effects of solvent misuse?

Answer 19

-Bronchospasm
-Arrhythmias
-Aplastic anaemia
-Hepatorenal and cerebral damage
May be fatal

Question 20

What is phencyclidine also known as?

Answer 20

PCP or angel dust

Question 21

What are the effects of phencyclidine?

Answer 21

Euphoria, peripheral analgesia, impaired consciousness or psychosis (may require anti-psychotics)