Alcohol dependence syndrome
Clinical features
- Compulsive need to drink
- Altered alcohol tolerance
- Stereotyped pattern of drinking
- Drinking takes primacy over other activities
- Repeated withdrawal symptoms
- Relief drinking to avoid withdrawal, e.g. early morning drinking
- Rapid relapse if patient drinks again following a period of abstinence
Management
Psychosocial support and group therapy
- Alcoholics Anonymous
Drugs (effects are enhanced by combining them with counselling)
- Naltrexone reduces the risk of relapse into heavy drinking and the frequency of drinking
- Acamprosate alters neurotransmitters and reduces drinking frequency
- Disulfiram (Antabuse) reacts with alcohol to form acetaldehyde which produces unpleasant symptoms to discourage drinking
Drug abuse
- Solvents 'glue sniffing'
- Euphoria
- Floating sensation
- Amnesia
- Visual hallucinations
- Inhalation of vomit
- Bone marrow/brain/liver/kidney toxicity
- Tolerance
- Amphetamines
- Stimulant
- Euphoria
- Psychological dependence
- Restlessness
- Over-activity
- Paranoid psychosis
- Cocaine
- Stimulant
- Hyperarousal
- Dependence
- Paranoid ideation
- Fits
- Coronary artery spasm/disease
- Perforation of nasal septum if inhaled
- Cannabis
- Exaggeration of pre-existing mood
- No definite withdrawal syndrome or tolerance
- Psychosis
- MDMA 'Ecstasy'
- Psychedelic effects
- Hyperpyrexia
- Acute hepatic/renal failure
- Possible chronic brain damage
- Hypnotics (e.g. benzodiazepines)
- Relaxation
- Sleep induction
- Dependence
- Withdrawal syndrome
- Respiratory depression
- Narcotics (morphine, heroin, codeine, methadone, pethidine)
- Calm
- Slight euphoria
- Analgesia
- Flattening of emotions
- Marked and rapid tolerance
- Withdrawal syndrome
- Respiratory depression
- Complications of injecting
- Infection (e.g. HIV/hepatitis B and C/ endocarditis)
- Vein thrombosis
Management
- Withdrawal programmes, e.g. using methadone
- Psychosocial support to help the addict live without drugs
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