ADDICTION Clinic session with dr sutahar Group A PIC: nadiah jalil Mr.

S 40 years old Chinese muslim, present with for follow up previous alcohol dependence. On further questioning he also has symptoms of depression.
1) What is alcohol dependence? A maladaptive pattern of alcohol use,

leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: a. Tolerance b. Withdrawal c. alcohol is often used in larger amounts or over a longer period than was intended d. there is a persistent desire or unsuccessful efforts to cut down or control alcohol use e. a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects f. important social, occupational, or recreational activities are given up or reduced because of alcohol use g. alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol (e.g. continued drinking despite recognition that an ulcer was made worse by alcohol consumption) 2) Symptoms of alcohol withdrawal Insomnia, anxiety,tremor, irritability, anorexia, tachycardia, hyperreflexia, hypertension, fever, seizure, hallucination, delirium Symptoms onset 6-24 hour, last to 2-7 days 3) Severity Mild: irritability, tremor, insomnia

Moderate: diaphoresis, fever, disorientation Severe: grand mal seizure 4) Define addiction? A: unmanageable use of one or more substances or chemical that is associated with discomfort or distress when that use is discontinued or severely reduced . sometime, it also can be associated with compulsive behavioural problems such as pathological gambling, internet/cyber addiction
5) What are the profiles of an addict?

-common in males -living in the inner parts of an urban area -addiction sets in, the individuals level of functioning is either impaired or delayed -An antisocial personality disorder may or may not predate its development usually develops as a consequence of pharmacological effects of most illicit compounds itself & combined with the high cost of acquiring it Manipulative

6) Types of addiction:

Behaviour Opioids/narcotics---Heroin, codeine , opium , morphine Stimulants---methamphetamines or syabu, amphetamines , ecstasy, cocaine Marijuana Or Ganja, Cannabis, Hashish Depressants---Alcohol , barbiturates, sedatives, tranquilizers Others---Inhalants (Glue, paint, solvents), ---ketamine

7) Stages of Addiction: 1. Fooling around the honeymoon stage 2. Being hooked loss of control and denial

3.

Hitting bottom paying the price for living in denial or out of control

4. Recovery the hard-earned freedom from the addiction

8) how do you manage addiction? 1. Provision of withdrawal services (i.e. detoxification wards etc)

substitution treatment/other appropriate pharmacological measures short-term measures (ease the distress of withdrawal but do not result in long-term changes on their own)

2. The long-term interventions assessments and treatment appropriate planning supportive care (individuals or families or caregivers) periodic monitoring and review medication facilitating post-withdrawal linkages

on-going outpatient-counselling therapeutic community/rehabilitation center self help group (alcohol anonymus (AA) or narcotic anonymus (NA)

(either scarce or disjointed)

3. Detoxification wards Overcome withdrawal Symptoms (General) Diazepam

Blood/Urine/Radiological Ix Supportive measures

-Aches/pain---PCM -Sleep---Zolpidem/etc -Vomiting/nausea---Maxolon -Nutrition ---MVT/Parenteral Vitamin B12 -Anxiety/nervousness--In addition to valium, short course sedatives (i.e. quetiapine/CPZ) 4. The long-term interventions Substitution therapy Methadone Suboxone (Buprenorphine + naloxone) Buprenorphine alone

Relapse prevention

Naltrexone --50 mg OD Acamprosate --666 mg tds

Nicotine replacement therapy/champix (varenicline) On going supportive care individuals or families or caregivers

facilitating post-withdrawal linkages therapeutic community/rehabilitation center Pengasih, Pusat Serenti etc

self help groups AA, NA etc

self help groups for families/caregiver