Addictive Behaviour Case Study
Sample Case
A 35 year old married man called Mr D was brought to hospital by ambulance. His colleagues at the bank where he works as a financial advisor had found him slumped over his desk. He had drunk a whole bottle of vodka. He had vomited profusely and was nearly unconscious.
On examination by the medical registrar, he was found to be mildly jaundiced with palmar erythema and clubbing of the finger nails. Abdominal examination revealed hepatomegaly.
Significant results of physical investigations:
- WCC - 6.2 ( 4.0-11.0 x 109/l)
- MCV - 108 ( 76-96 fl)
- GGT - 140 ( 11-51 IU/l)
- AST - 211 (5-35)
- ALT - 97 (5-35 IU/l)
He was admitted to a medical ward and seen the next day by the duty psychiatrist who noticed Mr D was shaking all over and perspiring. He kept wringing his hands and seemed very anxious.
At interview, he gave a history of heavy drinking for the past 8 months since his manager set new targets for the department. The drinking had caused many arguments with his wife which had culminated in her leaving with their 2 children to stay with her parents.
The psychiatrist inquired about other symptoms and learnt that Mr D felt he had lost control of his drinking and felt unable to stop. He spent as much time as possible drinking to cope with stress and always had a drink first thing in the morning to give him a lift before going to work.
Explain the underlying clinical phenomena.
Problem
He is an alcoholic
Management
- Detox them; get them clean, and deal with DTs
- Group Therapy; Get them to join AA
- Drug Therapy; put them on antabuse, which makes them feel terrible if they drink
Common Questions
Describe the features of a dependence syndrome (including alcohol)
Using stamp collecting as an example:
- Primacy: The hunt for stamps begins to take priority over other activities. It becomes a compulsion.
- Narrowing of Repertoire: The addict begins to stick to one staple, such a second class, or whisky.
- Tolerance develops: so it takes more stamps to satisfy.
- Rapid Reinstatement after Abstinence: After just a few day clean, the addict heads back down to the Post Office...
- Withdrawal symptoms: such as anxiety and tremor develop after a short period without a a quick "first class" hit, and are only reduced by buying more stamps.
Know the commonly abused substances and understand their effects
- Opiates: Heroin, Methadone, Codeine, Morphine and Opium. Main effect is euphoria. Apparently, its rather good.
- Stimulants: Cocaine, Crack, Ecstasy, Amphetamine. Hyperactivity, euphoria, aggression.
- Hallucinogens: LSD, Magic Mushrooms. Marked perceptual disturbances, crazy ideas.
- Weed: "Woah! Gets you stoned man..."
Know how to take an alcohol history
- How much do you drink?
- What do you drink?
- Who do you drink with?
- Are you worried/has anyone ever commented about your drinking?
- Do you have a problem if you try to stop drinking?
- Do you need an eye opener in the morning?
- If you have one drink, do you have to keep drinking?
Understand the terms tolerance and withdrawal
Tolerance: The addictive substance has less effect; more is needed than previously to maintain the same degree of intoxication
Withdrawal: Feelings of discomfort, distress, and intense craving for a substance that occur when use of the substance is stopped
Understand the consequences of excess alcohol consumption (physical /psychological / social)
Physical
Alcohol affects a large number of systems in the body including the cardiovascular, nervous, renal, digestive, endocrine, musculo-skeletal and obstetrics.
Psychological
- Dependence
- Compulsion to drink
- Cravings
- Withdrawal symptoms
Describe the epidemiology of substance abuse (including alcohol)
1/3 of the population abstain from alcohol, 1/3 drink lightly and 1/3 drink heavily.