Drug and Alcohol placement

I had my Drug and Alcohol placement as part of the psychiatry rotation this morning and i wanted to remember some things i learnt. I found it very interesting and even had the chance to talk to a patient in 'detox' and rehabilitation who had been using cannabis, methamphetamine and alcohol since he was 13 years old. Now in his 30's he wants a life back. Next Step provides a range of services for people experiencing problems associated with their drug and alcohol use, as well as support for families. Services inpatient withdrawal unit, outpatient treatment services and pharmacy, youth services and community clinical programs. There are a number of centres around Perth such as in Warwick, Fremantle and Thornlie and smaller centres outside of Perth such as in Bunbury, Albany and Geraldton. 

Next Step Drug and Alcohol Rehabilitation Center near Royal Perth Hospital

Interestingly the biggest reason people come into these places is for opioid abuse. Currently those affected can reduce heroin use by using replacement drugs such as the opioid methadone which is supplied by pharmacies as a way to slowly introduce those dependent on opioids to alternatives which are safer to use and place them on the path to decreasing drug use altogether (ideally). But it is the withdrawal of alcohol abuse which is the most dangerous as it can induce seizures and Delirium Tremens. 

The main symptoms of Delirium Tremens are confusion, diarrhea, insomnia, nightmares, disorientation and agitation and other signs of severe autonomic instability (fever, tachycardia, hypertension). These symptoms may appear suddenly but can develop 2–3 days after cessation of drinking heavily with its highest peak/ intensity on the fourth or fifth day and may be worse at night. Other common symptoms include intense perceptual disturbance such as visions of insects, snakes, or rats. These may be hallucinations which are primarily visual, or illusions related to the environment, e.g., patterns on the wallpaper or in the peripheral vision that the patient falsely perceives as a resemblance to the morphology of an insect. They are also associated with tactile hallucinations such as sensations of something crawling on the subject — a phenomenon known as formication. Delirium Tremens usually includes extremely intense feelings of "impending doom". Severe anxiety and feelings of imminent death are symptomatic of DT.

DT can sometimes be associated with severe, uncontrollable tremors of the extremities and secondary symptoms such as anxiety, panic attacks and paranoia. Confusion is often noticeable to onlookers as patients will have trouble constructing simple sentences or making basic logical calculations. 

General effects of alcohol relating to the neurotransmitters affected

We were given a little talk about the neurobiology of drug dependence which i have attempted to demonstrate below. Drug dependence is a compulsive behavior that is 50% due to genetics and triggered by a person's environment. Sort of like diabetes, some are us are predisposed to getting diabetes and when we do not look after our weight, diet and exercise we then trigger the diabetes and acquire the illness. 

Everybody has experienced something nice for example think of your favorite food. When you eat this food you increase levels of the neurotransmitter dopamine (1.) in an area called your nucleus abducens which tells you this is enjoyable. This information is relayed in a reward pathway to the area of the brain known as the frontal and prefrontal cortex. Here we have the ability to consciously control our reward, we can say 'no i have had enough of that food' or 'yes i would like another'. In those who take drugs, the levels of dopamine are significantly increased from the effects of the drug (2.) which tell them 'wow this is really good!' and they get a high. Over time whilst using the drug the amounts of dopamine reduce to normal levels hence people need more and more drugs to get the same effects (3.). What also occurs is those taking the drugs become accustomed to taking the drug to get this 'high' and it becomes a 'learned behavior' through signals to an area known as the hippocampus associated with memory. As the drug use continues, the pathway to the frontal cortex which allows us to consciously say 'no you don't need another one' dies away and the learned behavior pathway strengthens. This is what makes it even more difficult for those dependent on drugs to reduce and stop taking the drugs. It takes weeks to years for those affected to reduce this learned behavior and once again increase the reward pathway letting them make the conscious decision to say no.

The person we saw today was so determined to stop this time and get a life back, i wish him all the best! If he keeps up that determination he will be sure to pull through.