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Substance use disorder

Specialties > Child health

Background knowledge 🧠

Definition

  • Substance use disorder is a chronic condition characterised by compulsive substance use despite harmful consequences.
  • Includes a range of substances: alcohol, opioids, stimulants, and others.
  • Associated with physical and psychological dependence.
  • Considered a mental and behavioural disorder.

Epidemiology

  • Affects approximately 9% of the UK population at some point in their lives.
  • Higher prevalence in males than females.
  • Commonly begins in adolescence or early adulthood.
  • Strong association with mental health disorders.
  • Increased risk in socially disadvantaged groups.

Aetiology and Pathophysiology

  • Genetic predisposition plays a significant role.
  • Environmental factors include peer pressure, trauma, and stress.
  • Neurobiological changes: alterations in the brain’s reward system.
  • Dysregulation of dopamine pathways.
  • Chronic exposure leads to tolerance, dependence, and withdrawal.

Types

  • Alcohol use disorder: Most common form in the UK.
  • Opioid use disorder: Includes prescription and non-prescription opioids.
  • Stimulant use disorder: Includes cocaine and amphetamines.
  • Cannabis use disorder: Increasingly recognised with higher potency products.
  • Polysubstance use: Concurrent use of multiple substances.

Clinical Features 🌡️

Symptoms

  • Cravings and compulsive drug-seeking behaviour.
  • Inability to control substance use.
  • Neglect of responsibilities at work, school, or home.
  • Withdrawal symptoms when not using the substance.
  • Continued use despite knowing the risks.

Signs

  • Physical signs: weight loss, poor hygiene, needle marks.
  • Behavioural changes: aggression, mood swings, isolation.
  • Cognitive impairment: memory loss, impaired judgment.
  • Psychosocial impact: relationship breakdowns, legal issues.
  • Signs of intoxication or withdrawal specific to the substance.

Investigations 🧪

Tests

  • Urine drug screening: Detects recent substance use.
  • Blood tests: LFTs for alcohol use, FBC for general health assessment.
  • Imaging: Brain MRI or CT if neurological complications are suspected.
  • Mental health assessment: Identify comorbid psychiatric conditions.
  • Screening tools: AUDIT for alcohol use disorder, DAST for drugs.

Management 🥼

Management

  • Detoxification: Medically managed withdrawal.
  • Pharmacotherapy: Methadone or buprenorphine for opioid dependence.
  • Psychosocial interventions: Cognitive-behavioural therapy (CBT), motivational interviewing.
  • Harm reduction strategies: Needle exchange programmes, supervised consumption.
  • Rehabilitation: Inpatient or outpatient services.
  • Follow-up: Regular monitoring, relapse prevention plans.

Complications

  • Infectious diseases: HIV, hepatitis C from needle sharing.
  • Overdose: Respiratory depression, cardiac arrest.
  • Mental health disorders: Depression, anxiety, psychosis.
  • Social issues: Unemployment, homelessness, criminal activity.
  • Physical complications: Liver cirrhosis, cardiovascular disease.

Prognosis

  • Variable depending on substance and individual circumstances.
  • High relapse rate, particularly without ongoing support.
  • Better outcomes with integrated care (medical, psychological, social).
  • Mortality risk increased, particularly in opioid use disorder.
  • Long-term abstinence is achievable with comprehensive care.

Key Points

  • Substance use disorder is a complex and multifaceted condition.
  • Early recognition and intervention are crucial.
  • Multidisciplinary approach is key to effective management.
  • Ongoing support and follow-up improve outcomes.
  • Awareness of complications and comorbidities is essential for comprehensive care.

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Child health