Substance+Misuse+Answers+2008

=**Substance Misuse Answers 2008**=

(a) Briefly explain the components as he described them in his model. (4 marks)**
 * 1. Zinberg (in 1984) was one of a number of researchers and clinicians who have sought to articulate the key components of the drug using experience.

__drug__**:** dose, effects, addictive potential, purity, method of administration, use with other drugs, longer-term sequelae of use __user (set):__ age, gender, health (physical and mental), previous use of the drug (?tolerance), expectation of the drug experience, concomitant use of other drugs __setting:__ environment


 * (b) Mary Lim is a 20 year old office worker who enjoys a cigarette with her colleagues on the footpath outside her Grenfell St office a number of times a day. Use the model (above) to explain this drug use situation. (3 marks)**

__drug__**:** cigarette (nicotine), 100/100 addictive potential, inhaled, used often __user (set):__ 20 year old female, smokes a number of times a day __setting:__ with colleagues on the footpath outside her Grenfell St office


 * 2. ‘I'd always done a lot of glue as a kid. I was very interested in glue, and then I went to lager and speed, and I drifted into heroin because as a kid growing up everybody told me, 'Don't smoke marijuana, it will kill you’. The above is a quote from the 1996 film “Trainspotting” (directed by Danny Boyle). How does this ‘information’ correlate with data you have been given on the mortality and morbidity caused by social drugs in Australia? (2 marks)**

Marijuana is an illicit drug, but as shown above, regardless of the three types of social drugs, there is a potential for mortality and morbidity**.
 * || hospital episodes || deaths ||
 * alcohol || 43 032 || 3 271 ||
 * tobacco || 136 700 || 18 800 ||
 * illicit drugs || 14 471 || 1 000 ||

3. There are two main systems used worldwide to classify dependence, with commonality in their criteria. (a) Name the two systems. (1 mark)**

Dependence is classified as either: __physical:__ tolerance - adapts to drug, requiring higher doses withdrawal - absence of drug leading to physical reactions

__psychological:__ strong desire/compulsion to use drug connotations of role, activity, object (paraphernalia)


 * (b) Regardless of which system is used, explain which criteria must be fulfilled for a person to be nominated as drug dependent. (5 marks)**

At least 3 of: - tolerance - withdrawal - taking larger amounts or over a longer period of time than intended - persistent desire or unsuccessful efforts to cut down or control - spending a great deal of time and effort on activities to obtain or use the substance - giving up other significant activities - continuing use despite problems known to be caused by the substance

(4 marks)**
 * 4. (a) With regard to treatment of alcohol dependence, explain the rationale for each of the medications used to manage withdrawal (‘detox’).

benzodiazepines - to prevent seizures thiamine/multivitamins - due to eating less from calories gained by alcohol other anti-convulsants/antipsychotics analgesics/anti-emetics


 * (b) Often, after ‘detox’, patients are encouraged to maintain abstinence by the further use of medications. Discuss briefly two medications used for this purpose. (4 marks)**

acamprosate - similar to taurine and GABA naltrexone - blocks effects of endorphins, reducing cravings for alcohol


 * 5. Explain what the policy of Harm Minimisation encompasses. Include in your answer what three principles are key to this policy and one example of how each principle is applied. (5 marks)**

Three principles of harm minimisation: __supply reduction:__ scheduling of medications __demand reduction:__ health and education campaigns __harm reduction:__ opioid substitution treatment program, clean needle program