Knowledge guides

LG 12: Scientific foundations of addiction and related problems

Pathophysiology and clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant test performances and their relative values in different populations and settings. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

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Associated infectious diseases:

  • Relationships between substance use and blood borne virus infections, sexually transmitted diseases, and tuberculosis

Neurobiology:

  • Excitatory pathways
  • Inhibitory pathways
  • Neuroadaptation
  • Neuroplasticity
  • Neurotransmitter systems
  • Reward pathways
  • Withdrawal syndromes

Perspectives on addiction and its underpinnings:

  • Classification of substance use and addictive disorders using current International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM)
  • Perspectives on disorders due to substance use and addictive behaviours, including the disease model, biopsychosocial model, psychological model, social model, spiritual or existential model

Pharmacology, toxicology and withdrawal syndromes of commonly used substances:

  • Alcohol
  • Benzodiazepines and other sedative-hypnotics
  • Cannabis
  • Dissociative agents
  • Emerging substances
  • Hallucinogens
  • Nicotine
  • Opioids (illicit and prescribed)
  • Stimulants
  • Volatiles

Risk-based approaches to screening and assessment:

  • Alcohol Use Disorders Identification Test (AUDIT)
  • Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

Risk factors and environmental influences for substance use and addictive disorders:

  • Co-existing mental disorders
  • Cognitive impairment
  • Cultural factors, including legal status of different substances
  • Genetics and family history
  • Major disruptive events, such as epidemics, natural disasters, and war
  • Pain, other physical health problems, and related disability
  • Social determinants
  • Trauma and adverse developmental and other life events
  • Addiction medicine history and physical examination
  • Blood / Hair / Oral fluid / Urine toxicology in clinical setting
  • Breath analysis, carbohydrate-deficient transferrin (CDT), ethyl glucuronide (EtG), and phosphatidylethanol (PEth) in people with alcohol related disorders
  • Cognitive assessment tools relevant to assessing delirium and cognitive impairment
  • Investigations relating to associated infectious diseases, including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and sexually transmitted infections
  • Mental state examination
  • Other haematological and biochemical tests to detect and monitor secondary effects of substance use
  • Common elements of different models of addiction
  • Disentangling substance-induced clinical disorders from those of other aetiology or bidirectional influences
  • Pain and dependence
  • Prescription drug use:
    • aberrant use and dependence
    • concepts behind patterns of use and prescribing
  • Role of trauma and using trauma informed care practices