Substance use disorders
Alcohol, tobacco, vaping, opioids, methamphetamine and cannabis, including withdrawal and harm reduction.
High-yield points
NHMRC alcohol guidelines: no more than 10 standard drinks a week and no more than 4 on any one day; a standard drink is 10 g of alcohol.
Screen with AUDIT or AUDIT-C; use brief interventions in primary care.
Alcohol withdrawal: monitor with a withdrawal scale; diazepam for symptoms; give thiamine before glucose to prevent Wernicke encephalopathy.
Wernicke's triad: confusion, ataxia, ophthalmoplegia (often incomplete); treat with high-dose IV thiamine.
Opioid dependence: opioid agonist treatment with methadone or buprenorphine (including long-acting injectable buprenorphine).
Take-home naloxone is free without a prescription for anyone at risk of or likely to witness an overdose.
Smoking cessation: combination NRT or varenicline plus behavioural support (Quitline 13 7848).
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Alcohol advice | General advice to cut down. | NHMRC: no more than 10 standard drinks a week and 4 in a day. A standard drink is 10 g alcohol. |
| Tobacco and vaping | Smokeless tobacco and bidis are major concerns; e-cigarettes are banned. | Nicotine vapes are regulated medicines sold through pharmacies. Varenicline and NRT are PBS-subsidised; Quitline 13 7848. |
| Harm reduction | Needle exchange and OST through NACO programs. | Mainstream: needle and syringe programs, supervised injecting in Sydney and Melbourne, free take-home naloxone. |
| Opioid dependence | Buprenorphine-based OST; methadone limited. | Methadone or buprenorphine (including long-acting injectables), often prescribed in general practice. |
Alcohol advice
India (MBBS)
General advice to cut down.
Australia (AMC): what the exam expects
NHMRC: no more than 10 standard drinks a week and 4 in a day. A standard drink is 10 g alcohol.
Tobacco and vaping
India (MBBS)
Smokeless tobacco and bidis are major concerns; e-cigarettes are banned.
Australia (AMC): what the exam expects
Nicotine vapes are regulated medicines sold through pharmacies. Varenicline and NRT are PBS-subsidised; Quitline 13 7848.
Harm reduction
India (MBBS)
Needle exchange and OST through NACO programs.
Australia (AMC): what the exam expects
Mainstream: needle and syringe programs, supervised injecting in Sydney and Melbourne, free take-home naloxone.
Opioid dependence
India (MBBS)
Buprenorphine-based OST; methadone limited.
Australia (AMC): what the exam expects
Methadone or buprenorphine (including long-acting injectables), often prescribed in general practice.
The Australian context
Nicotine vapes are regulated as medicines in Australia and are only legally sold through pharmacies; recreational vaping products are banned. Harm reduction (needle and syringe programs, supervised injecting facilities in Sydney and Melbourne) is mainstream health policy.