Smoking cessation
Revise very brief advice, nicotine replacement therapy, varenicline or bupropion where appropriate, relapse prevention, pregnancy and comorbid mental health.
MRCGP AKT smoking, alcohol and substance misuse revision
These questions test practical GP care: smoking cessation, AUDIT, alcohol withdrawal risk, opioid dependence, harm reduction, safeguarding and comorbid mental health.
Quick answer
For AKT smoking, alcohol and substance misuse revision, prioritise smoking cessation, AUDIT, alcohol withdrawal risk, detox thresholds, relapse prevention, opioid substitution, naloxone, blood-borne virus testing, harm reduction and safeguarding.
What to revise first
Alcohol screening
Know AUDIT and AUDIT-C use, hazardous versus harmful drinking, dependence clues, brief interventions, withdrawal risk and when specialist input is needed.
Alcohol dependence
Cover community versus inpatient detox, withdrawal seizures, delirium tremens, chlordiazepoxide regimens, relapse prevention and vitamin supplementation.
Opioid dependence
Focus on methadone, buprenorphine, supervised consumption, shared care, overdose risk, naloxone, pregnancy and safe prescribing boundaries.
Harm reduction
Revise needle exchange, blood-borne virus testing, hepatitis B vaccination, hepatitis C treatment, safer injecting advice and non-judgemental follow-up.
Safeguarding and comorbidity
Link substance misuse with mental health, domestic abuse, child safeguarding, driving, employment, homelessness, exploitation and medication interactions.
Red flags to recognise quickly
- Alcohol withdrawal with seizures, delirium tremens, confusion, severe autonomic symptoms or high-risk comorbidity
- Opioid overdose, respiratory depression, reduced consciousness, polysubstance use or unsafe access to sedatives
- Pregnancy with alcohol or substance dependence, safeguarding concern, domestic abuse or child at risk
- Suicidal ideation, psychosis, severe depression, self-neglect or acute mental health crisis
- Jaundice, haematemesis, melaena, ascites, encephalopathy or suspected decompensated liver disease
- Injection-site infection, fever, endocarditis features, blood-borne virus risk or severe soft-tissue infection
Why this topic catches candidates out
The trap is either moralising or treating the problem as a single prescription. AKT answers usually reward practical, non-judgemental risk assessment, harm reduction, safeguarding awareness and knowing when specialist support is needed.
AKT substance misuse FAQ
Is smoking, alcohol and substance misuse tested in the MRCGP AKT?
Yes. It is a named RCGP curriculum topic. AKT questions can test smoking cessation, AUDIT, alcohol dependence, opioid substitution, harm reduction, blood-borne viruses, safeguarding and mental health comorbidity.
What should I revise first for AKT substance misuse?
Prioritise smoking cessation advice and medicines, AUDIT scoring, alcohol withdrawal risk, detox thresholds, relapse prevention, opioid substitution, naloxone, blood-borne virus testing and safeguarding.
How does AUDIT come up in AKT questions?
AUDIT is used to identify hazardous, harmful or dependent drinking. AKT stems may test score interpretation, brief intervention, referral thresholds or when withdrawal risk makes community management unsafe.
What is the AKT trap with opioid dependence?
The trap is treating opioid dependence as only a prescribing issue. Safe answers consider overdose risk, supervised consumption, shared-care boundaries, naloxone, pregnancy, safeguarding and blood-borne virus prevention.
Official sources
This is revision guidance, not official RCGP advice. Check current RCGP, NICE, local drug and alcohol pathways, safeguarding pathways and BNF guidance for clinical decisions. Last reviewed June 2026.
October sitting
Oct 26
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days
Keep moving, even on tired days.
Questions, mocks and explanations are free. Your first 2 hours of AKT audio are free. Full 4-month audio access is £79.