3- Substance Abuse D/o Flashcards
What are the 4 features of alcoholism?
- Craving
- Impaired control
- Physical dependence
- Tolerance
Understanding alcoholism is based on what model?
Bio-psycho-social model
Neurally, alcoholism is due to a balance between what?
Drive/reinforcement (ventral tegmental area) vs. executive control (prefrontal cortex)
Genetic predisposition to alcoholism is a/w with what physiological change?
Mutated dopamine transporter
What is the addiction cycle?
Preoccupation/Anticipation => Binge/intoxication => Withdrawal/negative affect (repeat)
T or F: Drug use will occur faster/more frequently if there is a genetic predisposition?
TRUE
What is the 3-step clinical process for recovery?
- Screen
- Diagnose
- Treat
During the screening phase of recovery, where does this typically occur and what screening tools are used?
Primary care
Cage or AUDIT
During the diagnosis phase of recovery, where does this typically occur and what screening tools are used?
Psychiatry/Addiction medicine
MAST, DSM
During the treatment phase of recovery, where does this typically occur and what screening tools are used?
In-patient (detox/rehab)
Out-patient (rehab/follow up)
Who are “at risk users” (substance misuse)?
> 14 drinks/wk for men vs. >7 drinks/wk for women OR
> 4 drinks/occasion for M vs. >3 drinks/occasion for F/seniors
Who are “problem users” (substance abuse)?
Those that experience problems related to substance abuse (health, legal ,family, school, work)
Who are “dependent users” (~addiction)?
Increased loss of control, alcohol related consequences, physiological dependence
If pt admits to alcohol use during HPI, what screening tool can be used to get additional information?
CAGE (4 questions taken from MAST, if score of 1+ consider AUDIT)
- Have you ever felt like you should Cutdown your drinking?
- Have you Annoyed people w/ your drinking?
- Have you ever felt Guilty/bad about drinking?
- Have you ever had a drink 1st think in the morning (Eye opener) to steady nerves/get rid of hangover?
What screening tool is best for alcohol abuse, problem drinking and asks about frequency?
AUDIT (10 questions, high specificity/sensitivity, score of 8+ = harmful/hazardous drinking)
How does the DSM5 organize substance related d/o?
- Class: substance related d/o
- Group: Substance-use d/o
- Disorder: By substance and by severity
- Group: Substance-induced d/o
- Disorder: intoxication, withdrawal, delirium, dementia, amnesia, psychosis, mood d/o, anxiety, sexual dysfunction, sleep d/o
- Group: Substance-use d/o
What are the sx a/w substance use d/o? (11)
- Taking more/longer than intended
- Desire to cut down (or unsuccessful attempts)
- A lot of time devoted to acquiring, using, recovering
- Craving for drug/to use
- Failure to fulfill obligations
- Persistent use despite social harm
- Giving up important things/reducing them
- Use in physically hazardous situations
- Use despite physical/psychological harm
- Tolerance
- Withdrawal
What is the DSM5 criteria for substance use d/o? Severity? Specifiers?
- 2+ w/in 12 months (*sx # from previous card)
- impaired control (sx #1-4)
- social impairment (sx #5-7)
- risky use (sx #8-9)
- pharmacological (sx #10-11)
Severity: Mild (2-3 sx), Mod (4-5 sx), sever (6+ sx)
Specifiers:
- W/ or w/o physical dependence (sx #10-11)
- TX Course (when, if in tx)
What are 3 motivational techniques for getting a pt into tx?
One-on-one Confrontation (don’t argue, just state the facts, make unique to pt and get pt/family to agree to tx)
Showing empathy
Offering hope
What is the disease model for alcoholism? (4)
- Alcoholism is a disease like any other medical condition
- Alcoholism has an “early stage”
- It is NOT the pts fault
- Can be tx w/ good prognosis
Pts w/ alcoholism can seek treatment anywhere along the spectrum of abuse. When should a pt absolutely seek help?
Tolerance + dependence + compulsion
What is the tx progression for substance use d/o
- Inpatient (detox in hospital, rehab 14-28 days)
- Out patient (rehab, 1/2 way house)
- Therapy (individual, group)
- Support from “inner circle”
What is a “Dual diagnosis”?
Pt w/ substance use d/o AND comorbid psychiatric condition
What strategies are used in individual therapy?
Motivation interviewing, CBT, behavior modification
What strategies are used in group therapy?
12 step programs, specific support groups
What meds are used to tx DTs in inpatient alcohol detox?
Diazepam
Lorazepam
Phenobarbital
What nutritional needs should be considers for inpatient alcohol detox?
Thiamine
What is included in for long term tx of substance use d/o? (4)
Disulfiram
Acamprostate
Naltrexone
Individual/group counseling (AA)
