5 Addictive Disorders Flashcards
What are Substance Use Disorders?
A problematic pattern of substance use that leads to functional impairment or distress. Frequent use alone does not indicate a disorder unless it causes significant problems.
What are the DSM-5 diagnostic criteria for Substance Use Disorders?
• At least 2 of the following within a 12-month period:
1. Using more than intended.
2. Persistent desire or unsuccessful attempts to cut down.
3. Significant time spent obtaining, using, or recovering from substance.
4. Craving to use substance.
5. Failure to fulfill obligations at work, school, or home.
6. Continued use despite social or interpersonal problems.
7. Limiting important activities due to substance use.
8. Using in dangerous situations (e.g., driving a car).
9. Continued use despite physical or psychological harm.
10. Tolerance (needing more to achieve the same effect or diminished effects with same dose).
11. Withdrawal (substance-specific syndrome upon cessation or reduction of use).
• Disorder is classified as mild, moderate, or severe based on number of criteria met.
What is the prevalence of Substance Use Disorders?
8% of U.S. adults have a substance use disorder. More common in men than women. Alcohol and nicotine are the most commonly used substances.
What psychiatric symptoms are common in Substance Use Disorders?
Mood symptoms (depression, anxiety),
psychotic symptoms (hallucinations, paranoia),
personality disorders are common.
Difficult to distinguish primary psychiatric illness vs. substance-induced illness.
Substance-induced symptoms improve with prolonged abstinence, whereas primary mental illness persists.
How can substance use be detected?
Urine Drug Screen (UDS) and Blood Tests can detect various substances.
What are the detection times for common substances in urine?
• Alcohol: Hours (breathalyzer, blood/urine test for metabolite).
• Cocaine: 2–4 days (up to 8 days for heavy users).
• Amphetamines: 1–3 days (varies by test sensitivity).
• PCP: 4–7 days.
• Opioids: 1–3 days (synthetic opioids may not be detected).
• Marijuana:
• 3 days for single use.
• Up to 4 weeks for chronic users (THC stored in fat cells).
• Benzodiazepines:
• Short-acting (Lorazepam): Up to 5 days.
• Long-acting (Diazepam): Up to 30 days.
What are the ‘Stages of Change’ in substance use treatment?
- Precontemplation: Patient does not see substance use as a problem.
- Contemplation: Patient considers cutting down.
- Preparation: Patient plans to change.
- Action: Patient actively reduces or stops use.
- Maintenance: Sustains behavior change and avoids relapse.
- Relapse: Returns to substance use.
What are common treatment options for Substance Use Disorders?
• Behavioral Counseling (CBT, Motivational Interviewing).
• Residential “Rehab” programs (28-day inpatient treatment).
• Intensive Outpatient or Partial Hospitalization programs.
• Community-based programs (e.g., SMART Recovery, AA, NA).
• Medication-assisted treatment (for specific substances).
How does alcohol affect the brain?
Activates GABA, dopamine, and serotonin receptors.
Inhibits glutamate receptors and calcium channels.
Causes CNS depression by increasing inhibitory signals.
What is the prevalence of Alcohol Use Disorder?
5% of women, 12% of men in the U.S. Most common co-ingestant in drug overdoses.
What are the symptoms of alcohol intoxication?
• Mild (BAL 20-50 mg/dL): Fine motor impairment.
• Moderate (BAL 50-150 mg/dL): Ataxia, poor balance, nausea.
• Severe (BAL 150-300 mg/dL): Lethargy, memory impairment, vomiting.
• Potentially fatal (BAL > 400 mg/dL): Coma, respiratory depression.
How is alcohol intoxication treated?
Monitor airway, breathing, circulation. IV Thiamine before glucose. Naloxone if opioid co-ingestion suspected. CT scan for head trauma if needed.
What are the symptoms of alcohol withdrawal?
Begins 6-24 hours after last drink. Mild: Insomnia, tremors, anxiety. Moderate: Seizures, hallucinations. Severe: Delirium Tremens (DTs).
What is Delirium Tremens (DTs)?
Medical emergency with 5% mortality. Symptoms: Hallucinations, agitation, autonomic instability, seizures.
How is Alcohol Withdrawal treated?
Benzodiazepines. Thiamine, folic acid, multivitamins. Monitor electrolytes, hydration, liver function.
What medications help maintain alcohol abstinence?
Naltrexone, Acamprosate, Disulfiram, Topiramate.
What is cocaine and how does it affect the brain?
Cocaine is a stimulant that blocks the reuptake of dopamine, norepinephrine, and serotonin, leading to increased sympathetic nervous system activity.
What are the symptoms of cocaine intoxication?
Euphoria, heightened self-esteem, increased energy, tachycardia or bradycardia, hypertension or hypotension, dilated pupils, psychomotor agitation or retardation.
How is cocaine intoxication managed?
Mild-to-moderate agitation: Benzodiazepines. Severe agitation or psychosis: Antipsychotics. Control hypertension and arrhythmias. Avoid beta-blockers.
What is the treatment for Cocaine Use Disorder?
No FDA-approved medication for cocaine addiction. Behavioral therapy is first-line.
What are the symptoms of cocaine withdrawal?
Post-intoxication depression, malaise, fatigue, hypersomnolence, increased appetite, severe dysphoria.
How do amphetamines affect the brain?
Amphetamines increase the release of dopamine and norepinephrine.
What are the symptoms of amphetamine intoxication?
Euphoria, increased energy, psychomotor agitation, hypertension, tachycardia.
How is amphetamine intoxication managed?
Benzodiazepines for agitation and seizures. Monitor vitals, provide supportive care.
What are the symptoms of amphetamine withdrawal?
Severe depression, anxiety, irritability, fatigue, hypersomnia.
What is PCP and how does it work?
PCP is a dissociative hallucinogen that antagonizes NMDA glutamate receptors.
What are the symptoms of PCP intoxication?
Agitation, depersonalization, violent behavior, hallucinations, paranoia.
How is PCP intoxication managed?
Minimize sensory stimulation. Benzodiazepines for agitation, muscle spasms, seizures.
Does PCP have a withdrawal syndrome?
No withdrawal syndrome, but ‘flashbacks’ can occur.
What are opioids and how do they work?
Opioids stimulate mu, kappa, and delta opioid receptors.
What are the symptoms of opioid intoxication?
Respiratory depression, sedation, slurred speech, nausea, vomiting.
What is the treatment for opioid overdose?
Naloxone, ensure airway, breathing, circulation.
What are the symptoms of opioid withdrawal?
Flu-like symptoms: Body aches, rhinorrhea, lacrimation, fever.
What is the treatment for opioid withdrawal?
Clonidine, Methadone or buprenorphine, NSAIDs for muscle aches.
What are the effects of nicotine?
Stimulates nicotinic receptors in autonomic ganglia. Highly addictive, causes physical dependence.
What are the withdrawal symptoms of nicotine?
Irritability, restlessness, increased appetite, anxiety, insomnia.
What are the treatments for nicotine dependence?
Varenicline, Bupropion, Nicotine Replacement Therapy, Behavioral therapy.
What are the DSM-5 criteria for Gambling Disorder?
Persistent and problematic gambling behavior, evidenced by: 1. Preoccupation with gambling. 2. Needing to gamble with increasing amounts. 3. Repeated unsuccessful attempts to cut down.
What is the treatment for Gambling Disorder?
Cognitive-Behavioral Therapy (CBT), Gamblers Anonymous, Treat comorbid psychiatric disorders.
