777 final SUD Flashcards
Substance Use D/Os:
- Alcohol-Use D/Os
- Caffeine-Use D/Os
- Cannabis-UseD/Os
- Hallucinogen-Use D/Os
- Inhalant-Use D/Os
- Opioid-Use D/Os
- Sedative-, Hypnotic-, and Anxiolytic-Use D/Os
- Stimulant- Use (amphetamine & cocaine use D/O)
- Tobacco –Use D/O.
(Non-Substance-Related D/O (includes one disorder)
Gambling Disorder )
Criteria to Diagnose
At least 2 of 11 criteria:
- Failure to fulfill major role obligations
- Physically hazardous situations of use
- Social and interpersonal problems
- Cravings
- Tolerance
- Withdrawal
- Larger amounts/longer time period
- Desire to cut down/control use
- Great amount of time spent to obtain/use/recover
- Activities given up
- Psycholgoical/physical problems
Alcohol Use Disorder The description and diagnostic criteria
A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period.
- Alcohol is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful effort to cut down or control alcohol use.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Craving, or a strong desire or urge to use alcohol.
- Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
Alcohol Use Disorder The description and diagnostic criteria, part 2
- Recurrent alcohol use in situations in which it is physically hazardous.
- Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
- Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol. - Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol
b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms)
Specifiers with AUD diagnosis
Specify current severity:
- 00 (F10.10) Mild: Presence of 2-3 symptoms
- 90 (F10.20) Moderate: Presence of 4-5 symptoms
- 90 (F10.20) Severe: Presence of 6 or more symptoms
Specify if:
In early remission
In sustained remission
In a controlled environment (rehab etc.)
Alcohol Intoxication
A. Recent ingestion of alcohol. B. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: 1. Slurred speech 2. Incoordination 3. Unsteady gait 4. Nystagmus (rapid eye movements) 5. Impairment in attention or memory 6. Stupor or coma
Alcohol Withdrawal
A. Cessation of (or reduction in) alcohol use that has been heavy & prolonged
B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A:
1. Autonomic hyperactivity (e.g., sweating or pulse rate > 100 bpm).
2. Increased hand tremor.
3. Insomnia.
4. Nausea or vomiting.
5. Transient visual, tactile, or auditory hallucinations or illusions.
6. Psychomotor agitation.
7. Anxiety.
8. Generalized tonic-clonic seizures.
C. Signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if: With perceptual disturbances
CAGE Questionnaire (CAGE)
Most widely used screening test for alcohol abuse & dependence
4 yes/no questions organized by a mnemonic acronym about alcohol consumption patterns and their psychosocial consequences
Takes only a few moments to administer
Yes answers to at least 2 of the 4 questions signify a positive screen and the necessity of a more extended work-up
Psychometric measures are significantly better than are single questions (“how much do you drink?) or lab values (e.g., breathalyzer or liver function tests)
Detects dependence but not risky drinking
Michigan Alcoholism Screening Test (MAST)
25 yes/no items concerning alcohol use Self-administered includes questions about tolerance and withdrawal and can point out longer term problems associated with chronic alcohol abuse no answers are scored as 0, yes answers are weighted from 1 to 5 based on the severity of the queried symptoms Scoring is: 0-4=no alcoholism 5-6=possible alcoholism >6=problable alcoholism.
Drug Abuse Screening Test (DAST)
Self-rated for drug abuse or dependency
28 yes/no questions; includes questions about tolerance and withdrawal so identifies chronic drug use problems
a briefer 20-item version is available and has psychometric properties that are nearly identical to the longer version
a total score of 5 or more is consistent with a probable drug abuse D/O
Fagerstrom Test for Nicotine Dependence (FTND)
High risk for medical problems
Smoking can interact with hepatic enzymes and alter the metabolism of psychotropic drugs
a 6-item, self-rated scale that provides an overview of smoking habits and likelihood of nicotine dependence
no recommended cutoff score but the average score in dependent smokers is 4 to 4.5.
SBIRT: Significant Progress in Screening for SUDs
A tool for integrating care of patients with SUDs into primary care
Facilitating care coordination with addiction services
SBIRT Components
Screen
Brief Intervention ( BI) or Brief Negotiated Intervention (BNI)
Raise subject
Ask permission
Establish rapport
Assess comfort regarding intake and consequences
Provide feedback
Review ATOD
Connect use and negative consequences
Make connection between use and medical visit
Discuss issues related to withdrawal and dependence (as necessary)
Enhance motivation
Assess readiness to change
Boost motivation
Negotiate and advise: Negotiate goal
Referral to treatment – abuse or dependence
Review ATOD use
Make connection with life issues
Make connection to medical visit
SBIRT -Evidence Base
Effective in decreasing excess alcohol intake in Primary Care, Emergency Departments Inpatient settings With adolescents
Therapeutic Communication
Encourage honest expression of feelings
Listen to what the individual is really saying
Express caring for the individual
Hold the individual responsible for behavior
Provide consequences for negative behavior that are fair and consistent
Talk about specific actions that are objectionable
Do not compromise your own values or nursing practice
Communicate the treatment plan to the patient and to others on the treatment team
Monitor your own reactions to the patient
Alcohol Use Disorder Medications
Acamprosate, disulfiram, and naltrexone (po and long aciting (Vivitrol) are the most common medications used to treat alcohol use disorder.
They do not provide a cure for the disorder but are most effective in people who participate in a Medication Assisted Treatment (MAT) program.
Stimulant Use Disoder
Amphetamine, cocaine, MDMA (molly, ecstasy), methamphetamine, nicotine, methylphenidate
How Consumed
injected, smoked, snorted, swallowed
Effects
↑ HR, BP, metabolism, feelings of exhilaration, energy, ↑ mental alertness
Consequences
rapid or irregular heart beat, ↓ appetite, weight loss, heart failure, nervousness, insomnia
Cocaine
CNS stimulant
Produces a sudden burst of mental alertness and energy and feelings of self-confidence, being in control, and sociability
“Cocaine rush” lasts 10 to 20 minutes
High is followed by an intense let-down effect in which the person feels irritable, depressed, and tired, and craves more of the drug
Biologic Responses to Cocaine
Increases the release and blockage of the reuptake of norepinephrine, serotonin, and dopamine
dopamine: euphoria and psychotic symptoms
norepinephrine: tachycardia, hypertension, dilated pupils and rising body temperature
serotonin: sleep disturbances, anorexia
Long-term use: depletion of dopamine
Cocaine Intoxication and Withdrawal
Intoxication
CNS stimulation followed by depression
Increasing doses: restlessness tremors and agitation convulsions CNS depression
Death: respiratory failure
Withdrawal
Norepinephrine depletion > person to sleep 12-18 hours
Then, sleep disturbances with rebound REM, anergia, decreased libido, depression, suicidality, anhedonia, poor concentration and cocaine craving
Other Stimulants
Amphetamines: Block reuptake of norepinephrine and dopamine, not as strong effect on serotonin (as cocaine does) Effect peripheral nervous system Methamphetamine Releases excess dopamine Highly addictive Used in a “binge and crash” pattern MDMA (Ecstasy) Causes hallucinations, confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia
