Addiction

Question 1

Addiction

Answer 1

Persistent and increased use of a substance or behavior that when discontinued causes distress and an urge to resume use despite related adverse consequences (psychological dependence)

Question 2

Dependence

Answer 2

repeated use of a substance for physical needs, leading to increased tolerance, and when discontinued results in physical withdrawal symptoms

Question 3

Abuse

Answer 3

use of any substance that deviates from approved social or medical practice

Question 4

Tolerance

Answer 4

condition in which repeated administration of a dosage causes a decreased effect despite increasingly larger doses

Question 5

Cross-tolerance

Answer 5

process by which one drug can be substituted for another drug, producing the same physiological and psychological effect (Ex: benzodiazepine and phenobarbitol)

Question 6

Neuroadaptation

Answer 6

physiological process caused by a physical change in the body due to repeated exposure to a substance (physical change is more prominent in some people and can lead to increase in relapse)

Question 7

Positive reinforcement

Answer 7

feeling that accompanies drug use; “feel good sensation”
DA mediated in VTA and nucleus accumbens, neuropeptides trigger release → reduces perception of effort needed to use the substance → DA receptor increasingly sensitized and eventually release can occur with visualizing related paraphernalia

Question 8

Negative reinforcement

Answer 8

coming down from high and withdrawal process; “feel bad sensation”
GABA mediated → trigger symptoms of dysphoria and anxiety

Question 9

Substance Use Disorder dx

Answer 9

2 or more of the following within 12 months:
-Increased consumption
-Unsuccessful attempts to quit/cut down
-Significant time spent obtaining/using/recovering
-Cravings
-Failure to fulfill major role obligations
-Social/Interpersonal problems
-Reduced social/occupational/recreational activities
-Use when physically hazardous
-Physical/Psychological problems
-Tolerance
-Withdrawal

Question 10

Withdrawal Syndrome dx

Answer 10

2 or more of the following are present:
-Palpitations
-Sweating
-Sleep disturbance
-Nausea/vomiting/diarrhea
-Hallucinations
-Agitation/restlessness/fidgety/irritable mood/depressed mood
-Anxiety or nervousness
-Seizures
-Shaking
-Fever/chills/cold sweats/piloerection (goosebumps)
-Headache
-Yawning
-Muscle aches

Question 11

Presenting symptoms with stimulant use

Answer 11

agitation, restlessness, irritability, grandiosity, elatedness, euphoria, aggression, and mood lability
(methamphetamine, amphetamines, cocaine)

Question 12

Presenting symptoms with depressant (alcohol/benzodiazepine) use

Answer 12

dysphoria, impaired attention/memory, disinhibition, psychomotor retardation, paranoia

Question 13

Presenting symptoms with hallucinogen use

Answer 13

mood swings, panic, aggression, paranoia, flashbacks, tremors, and impaired cognition

Question 14

Presenting symptoms with cannabis use

Answer 14

paranoia, confusion, and disorientation to time

Question 15

Presenting symptoms with inhalant use

Answer 15

irritability, delirium, confusion, and stupor

Question 16

Care during detox

Answer 16

Reduce stimulation of light and noise, frequently observe pt, check vitals every 4 hours, clear clutter, implement passive safety measures (night lights, fall risk), ensure adequate hydration and electrolyte repletion
Before discharge establish after-care and contingency plan for the first 7-10 days

Question 17

Detox treated inpatient if:

Answer 17

history of: delirium tremens, seizure disorder, pregnancy. Lack of social supports, unreliable clinical information, uncontrolled medical comorbidity