Addiction Flashcards
general def. of dependence
patient find the drug so pleasurable and reinforcing that they have difficulty controlling their use of the substrance
what is neurobio explanation
- in nucleaus accumbens and medial forebrain, DA is transmitter
- tied with memory and executive function
what does DA drive
survival benefits - food, sex, nurturing
how do drugs tie into these pathways
- cocaine directly blocks DA reuptake
- other drugs do so via other neurotransmitters
5 things that give a drug addictive potential
- rapid onset of action
- high potency at receptor
- short duration of action
- tolerance
- withdrawal
2 ways tolerance is increased
- # of receptors and sensitivity
2. levels of neurotransmitters
what does rate of tolerance developlment depend on
the effects - for opiods
- pain is slow
- sedation is fast
what happens in withdrawal
receptors that resist the drugs are now unoppsed - get opposite effects
how do genes inflence alc.
for naive drinkers
- fewer adverse effects
- greater tolerance
- more pos. effects
2 psychiatric risk factors
- use releives negative mood states
2. have other mental disorders
4 social risk factors
nothing to do, nothing to lose
- lack of meaningful life
- lack of social support
- cultural attitudes towards
- peer influences
6 clinical features of dep
- drug becomes main focus of time and life
- neglects major responsiblities
- continued use despite consequences
- try to quit but relapse
- tolerance, withdrawal
- cravings
4 Cs
Compulsive use
Cut down (unable)
Cravings
Consequences
steps to a substance use Hx
IPTARRR Initiation Pattern Treatment hx Abstinence Relapse Risk assessment Readiness to change
why is it important to address smoking
- killa
- smoking cessation counselling is one of the most cost-effective interventions available
benefits to quit
- breathe easier in 24hr
- cough better in 2 weeks
- risk of CAD down 50% in one year
- risk of stroke normalizes in 5 years
- risk of dying normalizes in 15 years
4 effects of nicotine
- psychoactive effects - chamelon
- CV effects - incre HR, output, BP
- app suppresion
- incr. metabolic rate
pharma of nicotine
binds to ACH receptor in nuleaus accumbens
why so addictive
- rapid onset
- 200 puffs a day
- easy to self regulate
- very reinforcing - hardest to quit
what is withdrawal timing of nicotine
24hr - beings - irritable, anxiety, depressed mood
5day - severe withdrawal last
months - still have the urge
4 general types of intervention
- init. smoking cessions
- counselling
- pharma
- combo - more effective than either alone
5 As of smoking cessation
- ask - do you smoke
- advise - clear and strong
- assess - within 30 days
- assist - START
- arrange follow up
what is START for assisste
Set a quit date Tell friends/fam Anticipate and plan for challenges Remove all cigs Talk to doc
4 meds
- nicotine replacement
- buproprion
- varenicline
- combo therapy
what is effect of meds
double chance
2 types of NRTs
patch - good in first 2 weeks
gum - good for breakthrough cravings
what is buproprion
atypical antidep - elevates DA levels
- 1-2 weeks to work
what is veranacline
champix
- partial nictotine agonist - give effect and blocks other nictoine
5 effective public health strategies
- incr. cost
- pass clean air leg.
- create effective anti-smoking
- ban tobacco advertising
- provide cessation aids
what is alc. epi
80% men and 60% of women use at some time
30-50% have an adverse effect
15% chance of disorder
what is psych effect of alc
CNS depressent
low dose - anxiolytic, pleasure, disinbi
high dose - sedative/hyponotic
2 main transmitters in alc
GABA - CNS inhibition
glutamate - CNS exitatation
what happens in acute, chronic and withdrawal of alc
acute - GABA dominant
chronic - equal
withdrawal - glut dominante - autonomic arousal
2 Sx with 6-24hrs of withdrawal
- tremor
2. diaphoresis
Sx at 8-254hrs
hallucinations
sx at 24-48 hours
seizures
sx of 72+ hours
DTs - can be high mortality
what are DTs
- tahcy
- tremor
- diaphoresis
- fever
- disorientation
goals of detox
- manage sx of withdrawal
- prevent serious events
- bridge to treatment
main treatment of withdrawal
benzos
5 stages of alc intervention
- ID
- intervention
- detoxification
- rehabilitations
- prevention
what is SBIRT
Screening, Brief Intervention, Referral to Treatment
3 important things to ask about
- all patients
- weekly amount
- maximum in a day over last month
CAGE
Cut down
Annoyed
Guilt
Eye-opener
what is brief screen
in past year how often have you have 5 or 4 drinks in one sitting
what is safe drinking
men - 15/wk and max 3/day
women 10/wk and max 2/day
can have an extra on special occasions
what is FRAMES brief intervention
Feedback Responsibilty is on patient Advice to change Menu of options Empathic style Self-efficacy
3 drugs for alc. and mech
naltrexone - opiod antagonist - don’t get high
acamproate - enhances GABA to releive sub-acute withdrawal
disulfram - ALDH inhib - get toxic buildup and feel bad
what is effect of opiods
act on mu opiod receptors and get sense of peace/happiness
why don’t all pts become addicted
most don’t have the reinforecing effects
3 keys for doctors when prescribing opiods
- select patients carefully
- titrate doses slowly and carefully
- watch for “aberrant behavior”
what is opiod withdrawal
- flu-like sx
- psych sx predominate
how does methadone work
has slow onset and long half-life
- releives sx without sedation or euphoria
what is buprenorphine (suboxone)
- sub-lingual partial agonsit
- binds tigtly and displaces other opiods
- ceiling effect so can’t OD
what is contingency mgmt
- daily dispensing, supervised
- gradual introduction of take home doses as well
- urine screens
compications of THC
- poor social funct.
- depression
- addiction
- MVA
- drug-induced psychosis
who to be concerned about with THC
more than a joint/day
what is THC use in pain
- weak evidence
- contains carconogens
what is cocaine effect
blocks re-uptake of DA
- most reinforceing drug
5 therapies of substance use
MI CBT AA contingency mgmt family therapy
what is MI
- collaborative! and conversational
- use PT strengths
- style is as a guide
- need to also be empathic
3 keys to CBT
- recognize triggers
- avoid high risk situations
- cope with cravings
what is AA programs
12 steps
- alc. is medical and spiritual disease
- abstinence based
- accept loss of control
- need a sponsor
what is contingency mgmt
based on operant conditioning
- reward abstience
- punish drug use
what does contingency mgmt look like
- find target bahev. (eg drugs in urin)
- clear consequences of success and failure
- immediate reinforcement
- incentives and punishments immediate
what is family therapy
rewards and focus on abstinent behavior while retoring family system
what is addiction among physician
lifetime 8-14%
M>F 7:1
more alc, opiods, sedatives
