Addiction Flashcards
Lifetime alcohol abuse incidence
17.8%
Lifetime alcohol dependence incidence
12.5%
Lifetime drug abuse incidence
7.7%
Lifetime drug dependence incidence
2.6%
Addiction in practice
1/5 patients will have non-tobacco substance use
Inpatient medical services: 23% current smokers, 14% alcohol misuse, 12% drug misuse
Preventable causes of death in 2000
1: tobacco (435K)
3: alcohol (85K)
9: illicit drugs (17k)
Response-reversal learning
behavior initially rewarded, then change to stimulus-punishment
Primarily OFC involvement
Deficient in SUD patients
AUDIT assessment for SUD
score >= 8 –> further eval
At risk drinking
men => 5 standard drinks in a day, or > 14 per week
women >= 4 drinks in a day or > 7 per week
Diagnostic criteria for SUD
role failures, hazardous use, interpersonal problems, craving, tolerance, withdrawal, more than intended, cut down, time spent, activities limited, use despite consequences
Mild SUD
2-3 criteria
Moderate SUD
4-5 criteria
Severe SUC
6+ criteria
SBIRT
Screening, Brief Intervention (for at risk drinking), Referral to Treatment (for SUD)
Antabuse side effects
metallic taste, headaches, drowsiness or fatigue, optic neuritis, peripheral neuropathy, hepatitis, rash
Antabuse contraindications
risk for MI, CVA cognitive dysfunction (can't understand or remember what will happen when you drink)
Naltrexone mechanism
pure mu opioid antagonist –> decreased DA release in nucleus accumbens, decreased drinking, blocked euphoria from alcohol
Naltrexone administration
qmonth depot shot, QD 50mg PO
Naltrexone side effects/complications
nausea, headaches, anxiety, sedation, hepatic failure (rare)
Naltrexone DDIs
decreased benefit from opioid analgesics, decreased benefit from some antidiarrheal, decreased benefit from opioid-containing cough meds
Acamprosate (Campral) mechanism
structurally resembles GABA –> enhanced GABA transmission, blocked glu tansmission –> reduced CNS hyperexcitability
Acamprosate contraindications
hypersensitivity to acamprosate, severe renal impairment (CrCl less than 30 ml/min)
Acamprosate side effects
diarrhea, anxiety, depression, insomnia, suicidality
Treatment of ETOH addiction
Antabuse, Naltrexone, Acamprosate
Treatment of Opioid addiction
methadone, buprenorphine, naltrexone
mechanism of methadone
long-acting mu agonist –> reduced use, reduced harm, increased quality of life
mechanism of buprenorphine
partial mu agonist
buprenorphine side effects
can precipitate withdrawal
Treatment for nicotine dependence
bupropion, nicotine replacement, varenicline
Bupropion effects
doubles quit rates, better outcomes in combo with psychosocial tx
Bupropion contraindications
hx seizure d/o, MAOi use, eating disorder
Bupropion side effects
insomnia and agitation
Nicotine gum side effects
TMJ, hiccups, dyspepsia
Nicotine gum contraindications
1 month post MI, serious arrythmias, gastric ulcers
Nicotine patch side effects
skin irritation, sleep problems if worn at night
Nicotine nasal spray side effects
nose/eye irritation and cough
Varenicline mechanism
partial a4B2 nicotinic acetylcholine receptor agonist
