Addiction I and II Flashcards
toxdrome and withdrawal of stimulants (amphetamines, methylphenidate, MDMA, cocaine)
tox: increase HR, BP, hot, diaphoretic, euphoria, mania, pyschomotor agitation, anxiety, psychosis, paranoia
withdrawal: hypersomnolence, depression, suicidality, dysphoria
toxdrome and withdrawal of cannavis
tox: increase HR, red eyes, dry mouth, increase appetite
withdrawal: mood changes, decrease appetite/sleep
toxdrome and withdrawal of opioids
toxidrome: decreased RR, decreased LOC, miosis
withdrawal: mydriasis, wet (N/V, diarrhea, rhinorrhea), increase pain, piloerection, yawning
toxdrome and withdrawal of alcohol
tox: decreased LOC, impiared memory, incoordination
withdrawal: tremor, seizures, insomnia, delirium
Risk Factors for Concurrent Disorders with Addiction
Family problems
Past or ongoing abuse or trauma
Family history of concurrent disorders
Discrimination
Genetic factors or predisposition
Unemployment, poverty, or unstable income
Lack of social network
Stress related to work or school
Adverse childhood experiences.
DSM v CRITERIA FOR SUBSTNACE USE DISORDER
(chew that cop)
C; cut down
H; health
E; excessive use
W; withdrawal
T; time
H; hazardous use
A; activities
T; tolerance
C; craving
O; obligations
P; personal problems
4 C’s of addiction
The 4C’s : compulsions, loss of control, consequences, cravings
how many hours after the last drinke would you get the shakes? alcohol withdrawal seizures? visual/auditory hallucinations? delirium tremens?
Course of Withdrawal occurs 12-48hr after having drinking and can be life-threatening
• Stage 1 (12-18hr after last drink): “the shakes” tremors, sweating, agitation, anorexia, cramp, diarrhea, sleep disturbances (sympathetic overdrive)
• Stage 2 (7-48hr): alcohol withdrawal seizures (tonic-clonic)
• Stage 3 (48hr): visual/auditory/olfactory/tactile hallucinations
• Stage 4 (3-5d): delirium tremens (delirium + diaphoresis, HR, RR, hand tremor, insomnia, psychomotor agitation, anxiety, N/V, visual/auditory/tactile hallucinations, seizures), confusion, agitation, tremors
Outline the SBRIT way of managing alcohol use disorder
• SBRIT: screen, brief intervention, referral to treatment
o Screen with CAGE: 1+ in women and 2+ in men
o Motivational interviewing
o Intervention with FRAMES: feedback, responsibility, advice, menu of option, empathy and self-efficacy
FRAMES intervention
feedback, responsibility, advice, menu of options, empathy, self-efficacy
key lab investigations for alochol use disorder
- Blood ethanol levels, CBC (macrocytosis), LFTs, Vit B12, folate, lytes
- CIWA: these should be done often!
o Physical (5): N/V, tremors, agitation, paroxysmal sweats, headaches
o Psychological/cognitive (2): anxiety, orientation/clouding of sensorium
o Perceptual (3): tactile disturbance, auditory disturbances, visual disturbances
o Max score is 67. Mild<10; moderate 10-20; severe>20
type of CBC findings with AUD
macrocytosis
outline the scoring system for the CIWA scale
CIWA: these should be done often!
o Physical (5): N/V, tremors, agitation, paroxysmal sweats, headaches
o Perceptual (3): tactile disturbance, auditory disturbances, visual disturbances
o Psychological/cognitive (2): anxiety, orientation/c_louding of sensorium_
o Max score is 67. Mild<10; moderate 10-20; severe>20
Key basics for withdrawal management of AUD
Basic: diazepam (if CIWA>10), thiamine, supportive hydration/nutrition, observe and repeat CIWA
Admit to hospital if
§ Still in withdrawal after >80mg of diazepam
§ Delirium tremens, recurrent arrhythmias or multiple seizures
§ Medically ill or unsafe for discharge
treatment for AUD (not withdrawal symptoms– this is long term treatment)
first line: naltrexone and acamprosate
second line: gabapentin and topirameate
third line: disulfiram
psyco: AA, CBT, addiction counselling, SMART recovery
contraindication for naltrexone
cannot have AST or ALT>3 times upper limit of normal
cannot have decompensated cirrhosis or acute hepatitis.
contraindications of acamprosate
cannot have renal failure, pregnant, or breasfeeding.
CAN be used with cirrhosis
key management for tobacco use disorder
Management: nicotine replacement therapy, bupropion/wellbutrin and varenicline
Key screening tool for oioid use disorder
Screening: COWS score to measure inpatient withdrawal
mandatory management for opiate use disorder
MUST OFFER OAT (opiate agonist therapy)
first line: suboxone (naloxone/buprenorphine)–> partial opioid agonist with high affinity, ceiling effect. Naloxone in it is just to prevent injection. can be in tabs
second line: methadone –> FULL mu opioid agonist. Methadone is nearly always daily witnessed ingestion. Typical titration is 10 mg/3 days. Can cause long Qtc. If >550, need immediate acute care cardiology and addiction med consult.
3rd line: Kadian (24 hour formulation of morphine)–> full mu agonist.
4th line: injectable hydromorphone (iOAT)
first, second, third and fourth line therapies for opioid agonist therapies
first line: suboxone (naloxone/buprenorphine)–> partial opioid agonist with high affinity, ceiling effect. Naloxone in it is just to prevent injection. can be in tabs
second line: methadone –> FULL mu opioid agonist. Methadone is nearly always daily witnessed ingestion. Typical titration is 10 mg/3 days. Can cause long Qtc. If >550, need immediate acute care cardiology and addiction med consult.
3rd line: Kadian (24 hour formulation of morphine)–> full mu agonist.
4th line: injectable hydromorphone (iOAT)
aspects of harm reduction for opioid use disorder
• Harm Reduction: naloxone kit, IVDU screening, supervision, safe prescribing of drugs with addictive prone drugs
how should you manage a GHB overdose
benzos
outline sequential, parallel or integrated treatment models for concurrent disorde rs
definition of concurrent disorder
Definition: persistent mental illness + substance use disorder or gambling addiction +/- substance induced disorder
Epi: more of an expectation than an exception (ie very common in substance use disorders); 7.9M have a concurrent disorder. Highest in bipolar, schizophrenia, PTSD, ADHD and eating disorders
4 steps to motivational interviewing
- planning
- evoking commitment/hope/confidence
- identify and focusin a target of chagne
- engaging and settling into a helpful conversation
DBT for Addiction: increase ___, interpersonal __, ___ tolerance, ___ regulation → “replace pills with skills”
DBT for Addiction: increase mindfulness, interpersonal effectiveness, distress tolerance, emotional regulation → “replace pills with skills”
12-Step Facilitation Model: highly accessible + free, modified extensively to cater to differing ____ system, emphasis on ____ addiction as a ___ that can be arrest but never ___, enhancing individual maturity and spiritual growth while minimizing self- centeredness
12-Step Facilitation Model: highly accessible + free, modified extensively to cater to differing belief system, emphasis on accepting addiction as a disease that can be arrest but never eliminated, enhancing individual maturity and spiritual growth while minimizing self- centeredness
outline the acceptance and commitment therapy
Acceptance and Commitment Therapy: combination of acceptance, mindfulness and values- based therapy. Fosters a sense of psychological flexibility and being mindful of inner experience to better engage in a more values-focus life
Ask → what are your values in your new life? Then work towards fulfilling your values.
ex/ someone says creating relationships is a value → every week tailor therapy in such a way that makes them feel like they are cultivating and nurturing connections with other people.
