Addiction III Flashcards
1
Q
describe substance intoxication
A
- the development of a reversible substance-specific syndrome due to recent ingestion of a drug
- the syndrome is due to drug effects on the CNS and causes significant maladaptive behavioral or psychological changes
2
Q
describe DSM-5 criteria for alcohol intoxication
A
- a significant maladaptive psychological/behavioral change (e.g. impaired judgement) PLUS ≥ 1 of the following:
- slurred speech
- incoordination
- unsteady gait
- nystagmus
- impaired attention or memory
- stupor or coma
3
Q
describe substance withdrawal
A
- the development of a substance-specific syndrome following cessation of a substance after heavy/prolonged substance use
- the syndrome causes significant distress or impairment in functioning
4
Q
describe acute withdrawal effects
A
- withdrawal symptoms tend to be opposite of intoxication
- symptoms usually appear within 72 hours after reduction of drug use and may last several weeks
- when the drug history of a patient is unknown, withdrawal effects can be mistaken for a medication side effect or undiagnosed medical complication
5
Q
describe diagnostic criteria for substance use disorder
A
- a maladaptive pattern of substance use as manifested by ≥ 2 of the following 11 symptoms in a 12 month period:
-
impaired control
- taken in larger amount that intended
- persistent unsuccessful attempts to cut back
- time consuming (obtaining, using, recovering)
- cravings or strong desire for the substance
-
social impairment
- failure to fulfill major role obligations (e.g. work)
- social/interpersonal problems related to drug
- reduction or important activities
-
risky use
- use in physically hazardous situations
- use despite having physical/psychological probem related to substance
-
pharamacological criteria (physical dependence)
- tolerance
- withdrawal upon cessation
- if tolerance and withdrawal are the only 2 symptoms after appropriate use of prescribed drug, then SUD not diagnosed
-
impaired control
6
Q
describe controlled (scheduled) substances
A
- controlled drugs are placed in one of 5 distinct categories (schedules) by the DEA based on its medical usefulness and its “harm risk”
- potential for abuse
- likelihood of causing addiction
- I = most harmful, V = least harmful
- doctor cannot prescribe drugs in Schedule I
7
Q
describe schedule I and schedule II drugs
A
- Schedule I: drugs with a high harm risk and NO safe, accepted medical use
- examples: heroin, marijuana, LSD, ecstasy
- Schedule II: drugs with a high harm risk but with safe and accepted medical use; these drugs are highly addictive
- examples: most opioids (morphine) and stimulants (methylphenidate) and some barbituates
8
Q
describe schedule III, IV and V drugs
A
- schedule III, IV, V: drugs with harm risk less than schedule II drugs with safe and accepted medical uses in the US
- examples:
- schedule III: several barbituates, anabolic steroids, codeine (Tylenol III), dronabinol (synthetic marijuana)
- Schedule IV: most benzos (diazepam)
- Schedule V: liquid codeine preparations (Robitussin)
9
Q
give examples of sedatives (CNS depressants)
A
- alcohol
- benzodiazepines (e.g. diazepam, lorazepam)
- barbituates (e.g. phenobarbital, secobarbital)
- barbituates have a low safety margin and high abuse potential
10
Q
describe symptoms of sedative intoxication
A
suppression of function
- intoxication
- sedation, sleepiness, decreased anxiety
- disinhibition, impaired judgement
- slurred speech, incoordination
- stupor or coma
- respiratory depression
- OD is potentially lethal
11
Q
describe other potential affects of sedatives
A
- anticonvulsant and anesthetic effects
- disrupted sleep architecture resulting in unrefreshing sleep
- alcohol-related brain damage (ARBD) (e.g. Korsakoff’s amnesia)
- cross tolerance to other sedatives
12
Q
describe withdrawal from sedatives
A
- withdrawal
- agitation, insomnia, anxiety
- ANS hyperactivity
- nausea or vomiting
- hand tremor
- transient hallucinations
- seizures
- the ANS hyperactivity can be fatal
13
Q
describe hallucinations from sedative withdrawal
A
- hallucinations
- can occur in any sensory modality, including tactile:
- formication: sensation of bugs crawling under the skin
- can occur as the main symptoms of withdrawal without physical symptoms (alcohol hallucinosis)
- can occur in any sensory modality, including tactile:
14
Q
describe delirium tremens (DTs) as seen in sedative withdrawal
A
- a delirium (a confusional state) may also occurs as part of sedative withdrawal:
- severe and uncommon
- seen after chronic heavy use of a sedative (esp. alcohol)
- associated with high mortality rate
15
Q
describe disulfiram (pharmacological treatments for alcohol withdrawal)
A
-
disulfiram (antabuse) inhibits the enzyme that breaks down acetaldehyde
- after alcohol use, acetaldehyde accumulation causes a toxic reaction (e.g. nausea) for 30-60 min
- USE: due to poor compliace, disulfiram is given only short-term if person will be in a high risk situation; knowing about toxic effect is disincentive to take first drink
