Addiction IV

Question 1

summarize intoxication vs withdrawal on sedatives and stimulants

Question 2

describe withdrawal from major stimulants

Answer 2

• withdrawal
  
  • dysphoric mood (MUST BE SEEN)
  • fatigue and psychotomor slowing
  • hypersomnia with vivid unpleasant dreams
  • increased appetite

note: overall, these symptoms are non-life threatening and thus considered relatively mild; no FDA-approved drug for stimulant addiction

Question 3

describe ecstasy/MDMA

Answer 3

• stimulant effects PLUS mild hallucinogenic effects (perceptual alterations)
  
  • common things look more interesting
  • empathogenesis
  • concern about neurotoxicity
  • other health consequences (e.g. hyperthermia)
  • reputation as a safe drug despite Schedule I status

Question 4

describe bath salts

Answer 4

• designer drug containing, in part, amphetamine-like chemicals (MDPV)
• acute toxicity includes:
  
  • agitation
  • paranoia
  • hallucinations
  • chest pain, tachycardia, hypertension
  • suicidality

Question 5

describe nicotine (intoxication and withdrawal)

Answer 5

• intoxication: DSM-5 does not recognize a category for nicotine intoxication
• withdrawal
  
  • dysphoric mood
  • restlessness, anxiety
  • difficulties concentrating
  • irritability, anger
  • increased appetite
  • decreased heart rate

Question 6

describe treatment of nicotine use disorder

Answer 6

• nicotine replacement therapies (e.g. gum)
  
  • these contain low amounts of “healthy” nicotine to decrease craving
• buproprion (Zyban) and verenicline (Chantix)
  
  • there is a black box warning on these drugs due to reports of suicidal, erratic behavior for both drugs

Question 7

describe caffeine (intoxication and withdrawal)

Answer 7

• intoxication: typically after a dose of > 250 mg of caffeine
  
  • increased energy, insomnia, nervousness
  • rambling thoughts
  • tachycardia
  • diuresis, GI disturbance, muscle twitches
• withdrawal:
  
  • headache
  • dysphoria
  • fatigue
  • decreased concentration

Question 8

DSM-5 does not recognize a “____-use” as a disorder

Answer 8

DSM-5 does not recognize a “caffeine-use” as a disorder

Question 9

list the classic hallucinogens, cannabis and dissociative anesthetics

Answer 9

Question 10

describe the main perceptual alterations seen with usage of classic hallucinogens, cannabis and dissociative anesthetics

Answer 10

• classic hallucinogens = hallucinations
• cannabis = distortions
• dissociatve anesthetics = depersonalization

Question 11

describe the classic hallucinogens

Answer 11

• LSD is one of the most potent hallucinogens and is long lasting (8-12 hrs)
• key symptoms:
  
  • visual, poorly formed hallucinations (unlike those in schizophrenia)
  • mydriasis (dilation of pupil)
• no withdrawal syndrome is recognized

Question 12

describe hallucination persisting perception disorder

Answer 12

• LSD is associated with “flashback” perceptual experiences long after LSD is metabolized
  
  • example symptoms:
    ​false perceptions of movement
  • intensifications of color

Question 13

describe cannabis intoxication

Answer 13

• psychological
  
  • perceptual distortions (e.g. intensification of senses, perception of slowed time)
• physical
  
  • conjunctival injection
  • increased appetite
  • dry mouth

Question 14

describe cannabis withdrawal

Answer 14

• psychological
  
  • irritability and nervousness
  • dysphoric mood
  • sleep disturbance (insomnia, vivid dreams)
  • decreased appetite
• physical
  
  • headaches, night sweats, stomach cramping, shakiness

Question 15

describe dissociative anesthetics intoxication

Answer 15

• intoxication
  
  • depersonlization
  • agitation, belligerence and confusion
  • impulsivity and unpredictability
  • nystagmus, hyperacusis
  • decreased responsiveness to pain
  • ataxia, muscle rigidity, seizures, coma

Question 16

describe treatment of dissociative anesthetics acute intoxication

Answer 16

PCP intoxication is a psychiatric emergency because of violent and unpredictable behaviors

• treatment of acute intoxication:
  
  • benzodiazepines/antipsychotics
  • reduced environmental stimulation
  • restraint may be needed
• no withdrawal syndrome is recognized

Question 17

summarize the hallucinogens and related substances (perceptions, symptom severity, eyes, behavior)

Answer 17

Question 18

describe opioid intoxication

Answer 18

• intoxication
  
  • initial intense rush followed by:
    
    • euphoria and drowsiness
    • dysphoria (as the high dissipates)
  • miosis
  • unconscious
  • respiratory depression
• treatment of OD
  
  • naloxone (Narcan): a short-acting opioid receptor is not used for addiction treatment

Question 19

describe opioid withdrawal

Answer 19

• withdrawal
  
  • dysphoria
  • nausea, vomiting, diarrhea
  • muscle aches, lacrimation and rhinorrhea
  • piloerection, sweating, fever
  • yawning
  • pupillary dilation
• although withdrawal is usually non-life threatening, opioid use is deadly from OD and from the health hazards associated with opioid addiction

Question 20

describe abstinence-based therapy for opioid treatment

Answer 20

• requires patient to be completely abstinent from opioid drugs
• often involves use of naltrexone (a long-acting opioid receptor blocker) to block opioid effects if relapse occurs
• tends to be unsuccessful

Question 21

describe replacement therapy for opioid treatment

Answer 21

• involves giving patient a safer opioid durg (methadone or buprenorphine)
• tends to be more successful than abstinence-based therapies

Question 22

what is the rationale for replacement therapy in opioid treatment?

Answer 22

• chronic, heavy opioid use results in:
  
  • anhedonia (due to reduced dopamine availability)
  • physical discomfort (due to reduced availability of endogenous opioids)
• these combined effects make abstinence a difficult goal to achieve, therefore replacement therapy helps

Question 23

describe methadone

Answer 23

• methadone (a Schedule II opioid drug)
  
  • when used for addiction treatment, methadone:
    
    • is only available at an official federally-regulated Opioid Treatment Program (OTP)
    • cannot be “prescribed”; it can only be administered or dispensed at an OTP

Question 24

describe buprenorphine (a Schedule III opioid drug)

Answer 24

• buprenorphine
  
  • when used for addiction treatment, buprenorphine:
    
    • is available from a doctor’s office after approval by the DEA
    • can be “prescribed”, “administered” or “dispensed” from a doctor’s office
• note: Suboxone = buprenorphine + naloxone
  
  • released only if medication is abused

Question 25

describe duration and benefits of replacement therapy in opioid treatment

Answer 25

• RT usually continues for at least 1-2 years
• benefits of RT:
  
  • oral administration
  • stable drug levels
  • less euphoria and less drowsiness
• RT (plus other interventions) results in healthier, productive and less crime-causing heroin addicts

Question 26

summarize intoxication vs withdrawal of sedatives, stimulants, hallucinogens & related drugs, and opioids

Answer 26