Addiction Med-Zalon Flashcards
1
Q
(blank) babies are born yearly after in-utero substance exposure
A
300,000
2
Q
Approximately (blank) children are in foster care
About (blank) of these placements are due to substance abuse
A
500,000
¾
3
Q
What are the co-morbidites with substance abuse?
A
Depression
Anxiety (esp. PTSD)
Personality disorder (esp. borderline personality disorder – BPD)
Bipolar disorder
4
Q
SUbstance abuse is often a form of (Blank) and (Blank) behavior
A
escape and avoidance behavior
5
Q
25-60% of clients with (bank) also have SUD
A
BPD
6
Q
Severity and treatment outcomes of SUD are worse in (blank) conditions
A
co-occuring
7
Q
THe lifetime prevalence of BPD in general US populations is (blank), where in netherlands it is (blank)
Why?
A
6%
1%
THey spend more on healthcare so people are able to get more help
8
Q
What is the lifetime prevalence rate of alcohol use disorder?
A
30%
9
Q
Point prevalence of “high risk” drinking is about (Blank)%.
Prevalence is higher in what group?
A
30%
younger age groups
10
Q
What are medical complications associated with Alcohol?
A
- Neurological – dementia, psychosis, seizure, depression
- Liver, CV, pancreas
- suicide
- MVAs and other traumas
11
Q
(blank) use correlates to violence (both perpetrator and victim), more so than other drugs
A
alcohol
12
Q
Patients that substance abuse disorders have increased (blank) and (Blank) from all medical conditions. Why?
A
morbidity and mortality
-they are harder to provide care for because of their medical complication and relationship problems (medicine is dependent upon good social support)
13
Q
What is the number one prescribed drug in the US?
What is the number 2 drug?
A
Vicodin
131. 2 million prescriptions in 2010, 99% of worlds supply
- simvastatin (94 million)
14
Q
The annual prevalence of nonmedical non-heroin narcotic use among 12th graders increased from 3.5% in 1991 to (blank)% in 2007
A
9.2%
15
Q
What age group uses nonmedical prescription opiods the most….college, 12th grade, or young adults?
A
12th grade
16
Q
Over the years, ED visits from narcotic use as (decreased/increased)
What types of narcotic analgesics have caused the most ED visits?
A
increased
-hydrocodone (and hydrocodone combo), oxycodone (and oxycodone combos)
17
Q
Recently, teens perceive prescription drugs as easier to (blank) than beer
A
buy
18
Q
What is diversion?
A
use a prescription for something else rather than intended purpose (i.e takin someones vicodin for fun)
19
Q
What are some iatrogenic causes of SUD (physician caused)?
A
- misunderstanding nature of addiction,
- notion that addiction is characterized by physical dependence or tolerance
- “addiction is vague term”
- DSM5 only describes SUD and grades the severity on a spectrum
20
Q
T or F
Enough painkillers were prescribed in 2010 to medicate every American adult round the clock for a month
A
T
21
Q
(blank) often correlates to physical signs of dependence and tolerance. However can also be suspected based on behavioral signs of (blank)
A
Addiction
compulsive use
22
Q
What are signs of compulsive use?
A
use despite harmful consequences, use that is escalating, pervasive urges to use, high risk behaviors, failed attempts to stop or reduce use.
23
Q
What did the DSM5 eliminate about the description of SUD? What did they combine?
A
the difference b/w abuse and dependence
-combined those features into a single spectrum oriented disorder with severity grading
24
Q
What is the DSM5 criteria for SUD?
A
Taken in larger amounts than intended. Failed attempts to control or stop. Excessive time given to use or recovery. Strong urges to use. Functional impairment. Ignoring harmful consequences. High risk behaviors. Withdrawal or efforts to avoid withdrawal. Tolerance: escalating use/ diminishing effects
25
SInce the DSM5 combined the criteria for substance abuse and substance dependence, they made a severity spectrum to show difference between dependency,,,, what is considered mild, moderate and severe?
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6 or more symptoms
26
How do you screen for SUD?
CAGE questions (developed for alcohol, has also been used for other substances)
- Cut down?
- Annoyed?
- Guilty?
- Eye-opener? (i.e having withdrawal symptoms and need substance to counteract symptoms)
27
What is this:
the proportion of cases that return true positives
What is this:
the proportion of non-cases that return true negatives
sensitivity
specificity
***ideally you want max sensitivity and max specificity
28
If you make diagnostic criteria less stringent, you catch more in your net but will runs the risk of (misdiagnosis resulting in (blank). What would you summarize this as?
false positives
| In crease in sensitivity but decrease in specificity
29
If you make diagnostic criteria more stringent, you will "let some get away" but those you "catch" will me more likely to be correctly diagnosd. This is a decrease in (blank) with an increase in (blank)
sensitivity
| specificity
30
(blank) tests usualy designed for high sensitivity
screening
31
(blank) tests usually designed for high specificity
confirmatory
32
What is a PPV?
| What is NPV?
- proportion of test positives that are true positives.
| - proportion of test negatives that are true negatives.
33
The higher your cage score the higher the (blank)
PPV
| CAGE score of 1=0.54, 2=0.75, 3=0.87, 4=0.92
34
T or F
SUD is a highly heritable phenotype
How so?
T
| 1st degree relatives of those with SUD may have as much as 8x risk.
35
SUD is a behavioral illness that has a phenotype that correlates to both (Blank and blank) variables
heritiable and acquired variables
36
SUD is highly co-morbid with other (blank).
(blank) triggers are still very clinically relavent
THUS we must view SUD as both a (blank) and (blank) condition
psych dx
enviromental
congenital and acquired
37
What is the clinical presentation of addicition as an illness?
- chronic
- multifactorial
- relapsing/remitting
- blurs the line between biological and psychological
38
Is an addiction a choice?
| Is treatment a choice?
no
| yes
39
T or F
| Motivation as a clinical sign has nothing to do with notions of “will power.”
T
40
(blank) is defined as a history of bein reinforced for a behavior
Motivation
41
(blank) is relative to context (environment) and must be measured on a continuous spectrum
motivation
42
Why is change slow?
because motivation is context dependent and emotional decisions are made quicker than logical ones.
43
T or F
Behavioral health treatments are lengthy treatments that must pass through specific stages of treatment (attachment, pattern search, working through and termination).
The type of treatment delivered is less important than the expertise of the health care provider.
SUPER FALSE!
44
Tell me about MI and the alcoholics?
there was a one time 30 minute MI intervention with alcoholics... never saw patietns again. 12 months later there was huge reduction in drinking as compared to control group
45
(blank) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population.
Dialectical Behavior Therapy (DBT)
46
What did the DBT trial show?
it hella reduced suicide
47
Validation will often (blank) the frequency of a behavior
decrease
48
What is (often) the most effective way to end an argument (if that’s your goal)?
say "I agree"
49
Science has now established that one of the most effective ways to decrease behaviors you want less of, especially hostile behaviors, is (blank)
validation.
50
T or F
| Validation DOES NOT mean approving or rewarding someone for their hostile behaviors.
T
| You can say "I see your point"
51
Rewards that occur quickly are more rewarding. T or F?
T-> rewards that you have to wait for are less rewarding
52
Rewards that you have to work hard for are less rewarding. T or F?
T
| -rewards that you dont have to work hard for are more rewarding
53
So how should you reward someone?
quick and easy
54
What is a negative reward?
| give an example
a reward that results from RELIEF OF SOMETHING (usually painful or unpleasant)
-When you pester someone to take out the trash, and then stop pestering when the task is done, you’ve provided a negative reward.
55
Many addictive behaviors (and clinically relevant behaviors in general) get reinforced through (blank)
negative reward.
56
Most drugs of abuse provide quick and easy access to rewards through relief of (blank)
pain or unpleasantness
57
In regards to addiction, Access to drugs is relatively much (blank) than effective medical care and psychiatric treatment or therapy.
easier
58
T or F
| Medical care/therapy takes much more time than drug effects.
T
59
What are the unpleasantnesses that people try to escape through drugs?
```
Other psychiatric illness, often co-morbid.
-Family history.
-Trauma / abuse / marginalization.
-Emotional vulnerability.
-Untreated or under-treated.
After effects of drug.
-Physical.
-Social.
-Economic.
```
60
What is emotional vulnerability?
have more emotional intensity and lasts much longer than normal people
61
Can emotional vulnerabilty be increased and is it heritable?
yes and yes
62
Is an increase in emotional vulnerability painful?
super painful, nobody wants this
63
Negative reward schedules also teach (Blank), so those with addiction (and other diagnoses) tend to avoid more effective tx as a result
Avoidance
64
Social mediators tend to reinforce (blank) or punish (blank)
avoidance
| open-ness
65
(blank) is more negatively rewarded, because the consequences of not using are much more severe. When the unpleasant consequence is more severe, the sense of relief and the negative reward is stronger.
And, the punishment of abstinence is much more severe.
And the rewards of treatment are much weaker.
What is the result of this?
Drug seeking / use
-Use is rewarded more and more and more.
Treatment and abstinence are punished more and more and more and more.
66
What results in increased dopamine?
alcohol, cocaine, opiates, THC
67
What do amphetamines do?
potent releasers and reuptake inhibitiors of mono-amines
| -may also function as MAOIs
68
(blank) may enhance prosocial behaviors through oxytocin pathways-rewarding for teens especially
ecstacy
69
What are good doctor skills?
- maintain your emotions at an even level
- radically accept the other persons emotions
- Be assertive and compassionate
- Exude self respect don’t waste time and energy trying to be someone else
- Self respect does not equal knowing all the answers
- Avoid power struggles-practice your ignoring skills “just because someone else is interested in something doesn’t mean you have to be”
70
How do you help an addict?
push with one hand and support with the other
71
How do you support and push a patient?
remember they are doing their best and give them motivation for doing well
72
What is the comprehensive tx for addiction?
multi-modal
- dual diagnosis programs
- tx hierarchies
- acceptance and change (you didnt cause your problems AND you have to solve them anyway)
- skills generalization
- support for doctor/therapist
73
What do doctors need to know about therapy?
- therapy interfereing behavior (caused by pnt) is part of the illness
- this will make you angry
- recovery is slow and painful for both doctor and pnt
- team tx is essential (dont go it alone)
- morbidity and mortality is high
- no one chooses this life
- These are the "cancers" of psych med
74
What is therapy interfering behavior?
Any behavior that gets in the way of effective treatment, or doesn’t actively support effective treatment.
75
What are some examples of therapy interfering behavior?
arguing, forgetting, angering, bullying, minimizing, discounting, ignoring, bargaining, thinking, talking, drinking, planning, shaming, guilting, insulting, challenging, attacking, negating, excusing, inattending, invalidating, blaming, yes-butting, side-tracking, self harming, etc…
76
What happens typically when a patient utilizes therapy interfering behaviors?
-pnt will emit TIB and then doctor will emit a TIB and it will result in even more TIB
77
What do addicitive illnesses tend to do to people surrounded by it?
tend to “draw in” those around the identified patient, and “trap” them in the illness
*****Often, those around the using person (including the doctor) may be as miserable, or more miserable, than the drug user.
78
What are potential doctor TIBs?
Ordering, directing, commanding, warning, cautioning, threatening, advising, suggesting, logic-ing, arguing, lecturing, telling, moralizing, disagreeing, judging, criticizing, blaming, shaming, ridiculing, labeling, interpreting, analyzing, withdrawing, distracting, side-tracking, bargaining, thinking, talking, drinking, planning, yes-butting, forgetting, invalidating, minimizing, self –harming, etc.
79
Why is addiciton like cancer?
| What does this mean for tx?
these illnesses take over a person’s entire life, and often the lives of those around them.
-tx needs to be equally pervasive and acceptance is a large part of tx
80
T or F
| No one intervention is going to be curative and recovery is slow and painful when it comes to addiction
T
81
T or F
| as a part of the illness, motivation waxes and wanes (for both patient and doctor)
T
82
Doctors have a duty to learn how to amplify (blank)
motivation (in themselves and others)
83
Doctors have a duty to not give up, or if they cant avoid giving up what should they do?
refer the patient to someone who hasnt given up
84
Lack of motivation is part of the (blank), Is not a reason to stop tx. Is a reason to do what?
illness
| increase interventions in the tx (yes, science can do this)
85
Is lack of motivation normal and expected in both patient and doctor when it comes to addiction tx?
YES
86
Drug addiction, perhaps more than any other DSM dx (except BPD) is a (blank) illness.
It is a family illness.
It is a community illness.
social, interpersonal
87
(blank and blank) support groups can benefit those suffering from the illness, even if they are not actively using.
Friends and family
| DBT friends and family, Al-anon etc.
88
(blank) is not about being a "push over" being "permissive" or " allowing people to do whatever they want"
What is it about?
clinical compassion
-undestanding how people got to the point that they are at, understanding that their current behaviors are real time efforts or coping skills to solve their problems, and why they want to do it.
89
WHy should you show clinical compassion?
pnts will trust and respect you more, they will provide you with more info, you can be more strategic
