Addiction Medicine

Question 1

unhealthy substance use in what two levels

Answer 1

pre-disease and disease

need to intervene at pre-disease

Question 2

addiction is like other chronic diseases?

Answer 2

yes

Question 3

initial substance use is chronic?

Answer 3

NO – THIS IS A CHOICE

Question 4

what is one of the most addictive drugs?

percentages?

Answer 4

nicotine
76% have tried

20% have addiction in entire population

Question 5

do all users become addicted?

what contributes?

Answer 5

heavy use and early use will increase addiction

about 25% of users become addicted

Question 6

alcohol risky behavior

defined in men or woman?

Answer 6

men – 5 or more drinks in a day / over 14 in a week

woman – 4 or more a day or greater than 7 drinks in a week (includes men over 65 years of age)

Question 7

1 drink is?

Answer 7

12 oz beer
5 oz wine
1.5 oz liquor

Question 8

breakdown / criteria for substance use disorder

number for each category?

Answer 8

mild 2-4
moderate 4-5
severe 6 or more

so only need two of these to be diagnosed with moderate

Question 9

drugs of abuse do what to the brain?

Answer 9

CHANGE THE BRAIN

• can see where in the brain they act and it is on the REWARD PATHWAY

Question 10

reward pathway

Answer 10

dopaminergic system
This is a necessary pathway for our lives
- endorphines turn it on

Question 11

what are two physiological adaptions to chronic opoid exposure

Answer 11

tolerance

physical dependence

Question 12

tolerance

Answer 12

increased dosage needed to produce specific effect

- develops readily for CNS and respiratory depression

Question 13

stimulants effect on dental? systemics?

Answer 13

teeth ground down, cracked, or loosened due to clenching or grinding; dry mouth; acids eat away at prtoective enamel
sores inside the mouth

systemics – chest pain/ myocardial infarction, kidney injury, stroke

Question 14

stimulants effect on dental? systemics?

Answer 14

teeth ground down, cracked, or loosened due to clenching or grinding; dry mouth; acids eat away at prtoective enamel
sores inside the mouth

systemics – chest pain/ myocardial infarction, kidney injury, stroke

Question 15

nicotine impact on dental

Answer 15

associated with increased pocket depth, loss of periodontal attachment, alveolar bone, and higher rate of tooth loss

Question 16

dental procedures jsutifying prohpylaxis?

Answer 16

Manipulation of gingival tissues or periapical regions of teeth (cleaning, extractions, suture removal, biopsies, placement of orthodontic bands)

Question 17

assessing treatment effectiveness in hypertension tx vs addiction tx?

Answer 17

hypertension – it works

addiction – it works IF THEY STAY ON THE TX

Question 18

about how long tx for addiction for them to overcome?

Answer 18

about 85%

Question 19

Buprenorphine is?

Answer 19

an FDA approved medicine to fight opoids

this is a partial agonist

Question 20

FDA approved medicine for cocaine and methamphetamine?

Answer 20

currently there are no FDA approved

Question 21

for tx of opoid can you prescribe methadone?

Answer 21

no – only in a clininc

Question 22

goals for using medications for opiod use disroders?

Answer 22

1. alleviate physical withdrawal
2. opoid blockade
3. alleviate drug craving
4. normalized neurochemistry

Question 23

buprenorphine is what type of treatment?

Answer 23

life sustaining

- proven in study

Question 24

describe altered pain experience in users?

Answer 24

1. patients with active opoid disorder have less pain tolerance than peers
2. history of use have less pain tolerance
3. patients on medication for opoid use disorders have less pain tolerance

Question 25

3 components of buprenorphine in treating acute pain

Answer 25

1. continue buprenorphine and titrate short-acting opoid analgesic
2. divide buprenorphine to every 6-8 hours
3. use supplemental doses of buprenorphine

Question 26

methadone maintenance tx for treating acute pain?

Answer 26

1. continue as verified
2. treat pain aggressively with conventiional analgesics, including opoids at higher (1.5 times) doses and shorter intervals
3. avoid using mixed antagonist / antagonists opoids
   as they can precipitate acute withdrawl

Question 27

Identifying and Addressing unhelahty substance us

‘SBIRT’

Answer 27

S- screening
BI - Brief intervention
RF- referral to treatment

Question 28

primary goal of SBIRT

Answer 28

identify and effectively intervene with those who are ata moderate or high risk for healthcare or physiosocial problems related to their substance use

Question 29

screening

Answer 29

questions to identify patietns with unhelahty substance use

usually only 2-3 questions to help identify patients who may have unhelathy substance use

Question 30

single item question charactersitics

drug and alchol example?

Answer 30

makes it easy and comfortable to answer

do you sometimes drink -yes/no
no - why
yes - how often

drugs - how many times in the last year

Question 31

what determines a positive screening test?

Answer 31

positive when the answer to either question of these is 1 or more

so naything beyond 0

Question 32

if screening is positive?

Answer 32

continue on to the brief intervention

Question 33

Brief Intervention

Answer 33

conversation to motivate patients who screen positive to consider healtheir decisions - like cutting back, quitting, or seeking further assessment

1. is non-confrontational
2. is non-judgemetnal
3. is directive
4. enhances morivation to change use behaviors

Question 34

feedback

component of what in SBIRT?

Answer 34

part of brief intervention

provide personalized feedback based on screening results and state your concern

1. ask permission to give information
2. discuss screening findings
3. link unhealthy substance use to any known or potential risks/consequences
4. ask for patient reaction

Question 35

Advice?

component of what in SBIRT?

Answer 35

In brief intervention

make a non-judgemental yet, explicit recommendation for change in behavior

next step after feedback - provide advice based on the feedback you just gave

Question 36

breakdown of brief intervention into components

Answer 36

1. FEEDBACK - ask if it okay to discuss results
2. ADVICE - non-jusdmental but explicit
3. NEGOTIATING A GOAL - discuss patient’s reaction and discuss plan for behavior change

Question 37

Negotiating a goal?

component of what in SBIRT?

Answer 37

Brief intervention
discuss rxn of patient reaction and discuss plan

negotiate a plan and ASSESS READINESS AND CONFIDENCE to change unhealthy use

Question 38

how to use readiness and cofidence ruler to change behavior

Answer 38

use a scale of 0-10 and extrapolate questions like why did you choose this number… why did you not choose this number/ lower or higher?

Question 39

Referral to treatment

Answer 39

ACTIVELY link patients to resources as needed

A referral to treatment happens only if you feel that the patient has a substance use disorder or expresses that he/she would o like further assistance. Remember, only about 7% of patients have a substance use disorder.

Question 40

BESST project?

Answer 40

grant to train students on the SBIRT
screen
Brief intervention
Referral tx

Question 41

if patient present with a history of opoid use disorder and maintains a buprenorphine prescription

if patient needs/ requires opoid analgesic how will you manage acute pain and their buprenorphine?

Answer 41

continue the buprenorphine and prescribe opiod analgesisc