Addiction Medicine in Practice Flashcards
What is addiction?
A state characterized by an overwhelming desire or need (compulsion) to continue use of a drug, and to obtain it by any means, usually with a tendency to increase the dosage, a psychological and usually a physical dependence on its effects, and a detrimental effect on the individual and on society
Population with substance use disorder and _______ are most likely to be seen in practice
Population with substance use disorder and MENTAL ILLNESS are most likely to be seen in practice
Role of primary provider in substance use disorder prevention
- Primary – Patient education
- Secondary – Screen high risk patients
- Tertiary - Prevention of progression and reduction of morbidity/mortality where Substance Use Disorders exist
Single Alcohol Screening Question (SASQ)
How many times in the past year have you had ….
5 or more drinks in a day? (men)
4 or more drinks in a day ? (women)
DSM-5
CRITERIA FOR SUBSTANCE USE DISORDERS
- USE IN LARGER AMOUNTS / LONGER PERIODS THAN INTENDED
- UNSUCCESSFUL EFFORTS TO CUT DOWN
- EXCESSIVE TIME SPENT TAKING DRUG
- FAILURE TO FULFILL MAJOR OBLIGATIONS
- CONTINUED USE DESPITE KNOWLEDGE OF PROBLEMS
- IMPORTANT ACTIVITIES GIVEN UP
- RECURRENT USE IN PHYSICALLY HAZARDOUS SITUATIONS
- CONTINUED USE DESPITE SOCIAL OR INTERPERSONAL PROBLEMS
- TOLERANCE
- WITHDRAWAL
- CRAVING
- SEVERITY: 0 TO 1 CRITERIA: NO DIAGNOSIS 2 TO 3 CRITERIA: MILD 4 TO 5 CRITERIA: MODERATE 6 OR MORE CRITERIA: SEVERE
Laboratory findings of organ damage or toxicological evidence of use
screen for
liver enzymes, GGT, CDT (carbohydrate deficient transferrin), MCV, triglycerides, Uric acid, EDAC (discriminant analysis)
Managed Care Categories for substance use
Level I - outpatient treatment
Level II - intensive outpatient programs (day/evening treatment, partial hospitalization)
Level III – medically monitored program (freestanding or hospital based)
Level IV – medically managed program (usually hospital based)
ETIOLOGY OF SUBSTANCE ABUSE - PSYCHOLOGICAL
- Higher incidence in patients with bipolar disorder, depression, anxiety disorders. Note ADHD and PTSD patients
- Higher incidence in patients with personality disorders
- No one particular psychiatric problem associated with addiction - there is no “addictive personality”
ETIOLOGY OF SUBSTANCE ABUSE – GENETIC / BIOLOGIC
- Evidence of polygenic inheritance of dopamine receptor, D2 allele
- Differences in ADH or ACDH enzymes
- Differences in dopaminergic, endorphinergic, or serotonergic pathways
Clinical Implications of Co-morbidity Between Alcohol and/or Drug Use Disorders and Other Psychiatric Disorders
Increased severity, disability and impairment in social/occupational functioning.
Poor overall outcome and lower probability of recovery.
Increased suicidality.
Increased economic burden of each co-morbid condition
“Revolving Door” Patients = System Strain + Staff Burnout
Need for specialized, higher intensity care
ETIOLOGY OF SUBSTANCE ABUSE – ENVIRONMENTAL / SOCIOCULTURAL
- Influence of socioeconomic status - bimodal distribution - U shaped curve (seen more in REALLY POOR and REALLY RICH)
- Role of parenting, peer groups, school
- Ethnic value systems may play a role - role models and their use of chemicals
Lifetime prevalence of substance use disorder (males vs. females)
15% in males (20-50)
5% in females
Incidence (point prevalence) of substance use disorder
6-8% in men
2-3% in women
Prevalence of substance use disorder in adolescents
criteria are not as clear, but 20% of males, 12% of females have problematic use before age 18
Most “MATURE OUT” of addiction – (NESARC CLUSTER 1)
Those with serious psychiatric issues may not (NESARC CLUSTER 4)
Prevalence of substance use disorder in elderly
prevalence of use decreases but many are not identified
