Addiction Medicine Part 2

Question 1

What is drug addiction

Answer 1

Drug addiction is a disorder of young people, especially males:
•onset is usually between 16-25 y.o. •males are more likely to be addicts (2:1)
•Initial drug use is a conscious decision and attributable to multiple factors (e.g., experimentation, coping strategy, etc.)

But once you’re addicted, its not your fault, its your brain telling you to give it more!

Question 2

Continued drug use is, in part, due to 5 drug induced effects on brain function: what are they?

Answer 2

1) Drugs that stimulate the brain’s reward circuitry, either directly or indirectly, signaling the person to repeat the behavior.
Reward Circuitry
►Dopaminergic pathway
•“mesolimbic” pathway
•ventral tegmental area to the nucleus accumbens

2) Stimulation of the reward pathway affects functioning of the prefrontal cortex, altering self- control.
3) Drug use may cause brain changes that result in physical withdrawal symptoms upon drug cessation. This discomfort may drive relapse.
4) Repeated drug use decreases the availability of DA. This is associated with prolonged feelings of anhedonia, which may trigger relapse (AKA the “protracted abstinence syndrome”).
5) Drug use has been paired with environmental/internal cues; these cues cause physiological changes that trigger drug seeking.

Question 3

What are factors that contribute to addiction risk:

Answer 3

•Genetics: Genes account for 40-60% of the vulnerability to addiction. What is inherited is still unknown (e.g., less dopamine availability).

•Psychosocial Factors (multiple) ▪Age of first use
▪Method of drug administration ▪Presence of other mental illnesses

Question 4

What are Key questions for Alcohol

There are 2 acronyms

Answer 4

CAGE QUESTIONS
▪C: Do you feel the need to CUT back on your
drinking?
▪A: Do you get ANNOYED with others for criticizing your drinking?
▪G: Do you ever feel GUILTY about drinking? ▪E: Do you ever need an EYE opener (morning
drink)?

Yes to more than 2 indicates concern

FOY QUESTIONS
“Has concern about your drinking behavior been expressed by your Family, Others, or Yourself?”

Question 5

What are the acceptable drinking limits for:

Men:

Woman:

What are normal amounts of alcohol?

Answer 5

Men: 4 drinks/day, 14 per week
Woman: 3 drinks/day, 7 per week

Question 6

What is the general description for Drug Rehabilitation

Answer 6

•in-patient setting
•usually ≥90 days (after this time, anhedonia is improved and relapse is less likely)
•recovery continues for a life time •early intervention is important
▪deterrents (e.g., denial, costs, stigma) often delay treatment by many years
▪successful treatment does occur (even if treatment was legally compelled)

Question 7

What does the Acute Phase of treatment focus on?

Answer 7

•detoxification (getting person off drugs) ▪supervised drug tapering
▪pharmacological management of short- term withdrawal symptoms
•treatment of associated medical problems (e.g., skin ulcers)
•treatment of comorbid psychiatric problems (e.g., depression)

Question 8

What happens during the Recovery Phase

Answer 8

Recovery Phase of treatment focuses on
preventing relapse. Challenges:
• difficulty reversing habits (and enduring the protracted abstinence syndrome)
• the “Abstinence Violation Effect” (AVE)
▪ relapse causing shame and further non-sobriety
▪ avoid AVE by:
• preparing addict for relapse
• not viewing relapse as sign of failure
• immediately returning to treatment

Utilizes a multi-modal approach, such as: 
▪ Cognitive-behavioral therapy
▪ Family therapy
▪ Referral to self-help groups
▪ Medication-assisted therapy

Question 9

What are the cognitive and behavioral components of CBT?

Answer 9

Cognitive:
• emphasize importance of abstinence
• learn to identify and correct self-defeating thoughts
leading to relapse
• have action plan ready to implement for high-risk situations

Behavioral: Remove/recondition cues that trigger drug- seeking behavior
• Contingency management programs:
■ Voucher system
■ reports to licensing body/employer after failing to achieve treatment goal
• Aversion therapy (emetic and faradic-shock)

Question 10

What is the idea behind self-help groups?

Answer 10

•not formal treatment but therapeutic
•includes inspirational testimony and moral support from others in recovery
•provides a source of impulse control (via “sponsors”)
•typically uses a “12-step” framework:
■1st step= admitting there is a problem.
■12th step=helping others with their addictions.

•Provides a forum to:
■share experiences (challenges and successes) regarding loved-one’s addiction.
■learn effective ways to cope with loved-one’s addiction. For example:
■avoid enabling behaviors– actions and/or reactions to the addicted person that perpetuate the addictive behavior.

Question 11

What is Medication-Assisted Therapy

Answer 11

Used as adjunctive treatment:
▪ to act as substitute for a more harmful
drug (“replacement” therapy)
▪ to decrease craving or to block the
effect of a drug of abuse
▪ for aversion therapy

Question 12

What is Substance Intoxication

Answer 12

The development of a REVERSIBLE substance-specific syndrome due to recent ingestion of a drug and its effects on the CNS
•Results in significant maladaptive behavioral or psychological changes

Question 13

What is Substance Withdrawal

When do withdrawal symptoms usually appear?

KEY

Answer 13

The development of a substance-specific syndrome following CESSATION of a substance after heavy/ prolonged use

Within 72 hours

Withdrawal symptoms tend to be opposite of intoxication.

Question 14

What is Substance Use Disorder

Answer 14

•A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues to use a substance despite significant substance-related problems.

Question 15

What is the definition of substance use disorder and what are the 11 symptoms (2 or more of which you should have) in order to be diagnosed within a 12 month period?

Answer 15

A maladaptive pattern of substance use as manifested by >2 of 11 symptoms in a 12- month period:

Impaired Control

(1) Taken in a larger amount than intended*
(2) Persistent unsuccessful attempts to cut back*
(3) Time consuming (obtaining, using, recovering) (4) Cravings or strong desire for the substance*

Social Impairment

(5) Failure to fulfill major role obligations (e.g., work)
(6) Social/interpersonal problems related to drug (7) Reduction of important activities*

Risky Use

(8) Use in physically hazardous situations
(9) Use despite having physical/psychological problem related to substance*

Pharmacological Criteria (“physical dependence”) (10) Tolerance (↓ effect of a dose due to repeated

use) *
(11) Withdrawal syndrome upon cessation*

Question 16

What is the difference between Drug Dependence and

Drug Abuse

Answer 16

Dependence: A pattern of drug use involving compulsive drug-seeking behavior

Abuse: A pattern of drug use with recurrent adverse consequences (e.g., role failures, use in risky situations, run-ins with law)