Alabsi- Alcohol and Substance Abuse Disorders

Question 1

True or false.
Drug abuse and mental disorders often co-exist.
Drug abuse may trigger/exacerbate mental disorders.

Answer 1

Both are TRUE!

Question 2

What are relevant statistics associated with substance abuse and mental illness?

Answer 2

High prevalence of substance use and abuse among pts w/ mental illness.

Many of these pts don’t receive treatment.

Question 3

What drug sx are similar to sx seen in mental illnesses?

Answer 3

Cocaine and meth> schizophrenia, paranoia, ahedonia, OCD
Stimulants > anxiety, panic attacks, mania, sleep disorders
LSD, Ecstasy, psychedelics > delusions/hallucinations
EtOH, sedatives, sleepaids, narcotics > depression and mood disturbances
PCP and Ketamine > antisocial behaviour

Question 4

What is the rationale for self-administration?

Answer 4

The mechanism of action for many drugs of abuse are similar to drugs used as psychotherapeutic agents.

This works for DA in the 5HT pathways.

Question 5

Why are chronic drug users more susceptible to mental illness?

Answer 5

Alterations in the brain related to drug use also effect mental illness.

Question 6

How do withdrawal symptoms resemble symptoms of psychiatric disorders?

Answer 6

Acute intoxication- mood sx
Withdrawal- anxiety and mood sx
Chronic use- delirium, cognitive changes

Question 7

How is adolescent SA linked to psychiatric disorders?

Answer 7

SUDs increase risk of development of psychiatric disorders

*Some psychiatric disorders can increase risk for development of SUDs

Question 8

What is the most important assessment tool for psychiatric disorders?

Answer 8

Thorough review of history, trigger of problems, benefits of behavior.

*Individuals w/ PD should be screened for SUD and vice versa.

Question 9

How do you diagnose PD in a pt who also has SUD?

Answer 9

• sx begin before onset of SUD
• sx persist during sustained periods of abstinence
• SA sx abate quickly
• Family hx positive

Question 10

How do you treat psychiatric disorders?

Answer 10

If possible delay treatment 1-4 weeks to allow for identification of transient substance-induced sx

Question 11

How do you treat comorbidity (SUD and PD)?

Answer 11

Treat PD and SUD at same time.
Use med w/ least abuse potential.
Maximize non-pharmacological tx.

Question 12

What is the role of psychotherapy in addressing SUDs and other PDs?

Answer 12

enhance self efficacy
decrease helplessness/dependency
Enhance coping strategies

Question 13

How is the tx of depression linked to SA?

Answer 13

Effective tx of depression is linked to decreased substance use

Question 14

How are SUDs and BPD linked?

Answer 14

1. Impulsivity, irritability
2. Neurochemical, kindling, neuronal loss
3. Responsivity to meds (anti-convulsant agents)

Question 15

How do you treat BPD and SUDs?

Answer 15

Li
Valproate
Carbamezpine
Psychotherapy- CBT is effective in both disorder (greater ASI > greater psychotherapy use)

Question 16

How are SUD and schizophrenia related?

Answer 16

• 50% have lifetime SUD–alcohol most common

- Reward dysfxn inherent in neuropathology (high DA in schizophrenics)–> increased vulnerability

Question 17

What is the tx for SUD and schizophrenia?

Answer 17

DA antagonists: haloperidol, fluphenazine
5HT/DA Receptor Antagonists: Clozaril, Risperidone, Olanzapine, Quetiapine, Ziprasidone, Aripiprazole
Naltrexone- helps tx cravings

Question 18

How do SSRIs impact SUDs?

Answer 18

Good for anxiety disorders
Only modest improvement for SUDs

*alcohol is the most common substance used in an anxious pt

Question 19

How is GAD related to SUD?

Answer 19

Strongly associated with drug use
Sx overlap–> diagnostic difficulty
*GAD in adolescents is assoc w/ progression to alcohol dependence (worsen course of illness)

Question 20

How is treatment that helps w/ depression linked to positive outcomes on substance use?

Answer 20

Treatment that helps w/ depression may NOT be causing the positive outcome on substance use, but it may be affecting the psychopathology which affects the outcome.

Question 21

How is panic disorder linked to SUDs?

Answer 21

Risk of panic disorder increases 2-4 fold in individuals w/ SUDS
*Panic attacks can be assoc w/ alcohol w/drawal

Question 22

How is Social anxiety disorder linked to SUD?

Answer 22

Fear of social situations has early onset, typically before SUD.

Prevalence of SUD in individuals w/ SAD is 48%.
Prevalence of SAD in individuals w/ SUD is 20%.

Question 23

How can you treat SAD and SUD

Answer 23

Paroxetine and motivational therapy help but there is a 7 week delay.

Question 24

How are PTSD and SUD linked?

Answer 24

PTSD negatively reinforces alcohol use.

High incidence of traumatic life events in individuals w/ SUDs.

Question 25

How do you treat PTSD w/ SUD?

Answer 25

Group therapy integrating CBT

-Emphasis on seeking safety, no trauma exposure

Question 26

Is sertraline an affective tx for PTSD and alcoholism?

Answer 26

Only in pts with early onset severe alcoholism and later onset PTSD

Question 27

How is ADHD linked to SUD?

Answer 27

ADHD in childhood and use of meds increases chance of SU issues in adulthood and is a way to mask sx.