B7-080 Substance Use Disorder Flashcards
diagnosis of substance use disorder requires symptoms in what general categories [4]
impaired control
physical dependence
social problems
risky use of substance
[…] symptom of substance use disorder indicates the individual is at risk
one
[…] symptoms indicate mild substance use disorder
2-3
[…] symptoms indicate moderate substance use disorder
4-5
[…] symptoms indicate severe substance use disorder
6+
therapy based upon principles of operant conditioning
contingency management
(often CM is added to another SUD treatment)
community reinforcement approach plus vouchers is an example of what type of therapy?
contingency management
the matrix model is helpful for individuals with […] SUD
stimulants
the matrix model is an example of […] therapy
behavioral
12 step facilitation therapy is an example of […] therapy
behavioral
Medication Assisted Treatment (MAT) is used for […] use disorder
opioid
OUD medications [3]
methadone
buprenorphine
naltrexone
OUD medication that is a full mu receptor agonist
methadone
OUD medication that is partial mu receptor agonist
buprenorphine
OUD medication that is mu receptor antagonist
naltrexone
has a very high affinity for mu receptors, so can out-compete other substances for binding
limits possibility of overdose [2]
buprenorphine
naltrexone
precautions of methadone [2]
prolonged QT
fatal overdose
common side effects of methadone [3]
sweating
constipation
respiratory depression
therapeutic dosage of methadone in adults
80-120 mg
precautions of buprenorphine [2]
withdrawal symptoms if taken too soon after an opioid
hepatitis
common side effects of buprenorphine [3]
nausea/vomiting
dizziness
constipation
can be administered via sublingually, orally, subq, subdermal implant, or transdermal patch
buprenorphine
common side effects of naltrexone [4]
nausea/vomiting
somnolence
injection side reaction
elevated liver enzymes
the patient must be opioid free for […] prior to using injectable naltrexone
7-10 days
precautions to naltrexone [2]
withdrawal if currently taking opioids
routine liver function monitoring
available orally or in IM monthly injections
naltrexone
depot injections are generally preferred for long term treatment, but what is a consideration?
naltrexone/buprenorphine cause withdrawal symptoms when taken concurrently with opioids
why do patients who were incarcerated have an increased risk of overdose after leaving the detention center?
naltrexone causes resensitization of mu receptors, so their previous usual dose is much more dangerous
rescue medication to prevent opioid overdose
naloxone
physicians must complete training to waiver to prescribe and dispence
buprenorphine
(under the Drug Addiction Treatment Act)
therapy that helps patients develop critical skills that support long-term abstinence such as recognizing and avoid the situation in which they are most likely to use
CBT
therapy that uses a prize-based system that rewards patients who abstain
contingency management therapy
addresses the impact of drug use patterns on familial relationships and improves overall family functioning
family therapy
therapy that addresses patient readiness for change and helps resolve ambivalence toward drug treatment/use
motivational enhancement therapy
a breakdown of intention to limit consumption in a particular situation
impaired control
biological adaptation to persistent drugs in the body
physical dependence
drug use in particularly hazardous settings
risky use
role failures impacting family and societal functioning
social problems
adaptive changes in the […] as a result of repeated intoxication/withdrawal cycles lead to reward deficit syndrome, increased stress reactivity and emotional dysregulation
amygdala
the […] part of the brain is involved in drug reward
nucleus accumbens
modes of administration that maximize […] are most reinforcing
rate of onset
IV> smoked > snorted > orally injested
Substance is taken in larger amounts or over a longer period than was intended
is a symptom of
impaired control
tolerance or withdrawal are symptoms of
physical dependence
There is a persistent desire or unsuccessful efforts to cut down or control substance use
is a symptom of…
impaired control
A great deal of time is spent in activities necessary to obtain, use or recover from the effects of a substance
is a symptom of…
impaired control
craving or a strong desire or urge to use the substance
is a symptom of…
impaired control
Recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home
is a symptom of…
social problems
Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
is a symptom of…
social problems
Important social, occupational, or recreational activities are given up or reduced because of substance use
is a symptom of…
social problems
Recurrent substance use in situations in which it is physically hazardous
is a symptom of…
risky use`
Substance use is continued despite knowledge of persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
is a symptom of…
risky use
The partial agoinist character of buprenorphine can elicit […] symptoms
withdrawal
the most successful approach to increase adherance to treatment and reduce illicit opioid use
Opioid agonists combined with psychosocial treatments
Individuals initiating OUD treatment with either [….] had better clinical and cost outcomes in several areas than those beginning their OUD treatment via an alternative care pathway
buprenorphine or methadone
The core principles of […] programs are acceptance, surrender and participation in the activities through peer-based meetings
12 step
therapy that centers around identifying triggers and avoiding risky situations
CBT
an incentive-based program based on operant principles
contingency management therapy
therapy that addresses ambivalence about recovery
motivational therapy
must be administered at certified Addiction Treatment Centers
methadone
requires specialized training to initiate therapy and avoid precipitated withdrawal
buprenorphine
The symptoms of preoccupation and anticipation of drug use reflect adaptive changes in which brain regions?
anterior cingulate, prefrontal cortex
brain structures guiding incentive salience
nucleus accumbens and thalamic nucleus
therapy particularly beneficial to address behavioral issues with young people and re-direct risky behaviors
family therapy
reverses monoamine and vesicular transporters leading to greater dopamine efflux
methamphetamine
factor that most predicts increased severity and poor clinical course of SUD
early use
increases the risk of developing SUDs by 2 to 4 times but it is not a predetermined outcome
family history
(Children of parents with SUD are still more likely NOT to develop an SUD than to develop one)
accounts for about 60% of the risk for developing SUD but does not predict the severity or course of illness
genetics
explores the positive and negative consequences of continued drug use and incorporates self-monitoring techniques to identifiy situations that increase risk for use and helps develop strategies to cope with cravings and avoid high-risk situations
CBT
therapy that specifically addresses cue-induced relapse
CBT
commonly incorporated into the film with buprenorphine to prevent melting/injecting drug
naloxone
(due to poor oral availability)
naloxone has […] oral availability
poor
naltrexone has […] oral availability
good
withdrawal symptoms are the result of
physiological dependence
reduces cravings and prevents withdrawal, but with a limited ceiling of effects thereby reducing the risk of fatal overdose
buprenorphine
methadone has […] potential for fatal overdose
full
buprenorphine has […] potential for fatal overdose
limited
what factor limits the use of buprenorphine?
severe physical dependence
integrated treatment plan incorporating pain management with motivational counseling to encourage adherence to treatment and monitoring
matrix model
patients with long history of SUD abuse have likely failed other therapies, so […] is used
matrix model
