BH- Substance use disorder Flashcards
1
Q
Drug Addiction
A
- A disease that is characterized by compulsive drug seeking and use despite harmful consequences
- A brain disease
- Drugs change brain structures which can lead to harmful
behaviors - DSM Dx: Substance Use Disorder, substance dependence and substance abuse
2
Q
NIH
Populations at Risk
A
- Babies exposed to legal and illegal drugs in the womb may be born premature and underweight and develop Neonatal Abstinence Syndrome (NAS). Exposure can slow child’s intellectual development and affect behavior later in life
- Adolescents often act out, do poorly academically, drop out of school. Often at risk for unplanned pregnancies, violence and infectious diseases
- Adults have problems thinking clearly, remembering and paying attention. Often develop poor social behaviors, work performance and personal relaps
- Children of Parents who abuse drugs often have chaotic, stressfilled homes, often experience child abuse and neglect. May set the stage for drug abuse in next generation
3
Q
Controlled Substances Act (CSA) regulates five classes of
drugs
A
- Narcotics
- Depressants
- Stimulants
- Hallucinogens
- Anabolic steroids
4
Q
What might you see in primary care?
A
- Stimulant/Adderall abuse
- Alcohol abuse
- Cough syrup abuse
- Escalating use of benzos and opiates
- Cocaine/heroin on the rise
- Club drugs?? molly?
- Inhalants, cold preparations
- Prescription abuses—wellbutrin, seroquel, clonodine,
neurontin, others???
5
Q
Substance Use Assessment
A
- What substance?
- When did the use start?
- How often and how much?
- What route is the substance used?
- Where/how is the substance obtained
- Treatment history periods of sobriety
6
Q
Alcohol Use Disorder
A
- A problematic pattern of use leading to clinically significant impairment or distress
7
Q
CAGE assessment
A
Alcohol ***must meet 2 criteria within a 12-month period
- Larger amounts taken or over longer period of time
- Persistent desire to cut down or control
- Greater time spent to obtain or recover from effects
- Continued use despite social consequences
- Social, occupational or interpersonal problems persist
- Social and occupational activities are given up
- Continued use despite knowledge of physical problems
- Tolerance develops
8
Q
Physical Effects on Body
A
- Peripheral neuropathy
- Alcoholic myopathy (acute and chronic)
- Wernicke Encephalopathy-Korsakoff’s Syndrome
- Alcoholic cardiomyopathy
- Esophagitis/gastritis/pancreatitis/Barrett’s esophagus
- Alcoholic hepatitis/cirrhosis of liver
- Fetal alcohol syndrome
9
Q
Treatment
A
- Motivational interviewing
- Alcoholics Anonymous
- Rational Recovery
- Counseling
- Group Tx
- Family Tx—important to include family; refer to Alanon
- Psychopharm
- Disulfiram (Antabuse) for ETOH
- Acamprosate (Cambral) must be abstinent; reduces cravings
- Vivitrol—Revia—Naltrexone
10
Q
Benzodiazepines and Opioids
A
Anxiety and pain management in primary care
- Controversial
- Concerning
- Counter-productive
- Short use appropriate until SSRI begins to work
- Long term use becomes problematic
11
Q
BZD and Opioid Patterns of Use
Two patterns emerge:
A
Two patterns emerge:
- One who becomes addicted after a genuine need for the
anxiolytic/analgesic (iatrogenic)
- One who uses for recreational purposes and obtains them
from illegal sources
12
Q
MA Online Prescription Monitoring Program
A
- http://www.mass.gov/eohhs/gov/department/dph/programs/hcq/drug-control/ma-online-prescription-monitoringprogram/
- Click here if you are with a pharmacy looking for information on reporting data to the PMP.
- Guidance on MA Online PMP Automatic Enrollment and
Requirements for Utilization - The Massachusetts Online Prescription Monitoring Program (MA Online PMP) is a secure website that supports safe prescribing and dispensing. A licensed prescriber or pharmacist may obtain authorization, through completion and submission of an enrollment form, to view the prescription history of a patient for the past year.
The MA Online PMP also assists state and federal investigative agencies in addressing prescription drug diversion by supporting ongoing, specific controlled substances-related investigations.
13
Q
Cannabis
A
- Second only to ETOH as most widely used
- Psychoactive ingredient: THC
- Natural substance; hash is more potent part of the plant
- Usually smoked; can be ingested
- Debate conts over legalization and reducing criminality
- Tolerance and dependence develop but tolerance is
rapidly lost
14
Q
Substance Use/Abuse and Psychological Issues
A
- Denial, depression anxiety, hopelessness, low self-esteem, and various psychiatric disorders are common
- Some will fear rejection by their provider
- Often fear the loss of the substance since they feel unable to survive without it—all portends a typical defensive posture
- Must treat the substance disorder as you treat the
underlying psychiatric disorder
15
Q
Intervention Strategies
A
- Aim of trmt is toward self-responsibility
- Combination of treatment strategies is best—therapy, meds, social support, psycho-education, etc.
- Motivational Interviewing (MI)
- A therapeutic modality designed to illicit change
- Express empathy, develop discrepancy, avoid
argument, roll with resistance and support self advocacy
