CADC1 exam Flashcards
Where in the brain is the reward pathway located?
limbic system, this pathway includes the nucleus accumbens which is targeted by drugs of abuse
Endorphins
proteins in the body that motivate behavior by producing feelings of wellbeing in various situations
GABA
An inhibitory NT;
Drugs that cause pinpoint pupils
opioids, depressants like codeine, fentanyl, morphine, heroin, methadone; and antipsychotics
Short-term psychological effects of alcohol
distortions of vision, impairment of coordination, impaired judgment, altered emotions and perceptions
Long-term psychological effects of alcohol
Depression, memory loss, pseudo-dementia, loss of libido
Short-term psychological effects of stimulants
euphoria, insomnia, irritability, confusion, anxiety, paranoia
Long-term psychological effects of stimulants
hallucinations, formication (bug crawling feeling), depression, loss of appetite, stimulant-psychosis, paranoia
Short-term psychological effects of psychedelics
incoherent speech, tactile sensory impairment, insomnia, confusion
Long-term psychological effects of psychedelics
depression, paranoia, confusion, flashbacks, catatonic syndrome, pseudo-schizophrenia
Dependence
Occurs when a person persists in taking a substance to satisfy a feeling, mitigate psychiatric illness symptoms, avoid difficult feelings, or to meet emotional needs; Continued use despite increasingly negative consequences
Psychological dependence
Occurs when a person persists in taking a substance to satisfy a feeling, mitigate psychiatric illness symptoms, avoid difficult feelings, or to meet emotional needs; Continued use despite increasingly negative consequences
Physiological dependence
Occurs when one uses to avoid withdrawal symptoms
Acute withdrawal
lasts 2-7 days; characterized by the strongest symptoms
Post-acute withdrawal
may last for weeks or months
Drugs that require detoxification
depressants: alcohol, opiates, benzo’s
The most common drug interaction in overdoses
A sedative + another sedative because they depress the central nervous system
The liver breakdowns how many grams of pure alcohol per hour (for a 150 lb person)?
7 grams/hr
Effects of excessive alcohol consumption over time
liver cirrhosis, ruptured esophagus, impotence, stomach ulcers and inflammation, possible damage to every organ system, respiratory depression.
Alcohol withdrawal symptoms
- 6-8 hrs- tremors, agitation, anxiety, hypertension, nausea, vomiting, anorexia, headache, insomnia, craving
- 24 hrs-6 days - disordered perceptions, hallucinations, delusions
- 7-48 hrs - possible seizures, delirium tremens
- 3-5 days- DT, global confusion, hallucinations, autonimic hyperactivity (only 5-6% of patients progress to this stage)
Alcohol acts on which NT’s
GABA (enhances inhibitory function)
Treatments for alcohol use disorder
- appropriate benzo’s to titrate symptom severity;
- monitor fluids, electrolytes, vital signs;
- detoxification in a hospital setting (usually lasts no longer than 5 days);
- meds that minimize tremors, seizures, rapid heart rate, high blood pressure
Antabuse (Disulfiram) is used to treat…
A medication that causes patients to stop using alcohol because if they take this med and drink, they become sick; can be used with methadone
CNS depressants
Alcohol, sedative-hypnotics, antipsychotics, tranquilizers
Benzodiazepines
A short-acting tranquilizer commonly used for the tx of anxiety, panic attacks, and insomnia; limited danger of fatal overdose; effcts include extreme drowsiness; over-sedation can be delayed days because of accumulation in the fatty tissues
Sedative- hypnotic withdrawal effects
anxiety, insomnia, agitation, seizures, death
Barbiturates
A type of sedative-hypnotic; highly addictive; high risk of overdose; withdrawal requires medical supervision
Short term and long term effects of barbiturates
short term: occur 20 min after ingestion; similar to alcohol; euphoria, confusion, slurred speech, stupor, sleepiness
long term: nausea/vomiting, constipation, bradycardia, high blood pressure, insomnia, anxiety, confusion, apnea, hypoventilation, nightmares, ataxia, dizziness, hallucinations, distorted thinking
Barbiturate withdrawal effects
Can be life-threatening; symptoms experienced within 8-16 hours after last dose and can last up to 15 days;
symptoms include anxiety, insomnia, weakness, restlessness, dizziness, nausea;
severe effects include tremors, seizures, hallucinations, psychosis, possible death from hyperthermia or circulatory failure
Rohypnol
the date rape drug; a tranquilizer that produces strong amnesia for events surrounding ingestion
Benzodiazepine withdrawal
does not typically involve significant hypertension or tachycardia symptoms like alcohol withdrawal; symptoms include agitation, elevated psychomotor activity, delirium, muscular weakness, elevated blood pressure, tremors, heightened anxiety and depression, unexplained euphoria or grandiosity; disorientation, hallucinations
Antipsychotics
Tranquillizers used in the tx of major mental disorders characterize by psychosis; Disrupt or reduce rates of NT activity; slowing activity helps reduce intensity of intrusive thoughts, feelings of paranoia, hallucinations, delusions, thought disorder, loose associations, ambivalence, emotional lability
Cocaine
A stimulant; variations include freebase and crack; takes 15-30 min to feel effects, and high wears off in 30 min-2 hrs;
Cocaine withdrawal
paranoia, depression, exhaustion, anxiety, mood swings, fatigue, insomnia, intense cravings; possible symptoms related to schizophrenia
Reward deficiency syndrome
When the dopamine system in hyper or hypo-functioning leading to low levels of pleasure, inducing greater activity of behaviors that stimulate the dopamine reward system
Amphetamine
A stimulant that produces alertness, wakefulness, increased focus, and decrease in appetite (often used as ADHD meds). Produced in pill form.
Methamphetamine
A stimulant produced from amphetamine that has been methylated twice (so it has a much stronger and quicker effect). Meth has no legitimate medical use. Usually produced in powder or crystal form
Meth/amphetamine physical effects
dry mouth, facial flushing, blood-shot eyes, hyperactivity, dilated pupils, restlessness, teeth grinding, headache, hyper/hypotension, fever, diarrhea, blurred vision, twitching, numbness, dry/itchy skin, acne, aphasia.
Chronic use effects: seizure, stroke, coma, heart attack, possible death
Crystal meth
a form of meth that has been processed into clear crystals that can be smoked
Meth/amphetamine psychological effects
alertness, anxiety, euphoria, increased libido, elevated energy, enhanced self-esteem, grandiosity, sociability, aggression, psychosomatic disorders, psychomotor agitation, repetitive/obsessive behaviors, paranoia
Chronic use: psychosis can occur
Meth/amphetamine withdrawal
depression, mental and physical fatigue, increased appetite, hypersomnia, vivid or lucid dreams, suicidal ideation
Meth/amphetamines have the most dangerous interaction with which drugs?
MAOI antidepressants mixed with meth/amphetamines can be life-threatening; SSRI’s have problematic interactions too
Serotonin syndrome effects
headaches, agitation, confusion, hypomania, hyperthermia, hypertension, hallucinations, coma, shivering, sweating, nausea, muscle twitching, hyperreflexia, tremor
Nicotine
A highly addictive simulant found in tobacco; dopamine is released very rapidly
Nicotine withdrawal
depressed mood, insomnia, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, dizziness, cough, constipation, stress, increased appetite, sore throat/gums, postnasal drip, tightness in chest
How long does nicotine withdrawal last?
It’s usually the worst the first week, and can last about a month
Nicotine replacement therapy
provides nicotine without other chemicals found in tobacco smoke to help manage withdrawal symptoms
What are the 5 A’s of tobacco treatment?
- Ask (about tobacco use)
- Advise (about smoking cessation benefits)
- Assess (the willingness to stop in the next 30 days)
- Assist (with resources)
- Arrange (to assess progress at a follow-up appt)
PPA
A synthetic form of caffeine
How do opiates effect the central nervous system?
They depress the CNS. Excessive ingestion can cause cardiac irregularities (usually slowing of the heart rate), or respiratory depression.
What happens when someone overdoses from opiates?
The heartbeat/breathing may stop
What are naturally derived opiates?
opium, morphine, codeine
Morphine
a narcotic; derived from the poppy seed, it is used clinically as a sedative
Codeine
A derivative of morphine. It is less potent. Used as a cough suppressant, antidiarrheal, anti-anxiety, with sedative hypnotic qualities
What are some synthetic/semi-synthetic opioids?
meperidine, oxymorphone, oxycodone, and heroin
Hydromorphone
a synthetic opioid related to morphine (it is more potent and faster acting)
Oxycodone
a synthetic opioid derived from codeine
Heroin
opioid derived from morphine; considered one of the most addictive drugs in existence; the most abused and dangerous narcotic; enters the brain much faster than morphine
Methadone
A long-acting opioid that is useful in treating addiction to narcotics. It blocks the effects of narcotics
What is an opiate antagonist?
It reverses the effects of opiates. Any medication that blocks opiate receptors in the brain so the user does not feel the effects of an opiate.
They are often used to treat opiate overdoses or addiction
Naltrexone
An opiate antagonist (Vivitrol, Revia, Depade); blocks the feelings of euphoria, which reduced cravings. It does not help with opiate withdrawal symptoms, so it’s usually used after withdrawal
Naloxone
An opiate antagonist (Narcan) that is used most frequently in opiate overdoses. It acts within minutes to counteract the effects if opiate toxicity. It can restore breathing and blood pressure
Buprenorphine
A semi-synthetic opiate antagonist (Suboxone, subutex, temgesic, buprenex, norspan, butrans); it remains bound to opiate receptors longer than other opiates, offering more enduring pain relief and lower level of physical dependence ; helps avoid opiate withdrawal symptoms
Why can’t suboxone be injected?
It’s formulated with Naloxone to deter IV abuse
Physical effects of narcotics
They can both decrease the sensation of pain and increase the perception of pain. They depress the CNS and can even stop breathing; effects include slurred speech, lack of coordination, impaired reflexes, constricted pupils, constipation
Psychological effects of narcotics
euphoria, tranquility, impaired judgment
With long-term abuse mood swings, depression, anxiety and fear are common.
Narcotic withdrawal
sweating, watery eyes, tremors, excessive nasal discharge, nausea and vomiting, yawning, muscle aches, cramps, difficulty urinating, constipation, loss of apetite, hypertension, fever, goose bumps, insomnia, anxiety, mood swings, panic attacks; not usually lethal
Fentanyl
a fully synthetic opiate
What do hallucinogens to do the CNS and the brain?
They both excite and depress the CNS. They change the levels of neurotransmitters in the brain. They distort perception, altering mood and cognition
Which hallucinogens are synthetic?
LSD and PCP
Hallucinogens withdrawal
is not a thing hahahah because they do not create physical dependence; tolerance may be developed though
What are the main psycho-active chemicals in hallucinogenic mushrooms?
psilocybin and psilocin
What is the psychoactive chemical in peyote?
Mescaline
PCP
is recognized as a hallucinogen but can also be a stimulant and pain killer. It can be smoked, swallowed, or injected. It has been used as an anesthetic. Effects vary person to person.
LSD
measured in micrograms because it is extremely potent; 30-50 micrograms will produce a psychoactive effect; considered a schedule I substance because it has no medical purpose; tolerance builds rapidly; derived from ergot
What are some dangers of LSD?
It is not addictive, but users may experience Hallucinogen Persisting Perception Disorder, flashbacks, depression, psychosis, vulnerability, reduced attention span, distorted perception, problems with abstract thinking, suicidal thoughts
THC
Delta-9 tetrahydrocannabinol – The chemical responsible for the mood-altering effects of cannabis
Cannabis withdrawal
can be experienced for about a week but are not severe; effects can include aggression, anxiety, depression, decreased appetite
short-term physical effects of cannabis
hypertension, increased respiratory rate, red eyes, dry mouth, increased appetite, slow reaction time
What do inhalants do to the CNS?
They depress the CNS
How do anti-depressants work?
Antidepressants counteract depression by manipulating brain chemicals that elevate mood
How do anti-anxiety meds work?
anti-anxiety drugs manipulate brain chemicals like GABA
What is Pharmacokinetics?
the subfield of physiology that determines a drug’s effects and abuse potential by examining the way the drug is absorbed, distributed, metabolized, eliminated, and excreted by the body.
How do drugs get to the brain when you inhale them?
When inhaled, the drug is rapidly absorbed through capillaries lining the air sacs of the air passages→ capillaries connect to lungs and the drug-ladden blood travels back to the viens and enters the heart→ the heart pumps it to brain and other organs
What is the fastest route of administration?
inhalation
What is the most dangerous route of administration?
injection, because it bypasses the body’s natural defenses
What is mucus membrane absoprtion?
Snorting, putting the drug under the tongue, or through cheeks and gums
How does mucus membrane absorption work, and how fast does it take?
drugs are absorbed by capillaries and enmeshed in the mucous membranes; takes 3-5 minutes
What is sublingual absorption?
under the tongue
What is buccal absorption?
through cheeks or gums
When a drug is ingested orally, how does it get to the brain? How long does it take to feel the effects?
drug passes through the esophagus, stomach, small intestine, capillaries, veins, and liver where it is partly metabolized; effects delayed 20-30 minutes
How does contact absorption work? How long does it take?
drug-saturated adhesive patches applied to the skin allow drug to be passively absorbed for up to 7 days
What does bioavailability have to do with drugs?
The actual amount of drug that enters the brain depends on the bioavailability of the drug, which is the degree to which the active ingredients of a drug become available to the target tissues after administration
What factors effect how drugs are distributed in the body?
Distribution depends on blood volume of person and the characteristics of the drug
What happens when a drug reaches the CNS?
The CNS serves as a gateway to the blood-brain and blood-cerebral spinal fluid barriers;
The brain is fatty, so it absorbs what kinds of substances?
fat soluble substances
What is passive transport?
happens when fat-soluble drugs pass from an area of where there is a higher concentration of a drug to an area of lower concentration
What is active transport?
occurs when water-soluble drugs cross the blood-stream barrier by attaching to protein molecules
Which body part is the key metabolic organ that breaks down and alters the chemical structure of drugs making them less active?
The liver
Drugs are primarily excreted through which organ?
Kidneys
What are pro-drugs?
pro-drugs are transformed by the liver’s enzymes into 3+active metabolites; they are eliminated slowly; affecting the body for hours or days
What are some examples of pro-drugs?
Valium, gabapentin, aspirin, levadopa
Factors that affect half-lives of drugs include:
age, race, heredity, gender, health, emotional state, presence of other drugs, allergies, weight, hormones, environmental factors
What is a half life?
An estimate of the period of time for the drug concentrate to break down to exactly one half
Which body parts make up the CNS?
the brain and spinal cord
What does the CNS do?
CNS receives messages from PNS, analzyes and responds to them; also enables us to remember, create, and respond to any situation
What part of the brain is responsible for cravings?
The old brain (the limbic system)
How does memory relate to addiction?
The more psychoactive a drug, the more rapid the memory bumps it will produce, therefore more deeply imprinted the memory
What is euphoric recall?
the brain tends to remember positive memories than negative
In which part of the brain do most emotionally-tinged memories occur?
The amygdala
Which part of the brain is responsible for motivation and obsession (aka “the go switch”)?
The nucleus accumbens
What happens to the nucleus accumbens with regular drug use?
heavy drug use alters neurochemistry which makes the NA more sensitive than normal to the drug and relapse
What is long-term potentiation?
an increase in neural connections results in higher sensitivity to drugs , increasing the risk of relapse
When an experience or other stimulus induces LTP in a cell, the cell responds more strongly to future exposures to the same stimulus
How does the “stop switch” work in the brain?
there is a cluster of neuron fibers that usually communicates the stop messages once satiation occurs by limiting the release of dopamine; this part becomes damaged very early with chronic use
What is the neuron cluster in the brain that is considered the stop switch?
Fasciculus retroflexus
What is allostasis?
the changing of the brain to protect the body, but the changes are not always beneficial; through this process, the body establishes a new normal
What are neurotransmitters?
Molecular bits of messenger chemicals that send info between neurons; Neurotransmitters are converted to an electrical signal and fired to the synapse
What are neurons?
nerve cells; building blocks to the nervous system
What do drugs do to the neurons?
They flood the space between neurons, effecting the way neurons communicate
What is the difference between endogenous opioids and exogenous opioids?
Endo: originating or produced within the body (like endorphins and enkephalins); the body’s natural pain killers
Exo: externally produced painkillers (like morphine, heroin, opium)
What are agonist drugs?
It mimics neurotransmitters; facilitates the normal action of neurotransmitter and binds to receptors; does the same as the neurotransmitter is supposed to do
What are some examples of agonist drugs?
methadone (endorphin agonist); cocaine is the closest agonist to dopamine
What are antagonist drugs?
binds to a receptor but doesn’t activate; blocks neurotransmitters
What are some examples of antagonist drugs?
narcan, methadone
Which neurotransmitters are the most important in addiction?
dopamine, endorphins, serotonin, GABA, and glutamate
What does norepinephrine and epinephrine do for the body?
Function as stimulants when activated by the demand from the body for energy; they stimulate the autonomic nervous system, affect motivation, hunger, attention span, confidence, and alertness (aka adrenaline, noradrenaline)
What does dopamine do for the body
The most crucial neurotransmitter involved in both substance and process addictions; Helps regulates fine motor muscular activity, emotional stability, satiation, and the addiction pathway
When is dopamine released?
Dopamine is released when an effect is much better than expected
Which neurotransmitter sustains addiction?
Glutamate
What does histamine do for the body?
Controls the inflation of tissues, local immune responses, and allergic reactions;
also helps regulate sleep and emotional behavior
What does serotonin do for the body?
Helps control mood stability (including depression and anxiety), appetite, sleep, and sexual activity
What does GABA do for the body?
The brain’s main inhibitory neurotransmitter; controls impulses, muscle relaxation, arousal, and generally slows down the brain;
What does glutamic acid do?
Enhances the prominence of dopamines effects when it’s released in response to psychoactive drugs
Which amino acid is present in 80% of the brain’s neurons?
Glutamic Acid
When is a person considered tolerant to a drug?
when larger amounts must be taken as the body adapts to protect itself
What is dispositional tolerance?
the body speeds up the break-down of a drug to eliminate it; the body produces more enzymes to metabolize the drug, requiring greater quantities to achieve the same level of intoxication
What is pharmacodynamic tolerance?
nerve cells become less sensitive to the effects of drugs as the body produces an antagonist to it; the brain generates fewer receptor sites and more antagonists (aka downregulation)
What is behavioral tolerance?
the brain learns to compensate for the effects of drugs by using parts of the brain not affected
What is reverse tolerance?
as the drug destroys certain tissues or with age, the user can be more sensitive and less able to handle moderate amounts
What is acute tolerance?
the brain and the body begin to adapt almost instantly to the toxic effects of a drug
Experiencing minimal effects of a drug for months then suddenly experiencing an intense reaction is an example of what kind of tolerance?
inverse tolerance
Which kind of tolerance best describes this situation: when a person develops tolerance for alcohol and they also develop tolerance for marijuana without ever having used marijuana before
cross-tolerance
When a tolerance to sedatives to achieve an emotional high occur more rapidly than tolerance to their depressant effects, which kind of tolerance is happening?
Select tolerance
What is one sign of tissue dependence?
withdrawal symptoms
When is a person considered tissue-dependent on drugs?
when the body biological adapts to prolonged use of a drug, producing an allostatic state of the body
When is a person considered psychologically dependent on drugs?
when a desire for the positive effects of a substance or to avoid negative emotions or effects can reinforce use
What is the last phase of withdrawal that can last several months after last use?
post-acute withdrawal
What is considered drug abuse?
the continued use of a drug despite negative consequences
Which type of drugs force their release and infuse the body with large amounts of extra energy before the body needs it?
Stimulants
Why does weight loss occur with stimulant use?
they trick the body into thinking basic nutrition and hydration needs have been satisfied
What is down regulation?
A decrease the number of dopamine and serotonin receptor sites in the nucleus accumbens, causing the brain to crave even more of a drug to overstimulate the remaining receptors
How long is cocaine usually detectable in urine?
up to 36 hours
Which neurotransmitter are affected by cocaine and how?
Cocaine prevents the reabsorption of norepinephrine, epinephrine, and dopamine, thus increasing their concentration in the synapse, intensifying their effects; serotonin is also released and then quickly depleted; the fight center in the limbic system is overactivated;
What is formication
The imbalance in sensory neurons causes the feeling of bugs crawling on skin
How long does a meth high last?
4-6 hrs
Where in the brain are opiate receptors located?
in the brainstem
What is the differences between Hyperalgesia and Hyperpathia?
Hyperalgesia: temporary increase in sensitivity of nerve cells
Hyperpathia: an abnormal increase in pain
What physical sensations might a regular opioid user experience when they stop using?
pain expands all over the body because the body stops producing endorphins; long-term use makes pain worse
How does hyperalgesia work?
the body oversimplifies pain messages, warning the brain to do something to lessen the pain→ temporary pain increase due to increased sensitivity of nerve cells
Alcohol molecules are small and soluble in both water and fat, so it enters the capillaries in the walls of the small intestine, moving easily into any organ or tissue. This is an example of what kind of diffusion?
Passive diffusion
How long does it take for the body to being eliminating alcohol?
immediately, because the body thinks its poison; 1-10% is immediately excreted, 90% is metabolized
What blood alcohol content is considered legal intoxication?
0.08
How many drinks is considered a binge?
consuming 5+ drinks in one sitting
At what BAC does alcohol poisoning occur at?
BAC .40
How does liver damage effect the body?
liver damage allows alcohol to travel to other organs in its original toxic form
Inflammation of the liver due to alcohol use is called…
alcoholic hepatitis
Cirrhosis
occurs when an excessive amt of liver cells are killed causing scarring; occurs because the metabolic process produces metabolites that are more toxic than the alcohol itself
What is the most advanced form of liver disease?
Cirrhosis
A long-term alcoholic who is experiencing symptoms of disorientation, memory failure, false memories may have which alcohol-induced syndrome?
Korsakaff’s syndrome
When the liver becomes less able to metabolize alcohol with long-term use, this is an example of which tolerance?
reverse tolerance
When a dependent alcohol user experiences shakiness about 2-3 days after quitting, this is called…
delirium tremens
How long can delirium tremens last?
10-50 days
Ketamine is considered what kind of drug?
a hallucinogen
How does THC affect the brain?
THC has a strong impact on the amygdala, which is the emotions center
THC artificially stimulates the amygdala, making the mundane interesting
THC effects memory by acting as a an agonist of GABA, causing short-term memory impairment
Marijuana can stay in fat cells for how long?
Around 3 months for chronic users
Schedule 1 drugs
1: drugs with a high abuse potential and no approved medical use (heroin, LSD, peyote, psybicilin, mescaline, MDMA, and marijuana
Schedule 2 drugs
2: substances with high abuse potential even though they have medical uses (including cocaine, meth, opium, morphine, oxycodone, and methylphenidate)
Schedule 3 drugs
3: substances with less abuse potential (including buprenorphine, anabolic steroids, ketamine, and marinol)
Schedule 4 drugs
4: drugs that have even less abuse potential (xanax, ativan, klonopine, valium, ambien)
Schedule 5 drugs
5: substances with very low abuse potential because of very limited quantities of narcotic and stimulant drugs; generally used for antidiarrheal, antitussive, and analgesic purposes (cough medicine like Robitussin or lyrica)
What is the MOST common symptom of Wernicke’s encephalopathy?
Confusion
Which of the following conditions does alcohol NOT induce? Cirrhosis Hepatitis Nephrosis Steatosis
Nephrosis
What is diathesis?
A predisposition (to addiction)
How much of susceptibility to addiction come from heredity? What does the other portion come from?
40-60%, the other 40-60% comes from the environment
How many genes have been identified as having an effect on addiction?
At least 89
Meth sets apoptosis in motion, what does that mean?
cell death because damaged cells are programmed to kill themselves
Nicotine produces immediate and long-term changes in which neurotransmitters?
Dopamine and norepinephrine
What does the peripheral nervous system control?
how the body responds to external stimuli
What does cocaine do to which neurotransmitters?
Blocks norepinephrine, serotonin, dopamine, and other NT’s from being reabsorbed–> the chemical buildup of NT’s cause euphoria
What is a prodrug?
an inactive form of a drug that is converted to a pharmacologically active drug within the body by metabolic processes.
What does motivational interviewing primarily involve?
help client’s discover their own desire to change through reflective listening, identifying variances between behavior and personal goals, deflect arguments, redirect client resistance to desires and goals, nurture optimism
What percentage of people with a dual diagnosis receive tx for their SUD and MH?
7.4%
What factors affect screening instrument validity?
The setting in which the screening occur, the wording of instructions, the amount of privacy, and rapport
What does GATE stand for?
Gather info, Access supervision, Take responsible action, Extend the action
Name an alcohol abuse screening that is meant to be used with adolescents
CRAFFT
What is the most important introductory statement in a suicide evaluation?
I need to ask you a few questions about suicide
How must assessment info be handled to be the most effective?
Assessment info must be converted into clear goals, objectives, and action steps
How many levels of treatment placement are recognized by ASAM?
Four
The stage of change model addresses how many client stages?
Five (precontemplation, contemplation, preparation, action, relapse)
What are SOAP notes?
Subjective, Objective, Assessment, Plan
What are DAP notes?
Data, Assessment, Plan
DIG-FAST evaluates which psychological state?
symptoms of mania
According to ASAM, what is the minimum amtount of treatment time that intensive outpatient must provide?
9 hours a week
What is the recommended minimum durations of days for intensive outpatient?
90 days
What are the ASAM levels of care?
0.5- early interventions
1 - basic nonresidential outpatient, like counseling
2 - Intensive outpatient or partial hospitalization
3 - Residential/ inpatient, planed regimen of care in a 24 hr setting
- medically-managed intensive inpatient
- Which of the following lack effective treatment medications?
Cocaine
Marijuana
Both
Neither
Both
Antabuse is contradicted for clients whose dependence combines which drugs?
just alcohol
What is the SDSS designed to measure?
the quantity and frequency of recent drug use (past 30 days)
What is physiological dependence determined by?
if withdrawal is present; if there is a need for significantly more of a substance to reach desired effect or intoxication
When behaviorally assessing for co-occurring disorders, what is the most important variable to consider?
drug toxicity or withdrawal symptoms
What is the most effective treatment for adolescents in terms of less drug use at treatment completion?
family therapy
What does culture-bound syndrome mean?
An illness unique to a certain group and/or an illness presenting or interpreted distinctly due to cultural influence
What is the difference between AIDS and HIV?
HIV is the virus that causes AIDS. AIDS is the final stage in the HIV disease process
What is the CAGE questionnaire a screening for?
alcohol use
The most important service a case manager can provide is
referrals to the least-restrictive level of care and resource options that promote autonomy
Aisha has completed her treatment at an in-patient facility and is ready to be discharged. She has asked her counselor to recommend a therapist to work with her and her husband on an out-patient basis. This process is BEST viewed as an example of :
A referral
Which type of therapy is most directive, offering the greatest potential for abuse of power by the counselor?
Gestalt
The primary purpose of professional credentialing for counselors is to:
Protect public safety by ensuring that counselors meet minimum standards of competency
The concept of informed consent requires that before agreeing to accept treatment, clients should know their rights and obligations, therapeutic goals, fees for services and
The limits of their confidentiality
Restlessness, nervousness, flushed face, muscle twitching, tachycardia, or cardiac arrhythmia are al signs or symptoms of:
caffeine intoxication
Of all of the possible substance use disorders, which one is typically not seen in older children or adults
Inhalant Use Disorder
Autonomic hyperactivity, hand tremor, nausea or vomiting, psychomotor agitation, grand mal seizures are all signs or symptoms of:
sedative, hypnotic, or anxiolytic withdrawal
In the United States, the population that experiences the lowest prevalence of alcohol use disorder is:
AAPI’s
Classical and operant conditioning are associated with __________________ therapy.
behavioral
One basic principle of documentation requires the counselor to:
Describe events in objective terms, using measurable language that can be easily understood.
The ______________________ model of addiction explains addiction as a consequence of personal choice.
moral
How does solution-focused brief therapy differ from many of the other approaches to counseling?
Emphasis is placed on the present and future while devaluing the past
The goal of complete abstinence is most consistent with the ______________ model of addiction
Disease
Which kind of tolerance can develop between natural and synthetic opiates, but not between opiates and CNS depressants
cross tolerance
The idea that people have an in-born desire to self-actualize is associated with:
humanistic theory
The central focus or “charge” of the twelfth step of Alcoholics anonymous is:
Service to others
In the DSM-5, for a substance use disorder severity indicator of mild, how many criteria must be present?
2-3
CSAP
Center for Substance Abuse Prevention
PCP Medical uses
vet anesthetic
Phencyclidine
PCP
Genetic model of addiciton
Based on the belief that individuals have a genetic predisposition to certain behaviors.
Which theory would this statement fall under:
Problematic substance use results from deficits in learning, emotional dysfunction or psychopathology that can be treated by behaviorally or psychoanalytically oriented dynamic therapies.
psychological/psychodynamic model of addiction
3 legacies of AA
- Recovery
- Unity
- Service
Stages of addiction
- Use
- Misuse
- Abuse
- Dependency
Therapy based on the idea that feelings and behaviors are caused by a person’s thoughts, not on outside stimuli like people, situations, and events. Goal is to teach the person to recognize situations in which they are most likely to drink or use substances, avoid these circumstances in possible, and cope with other problems and behaviors which may lead to their substance use.
CBT
Addressing a crisis
Crisis intervention Is a process where a response team or individual identities, assesses and intervenes with the person in crisis to return the person to their prior level of functioning as quickly as possible and to lessen any negative impact. Crisis intervention steps - Assessing the severity of the crisis. - Forming a connection. - Exploring the problem. - Dealing with feelings and emotions. - Generating alternative solutions. - Development of an action plan.
Model that says that the adaptation to toxic effects of psychoactive drugs causes the development of tolerance, tissue dependence, withdrawal, psychological dependence, and ultimately addiction. Also referred to as allostasis.
Academic model
Model that says the combination of heredity and environment creates a predisposition or susceptibility to chemical or behavioral dependency that can be triggered and aggravated by using psychoactive drugs or by acting out certain behaviors.
diathesis model
The year the reusable hypodermic needle was invented.
1855
An established pattern of alcohol use with no major negative consequences.
Habituation
Pleasure/Euphoria is experience in this system.
limbic system
Speedball
A mixture of heroin and cocaine.
Mu receptors
Receptors that block pain transmission, trigger the reward/reinforcement pathway, and depress the autonomic nervous system, including respiration, blood pressure and purple constriction.
Kappa receptors
Receptors that control pain at the spinal cord level and induce nausea and dysphoria rather than euphoria. They can also induce some psychedelic effects.
Niciceptin Receptors
Receptors that are in involved with most somatic and visceral pain modulated by substance P
Short-acting opioids
heroin, morphine, hydromorphone
Long acting opioids
methadone
Synergism
Occurs when two or more drugs interact in a way that magnifies their effects or side effects.
LSD stands for
Lysergic Acid Diethylamide
Psychedelics overload the ______, making the using acutely aware of every sensation.
sensory pathways
12 step tradition step 1
We admitted we were powerless over alcohol and that our lives had become unmanageable.
12 step tradition step 2
Came to believe that a power greater than ourselves could restore us to sanity.
12 step tradition step 3
Made a decision to turn our will and our lives over to the care of God as we understood Him.
12 step tradition step 4
Made a searching and fearless moral inventory of ourselves
12 step tradition step 5
Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
12 step tradition step 6
Were entirely ready to have God remove all these defects of character.
12 step tradition step 7
Humbly asked Him to remove our shortcomings
12 step tradition step 8
Made a list of all persons we had harmed, and became willing to make amends to them all.
12 step tradition step 9
Made direct amends to such people wherever possible, except when to do so would injure them or others.
12 step tradition step 10
Continued to take personal inventory and when we were wrong promptly admitted it.
12 step tradition step 11
Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12 step tradition step 12
Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Wellbutrin and Manerix are examples of what kind of medication?
MAOI antidepressants
Zoloft, Prozac, Luvox, and Paxil are examples of what kind of medication?
SSRI antidepressants
Rispradol and Haldol are examples of what kind of medication?
antipsychotics
Gabapentin and Klonopin are examples of what kind of medication?
Mood stabilizer (anticonvulsant)
The Federal Confidentiality Act requires…
A client to sign an ROI before any info is shared, indicating exactly where the info will be shared and to whom. Clients can revoke ROI’s at any time.
Clients must have their rights explained to them
Confidentiality must be understood by support staff and visitors
Exceptions to the Federal Confidentiality Act include…
If the counselor is a threat to self and others
In consultation with a supervisor, attorney, or medical personnel in an emergency
Suspected child abuse or neglect
Helpful drugs in cocaine detox include…
buprenorphine, but no real pharmacotherapies have been used in cocaine treatment
Goosebumps are most associated with withdrawal from which kind of substance?
Narcotics (opiates)
Why is caffeine helpful for migraines/headcahes?
It causes the blood cells in the brain to constrict
Dilaudid belongs to which category of drugs?
Semisynthetic opiates
CNS Depressant barbiturate family chemical names usually end in which letter combo?
“Al” or “bital”
Benzodiazepine chemical names usually end in which letter combo?
“am” (xanax is alprazolam, valium is diazepam)
Stimulant chemical names usually end in which letter combo?
“ine” (nicotine, cocaine, amphetamine)
Opiate chemical names usually end in which letter combo?
“Ine/one” (codeine, heroin, hydrocodone, morphine, oxycodone)
Inhalant chemical names usually end in which letter combo?
“ane/ ene” (butane, propane)
Anabolic steroid chemical names usually end in which letter combo?
“one” (nandrolone, methyl testosterone)
Ecstacy or MDMA is a designer drug made from which two chemicals?
MDA (sassafras) and methamphetamine
What are some elements of psychological addiction?
the need to get drugs is the most important thing in life, inability to function without drugs, life is not worthwhile without drugs, inability to abstain, preoccupation or depression, inability to control amount used , personality changes
What is the most common treatment modality for addiction?
Intensive outpatient
What is “angel dust”?
PCP (phencyclidine)
ReVia is a brand name for…
Naltrexone (used for alcohol use disorder to reduce cravings)
What is the difference between benzodiazepines and sedatives?
Benzo’s target anxiety rather than being general CNS depressants.
Benzo’s create less drowsiness and physical impairment
They are safer (larger amounts can be taken, while larger amounts of sedatives can be fatal)
The effects of anxiety reduction last longer
What is the difference between benzodiazepines and barbiturates?
Benzo’s are tranquilizers, barbiturates are sedatives
What is the most important element of barbiturate treatment?
Medical supervision because of the high-risk for a life threatening episode and determining if other drugs are being used
What is free-basing?
A method of smoking crack cocaine that allows the chemical to enter the body in a pure form
What are some “club drugs”?
Ecstacy, Ketamine, GHB, roypnol
What is considered “recreational use”?
the use of drugs in a social setting, infrequently and with small amounts
What is considered “circumstantial use”?
drug use to get a particular effect
What is considered “compulsive use”?
use on a daily basis in larger amounts (classified as addiction)
What is considered “intensifed use use”?
the use of drugs on a daily or almost daily basis, but in low amounts. Use is motivated by alleviating a problem or boosting levels of performance
Schedule V drugs contain what level of abuse liability?
The least
MAT works because it targets which kind dependence?
Cross dependence
Which 3 are NOT major classes of psychoactive chemicals? CNS depressants CNS stimulants Narcotics Sedatives Hallucinogens Cannabis Tranquilizers Solvents/Inhalants Steroids Psychotropics Amphetamines
Sedatives (CNS depressant)
Tranquilizers (depressant)
Amphetamines (Stimulant)
The autonomic nervous system is responsible for…
basic body functions like respiration, digestion, circulation
List some aspects of the dependent delusional system
(basically any defense mechanism)
repression of feelings or incidents blocked from memory
blackouts- blocks memory
euphoric recall
denial
rationalization
projecting and blaming
intellectualizing
Defense mechanisms are most associated with which model of addiction?
Psychodynamic
What are some dangers of inhalant use?
hearing loss, CNS and brain damage, liver and kidney damage, blood oxygen depletion
Analgesics are also known as …
opiate narcotics
Talwin and Ritalin
Talwin is a painkiller and Ritalin is a simulant, combined they produce a euphoric high similar to speed balls
What are the stages of the recovery prone style?
transition (when the need for abstinence is accepted)
stabilization (hope and motivation developed)
early recovery (acceptance of the disease of addiction)
middle recovery (lifestyle balance established)
late recovery (recognition of the affects of childhood problems)
maintenance (a recovery program is maintained)
Which theory best describes these core principles:
- focus on helping the client be who they want to be
- “re-owning” oneself
- change takes place when clients engage in their senses and are aware of movement in their life
- focus only on present
Gestalt therapy
Which theory best describes these core principles:
- there is a purpose for all behavior
- an imaginary goal directs all human bx (fictional finalism)
- birth order affects a person’s bx
Alderian / Individual therapy
Which theory best describes these core principles:
- strength-based focus on successes
- simple, straightforward methods that address solutions to a problem directly
- focus on past and present
- once you know what to do, do more of it
- if something doesn’t work, do it differently
Solution-focused therapy
Which theory best describes these core principles:
- focus on motivating and mobilizing the conditions that enhance change
- change occurs in stages (pre-contemplation-maintenance)
- belief that clients are internally motivated
- emphasis on personal choices
- humanistic foundation
Motivational enhancement therapy (MI)
Adolescent personality and social development is mainly centered around which element?
Identity
Which theory best describes these core principles:
- it’s not an actual event that disturbs people, but how they see it
- uses the A-B-C model
- therapist questions clients faulty or irrational thinking
Rational Emotive Behavior Therapy (REBT)
Which theory best describes these core principles:
- human functioning is guided by doing, thinking, feeling, and physiology
- a person’s negative reaction to an event serves a purpose
- focus on building self-worth and strength, taking control of one’s life
- techniques of giving direction, making a plan and sticking to it
Control Theory / Reality Therapy
Which theory best describes these core principles:
- it’s the client’s responsibility to find a way to deal with reality
- the better the client knows themselves, the better the more aware they will be and the better they will be able to identify their best behavior
- the counselor tries to understand how the client sees themselves in the world
- key elements are congruence, empathy, positive regard
person-centered therapy
Which theory best describes these core principles:
- humans are influenced by powerful unconscious drives
- anxiety results from the powerful inner sexual drives encountering the external world
- the ego engages in defense mechanisms
- a person uses to deal with internal pain
psychoanalytical theory
Which theory best describes these core principles:
- use of modeling
- appropriate behavior can be learned through observation, practice, and reinforcement
Behavioral modification theory
Which theory best describes these core principles:
- therapy is used to understand conflicts that are present in a family setting
dynamic family therapy
Which theory best describes these core principles:
-based on the concept that conflict, emotions, and boundaries within a family or fused or entangled
Bowenian family therapy
Which theory best describes these core principles:
- the counselor tries to change the dysfunctional structure of the family
Structural family therapy
Intimacy vs Isolation is considered a task for what stage of life?
Young adulthood
Time of integrity vs Despair is considered a task for what stage of life?
Late adulthood
Research shows that ___% of persons in the US age 65+ are addicted to alcohol
2-10%
__ out of 5 people who is being treated for a medical or psychiatric problem is also having problems with alcohol
1 out of 5
What are the differences between guilt and shame?
Shame: refers to what one believes about themselves internally
Guilt: has to do with behavior, refers to the feeling that they’ve done something wrong
What is the PAC of NAADAC?
the peer assistance committee
What is PAC’s objective?
to make treatment available for professionals and their families
to work with ethics committees to address impairment
provide education and support
What happens if a professional refuses to get treatment?
The counselor will be notified by mail from the PAC and will be told that an assessment will proceed if they do not comply and they will be reported to the ethics committee.
Not believing that there is a connection between one’s life problems and drug use or that one is addicted is called…
denial
_______ is the feeling of contradictory emotions or feelings at the same time.
ambivalence
What are the first steps when treatment is intiated?
Establish rapport, give an introduction to treatment, get a drug usage history, develop a plan with the client
An important skill of preventing relapse is…
Recognizing triggers and negative changes in thoughts, feelings, behaviors
What are some primary tasks in the “maintaining abstinence” stage?
Recognizing triggers that cause use, developing and using healthy coping skills, addressing the dangers or relapse,
What is the criteria for “early remission”?
Not meeting any of the SUD criteria (except craving) for 3 months to 1 year.
What is the criteria for “sustained remission”?
Not meeting any of the SUD criteria (except craving) for 1 year or longer
A condition where another individual is controlled by another individual. Acceptance, security, and love is hinged on how the addict wants you to behave
Codependence
How does drug use affect adolescents’ social and emotional development?
May create reliance on drugs rather than people to create relationships or as a primary relationship
They are usually academically under-achieveing and don’t feel the need to set goals
Rules, morals, values are usually avoided
How does drug use affect adolescents’ cognitive development?
Interferes with the maturation of abstract thinking
Development of reasoning an thinking skills is impaired
Problems with recall and short-term memory
More use of avoidance rather than language to deal with conflict
_____% of adolescent suicide had drug use as a factor
67%
What are some primary developmental tasks of adolescence?
- developing an identity separate from parents
- comfortableness with body image and psychology; ability to be intimate
- development of a sense of purpose
- develop social problem solving skills, controlling impulses, and self confidence; develop feelings of empathy and skills to maintain friendships
- ability to express oneself with abstract ideas and thoughts
What is sequential treatment?
A method of treating dual disorders characterized by treating one disorder followed by the second disorder
What is parallel treatment?
A method of treating dual disorders characterized by treating all disorders at the same time, involving two different treatment programs
What is integrated treatment?
A method of treating dual disorders characterized by a program that addresses all disorders
What barriers exist that prevent the identification and treatment of the elderly with SUD?
Ageism and the idea that problems that exist with an elder is only because of aging.
Professionals are often slow to identity substance use as a problem because many of the symptoms of substance use and aging are the same
The existence of both medical and psychiatric conditions can hamper the dx
What are some considerations for elderly people using prescription drugs?
Dementia and delirium is often diagnosed as alzheimer’s
Older people experience an increase in the severity of side effects of rx drugs (memory, daytime sleeping, and attention are affected)
A client over-identifying with a counselor of the same ethnic background is an example of …
transference
How a counselor feels about the client
countertransference
What are action responses?
probes, questions, confrontations
What aspects are important in assessing the degree of lethality in a suicide screen?
specific and current plans of suicide, plans to obtain tools for suicide, location, timeline, commitment
When is crisis counseling appropriate?
When there is a total loss of coping skills, extreme dysfunction
Therapeutic communities
residential treatments lasting 6-12 months
What are best practices around self disclosure?
Do not disclose if it will cause the client anxiety or may burden the client. Look at the benefits of disclosure for the client before speaking out.
What are some psychiatric symptoms that can be present with people with HIV?
insomnia, dementia, personality disorders, depression
Why is replacing an addiction not super helpful?
There is still compulsive behavior present, and that takes away control over one’s free choice.
What is the counselor’s primary tasks in motivational enhancement therapy?
help the client see the connection between their behavior and their goals.
help the client make self-motivational statements about change
What is a necessary factor in creating behavior change?
Intrinsic motivation
Opiates vs Opioids
Opiate – narcotic analgesic derived from an opium poppy (natural)
Opioid – narcotic analgesic that is at least part synthetic, not found in nature
one reason why gases are used as general anesthetics is because
their blood levels are easy to control because they can be exhaled
What is an example of a street drug that belongs to the cathinone family of drugs?
bath salts
What fraction of children with ADHD are prescribed methylphenidate?
2/3
Why is it problematic that cocaine remains classified as a narcotic by the U.S. Drug Enforcement Administration?
Narcotics are defined as a sleep-inducing drug
The salt form of psychostimulants is necessary for the insufflation (snorting) route because drugs must be _____ for proper absorption through membranes of the nose, throat, and lungs.
water soluble
methylecgonidine
byproduct of the freebase synthesis process
Sandro uses both alcohol and cocaine. What effect is this likely to have?
Production of the metabolite cocaethylene, and Na+ channel blocking in high concentration causing serious adverse effects and possibly death
Psychostimulants reduce hunger through actions in the _____.
hypothalamus
Amber uses cocaine during her pregnancy. What is the greatest risk that this poses to her unborn child?
Lower fetal growth and severe injury to the fetus including hemorrhage, ischemia and neuronal death caused by limited oxygen availability and nutrient delivery
What is a physiological change associated with methamphetamine usage that contributes to meth mouth?
Activation of the sympathetic nervous system which reduce salivation and causes dry mouth
Drugs that facilitate GABA neurotransmission may be effective in preventing psychostimulant relapse because they may _____.
interrupt associative addiction
The reinforcing features of psychostimulants rely on the activation of dopamine D2 receptors. For cocaine in particular, two other mechanisms are also responsible for its reinforcing properties: _____.
Dopamine D1 and serotonin receptors
What are three primary causes of tobacco-related deaths that occur each year?
Cancer, pulmonary disease, and cardiovascular disease
Heather smokes a cigarette. When will she likely experience peak absorption of nicotine?
7 minutes
How does the brain compensate for the repeated closing of nicotinic-receptor channels caused by nicotine binding?
Upregulation - the increased production of proteins
What is the link between cigarette smoking and stroke?
Nicotine causes arteries and blood vessels to narrow and constrict, increasing heartrate. This increases risk of stroke and diseases associated with impoverished blood flow.
A disruption of which enzyme would lead to the build up of alcohol in your body?
Alcohol dehydrogenase
Sean is a chronic user of alcohol. What types of changes on the GABAenergic would we expect to find in Sean’s brain?
Chronic administration reduces the number of GABA(A) receptors, receptors become less effected by alcohol, and alcohol produces a lower increase in endorphin levels resulting in less inhibition of GABA receptors
What hypothesis did Conger (1956) develop to explain habitual alcohol use?
Tension reduction hypothesis
Tyler finds himself in the emergency room after suffering from alcohol poisoning. Tyler’s BAC must have been at least _____.
.25
Barry, an alcoholic, suffers from alcoholic cardiomyopathy. What are the characteristics of this disorder?
Low cardiac output because of enlargement of the heart and dilation of the heart chambers. This leads to congestive heart failure, the inability to adequately supply blood to the body.
Derek, an alcoholic, was just diagnosed with Korsakoff’s syndrome. A possible cause and a symptom of this syndrome is _____.
Vitamin B deficiency (memory loss, false memories, poor insight, apathy, and tremor)
Gamma-hydroxybutyrate (GHB) is both a drug and a neurotransmitter that has what type of effects on the central nervous system (CNS)?
depressant
Why is GHB hard to detect?
It remains in detectable levels only for about 4-8 hours, and in the urine for 8-12
GHB is most associated with which NT?
GHB is a natural metabolite of GABA
Studies find that strong doses of GHB lead to _____.
increased blood pressure
What pharmacological characteristic do most inhalants have?
High lipid solubility for rapid absorption and penetration and rapid elimination.
The primary naturally occurring opioids found in opium are _____.
Morphine and codeine
How do opioids increase dopamine levels?
Primarily by binding to Mu opioid receptors on GABA neurons
Aside from its analgesic properties, opioids are also commonly used to treat _____.
Diarrhea, cough
The first step in the metabolism of alcohol is its conversion to
Acetaldehyde
An intense withdrawal syndrome after long-term heavy drinking that includes irritability, convulsions, and hallucinations would be considered
Delirium tremens
A blood alcohol level of _______% is lethal in half of the population, but because unconsciousness occurs at a BAC of around _______%, drinking is often stopped before the lethal level is reached.
0.45; 0.35
Buprenorphine vs methadone
Methadone is a full opioid agonist. It binds fully to mu-opioid receptors allowing it’s effects to be felt fully, and increase as the dose increases.
Buprenorphine is a partial mu-opioid agonist, so while it binds fully to receptors, it does not produce the same intensity of effect as methadone and other full agonists. The ceiling effect makes buprenorphine a safer option . Bup includes naloxone
The approach of a contingency management program involves reducing _______ while increasing _______, and is based on the idea that drug-taking is an operant response.
drug reinforcement; non-drug reinforcers
Ephedrine
active ingredient in ephedra; used to treat asthma by dilating bronchial passages by stimulating sympathetic branch of autonomic nervous system
Benzedrine
brand name for drug was used to treat stuffy noses due to colds (amphetamine)
Pseudophedrine
ingredient in cold medicines that can be used to make methamphetamine
synthesis
the forming of neurotransmitter by the action of enzymes
enzyme
large molecule that assists in either the synthesis or metabolism of another molecule
metabolize
to break down or inactivate a neurotransmitter through enzymatic action
