Chap. 11 - Substance-related disorders Flashcards
According to psychodynamic theory, addicts are stuck in the _____ stage of development
Oral
Positive reinforcement, such as euphoria and disinhibition, is mediated by which NT pathway?
DA
Negative rewards, such as anxiety and dysphoria, are mediated by which NT pathway?
GABA
Reinforcement occurs in the reward center of the brain, which is comprised of the _____ _____ _____ and the _____ _____.
Ventral tegmental area
Nucleus accumbens
DA release within the reward center is enhanced by the further release of morphine-like NTs called _____.
Neuropeptides
Name two neuropeptides
Enkephalins
Beta-endorphins
__% of psych patients are also experiencing substance use or dependence
50%
Individuals with SZO are __ times more likely than the general population to experience SUD, and those with BIP are __ times more likely.
SZO 4x more likely
BIP 5x more likely
The most commonly abused drug is _____
Alcohol
Gender with higher rate of substance abuse
Men
Ethnicities with highest and lowest rates of SUD
African Americans, Hispanics, and Native Americans are highest
Asian-Americans are lowest
__% of all traffic deaths and __% of all crimes occur under the influence of alcohol
55% of traffic deaths and 50% of crimes
Lifetime risk for alcohol dependence is __%
15%
Family hx of ___ and ___ are predispositions to SUD
MDD
SUD
The most common screening tool alcohol abuse is the ____ screen, which stands for…
CAGE Ever tried to cut down? Get annoyed when people talk to you about your drinking? Do you feel guilty about your drinking? Do you need an eye-opener?
Scoring the CAGE
0-2 - mild to moderate risk
3-4 high risk
Substance dependence is defined as 3 or more of the following in a 12-month period:
Tolerance Withdrawal Using larger amounts than intended Cravings or an inability to cut down Large amounts of time spent scoring, using, or recovering Decreased activities due to use Using despite consequences
Substance abuse is defined by (4)
Maladaptive pattern of use
Repeated failure to fulfill role obligation
Using in a dangerous situation (like driving)
Continued use despite consequences
Scoring the CIWA:
0-8?
9-15?
16+?
0-8 - mild withdrawal
9-15 - moderate withdrawal
16 or more - severe withdrawal and possible DTs
Tolerance
Need for increased quantities of drug to achieve the desired effects
Withdrawal
Behavioral and physiological changes occurring when serum or tissue levels of drug decline
Early partial remission
One or more, but less than full, criteria have been met for at least one month but less than 12 months
Sustained partial remission
One or more, but less than full, criterial have been met for 12 months or more
Early full remission
No criteria have been met for more than one month but less than 12 months
Sustained full remission
No criteria have been met for 12 months or more
Withdrawal is defined as having at least two of these eight symptoms within hours or days of cessation…
Tremor Insomnia Autonomic hyperactivity N/V Hallucinations or illusions Psychomotor agitation Anxiety Seizures
Four commonly elevated lab values in the alcoholic
GGT
MCV
AST
ALT
Drug class used for management of alcohol withdrawal?
BZO
Aversion treatment may involve prescribing…
Disulfiram (antabuse)
Is addiction an individual or a family disease?
A family disease
Who needs help - the addict, the family member, or both?
Both
