Chapter 32: Substance Use Disorders

Question 1

Knowledge of abuse needed by health care providers​

Answer 1

Diagnosis and treatment of acute toxicity​

Diagnosis and treatment of secondary medical complications of drug abuse​

Facilitating drug withdrawal​

Providing education and counseling to maintain long-term abstinence

Question 2

drug abuse

Answer 2

Using a drug in a fashion inconsistent with medical or social norms​

By this definition, drug abuse is culturally defined. Thus, what is considered drug abuse may differ in individual cultures. For example, in the United States, moderate consumption of alcohol is not usually considered abuse. In contrast, any ingestion of alcohol may be considered abuse in some Muslim societies. Furthermore, cultural definitions of abuse can change over time. For example, when psychedelic use first became popular in America, these agents were legal and their use was not generally disapproved. However, when use of psychedelics became widespread, our societal posture changed and legislation was passed to make the manufacture, sale, and use of these drugs illegal.

Question 3

drug addiction

Answer 3

A chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences​

Addiction is a very complex phenomenon that includes social, psychological, genetic, and environmental components.​

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Note that nowhere in this definition is addiction equated with physical dependence. Although it is related to addiction, physical dependence is neither necessary nor sufficient for addiction to occur.​

Question 4

tolerance

Answer 4

A state in which a particular dose elicits a smaller response than it did with initial use. As tolerance increases, higher and higher doses are needed to elicit desired effects.​

Question 5

cross-tolerance

Answer 5

A state in which tolerance to one drug confers tolerance to another.​

Question 6

psychologic dependence

Answer 6

An intense subjective need for a particular psychoactive drug.​

Question 7

physical dependence

Answer 7

A state in which a withdrawal syndrome will occur if drug use is discontinued.​

Question 8

cross-dependence

Answer 8

The ability of one drug to support physical dependence on another drug.​

Question 9

withdrawal syndrome

Answer 9

A constellation of signs and symptoms that occurs in physically dependent individuals when they discontinue drug use.

Question 10

Diagnostic Criteria for Substance Abuse Disorder

Answer 10

Continued use of a substance despite significant substance-related problems​

Change in brain circuitry that persists despite detoxification​

Diagnosis of a substance abuse disorder is based on behaviors related to the continued use of a substance​

Physical dependence can exist without addiction, such as in cancer patients that are taking high doses of opioid painkillers.

Question 11

factors that contribute to drug abuse

Answer 11

Reinforcing properties of drugs -Drugs can be reinforcing through induction of a pleasurable state or reduction of a negative state (stress/anxiety).
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Physical dependence -More dependence, worse withdrawal ​

Psychologic dependence​

Social factors​ -Peer pressure​

Drug availability​

Vulnerability of the individual

Question 12

3 things that happen when a person tries drug for first time

Answer 12

1. Try drug and never use it again ​
2. Try drug and use occasionally ​
3. Try and have compulsive use

Question 13

Neurobiology of Addiction

Answer 13

Voluntary users can become compulsive users as a result of molecular changes in the brain​:

Reward circuit normally serves to reinforce behaviors essential for survival​

Major transmitter is dopamine​

Addictive drugs cause release of dopamine, activating the reward circuit​

Activation of reward circuit encourages repetition of behavior​

The amount of dopamine released by addictive drugs may be 2 to 10 times the amount released by natural stimuli.

Question 14

Principles of Addiction Treatment

Answer 14

With therapy, 40% to 60% of addicted individuals can reduce drug use​

Ideal goal of treatment is complete cessation of drug use, but any reduction of use is beneficial​

Sustained moderation is very difficult for opioid, cigarette, and alcohol abuse​

Recovery is a prolonged process requiring multiple treatment episodes

Question 15

The Controlled Substances Act​

Answer 15

Comprehensive Drug Abuse Prevention and Control Act of 1970​

Record keeping​

Drug Enforcement Agency Schedules I to V​

Prescriptions​

Labeling​ -
Schedule 2,3,4 “federal late prohibits transfer of this drug to any persons that it is not indicated for”​ Need DEA to prescribe schedule 2 drug

State laws​ -may be more restrictive

Question 16

A patient states that the dose of oxycodone he currently receives does not provide the same pain relief as it used to. The nurse understands that the patient has developed what?​

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Physical dependence​

Tolerance​

Withdrawal syndrome​

An addiction

Answer 16

Answer: B​

Rationale: Tolerance occurs with regular drug use and is a state in which a particular dose elicits a smaller response than it did with prior use.

Question 17

A patient is in treatment for alcohol addiction and has relapsed since his last visit. The nurse knows this does not mean treatment has failed. Why?​

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Relapse indicates pharmacologic treatments are working. ​

Addiction is a chronic, relapsing disease that takes time to treat.​

Alcohol addiction is particularly difficult to treat.​

Patients often relapse during initial treatment.​

Answer 17

Answer: B​

Rationale: Addiction is a complex phenomenon that will have causes and consequences unique to each individual’s experience of the disease. Additionally, neurological remodeling that occurs during treatment takes time.