Clinical approach to substance abuse disorders

Question 1

What is physical dependence?

Answer 1

• normal physiologic adaptations of the body to the presence of an opioid.
• Physical dependence can be a result of good medical care as someone that needs chronic pain relief, they are physically dependent.

Question 2

What is addiction in comparison to physical dependence?

Answer 2

• Essentially the take away is that addiction has an underlying genetic component, they are responding to the stimulus differently.
• physical dependence is relieving symptoms outside of the brain circuitry system.

For example alcohol to deal with depression is different then an addiction to alcohol solely because your circuitry in your brain is off.

Question 3

What is reward deficiency syndrome?

Answer 3

• dopamine system malfunction
• malfunction is complicit in vulnerability to addiction
• helps us understand “compulsive” use that characterizes addiction vs physical dependence

Question 4

What is addictophrenia spectrum?

Answer 4

A strictly conceptual model used for risk assessment and treatment planning.

• the biggest risk was chronic psychosocial trauma starting at a young age

The younger the kid the worse off they are.

Question 5

(TEST) Substance use disorder diagnostic criteria

Answer 5

• using larger amounts for longer time
• persistent desire or unsuccesful attempts to cut down or control use
• great deal of time obtaining, using, or recovering
• craving
• fail to fulfill major roles (work, school, home)
• persistent social or interpersonal problems caused by substance abuse
• important social, occupational, recreational activities given up for reduced
• use in physically hazardous situations
• use despite physical or psychological problems caused by use
• Tolerance
• withdrawal

Question 6

What does substance use disorder severity depend on?

Answer 6

• # of diagnostic criteria documentedmild: 2-3 symptoms

Moderate: 4-5 symptoms

Severe: 6 or more symptoms

Question 7

What are the specifiers of substance use disorder?

Answer 7

• In remission: no criteria >3 months <12 months (except craving)
• In sustained remission: no criteria >12 months (except craving)
• In a controlled environment: access to substance restricted (ex. Jailed)

Question 8

What is a substance induced mental disorder?

Answer 8

The disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication. Note: that the medication has to be known to have these side effects.

Question 9

What is neuroadaptation?

Answer 9

refers to underlying CNS changes that occur following repeated use such that a person develops tolerance and or withdrawal.

Question 10

He made a big stink about the benefits of alcoholics anonymous and narcotics anonymous. What are the benefits?

Answer 10

1. patients get through the first 90 days without us more often then those that dont go.
2. they have less recurrence or relapse then those that dont go.

Question 11

What is the early symptoms of alcohol withdrawal (0-24 hours)?

Answer 11

anxiety, irritability, tremor, HA, insomnia, nausea, tachycardia, HTN, hyperthermia, hyperactive reflexes

Question 12

What are the symptoms of alcohol withdrawal around 24-48 hours?

Answer 12

seizures usually grand mal

Question 13

What are the symptoms of alcohol withdrawal around 48-72 hours?

Answer 13

Delirium Tremens

altered mental status, hallucinations, marked autonomic instability, life threatening.

Question 14

What is Delirium Tremens?

Answer 14

• occurs 3-10 days following last drink.
• agitation, global confusion, disorientation, hallucinations, fever, HTN, diaphoresis, and autonomic hyperactivity
• global confusion is the hallmark of Delirium Tremens.

Question 15

TEST - CIWA

• Clinical Institute Withdrawal Assessment for alcohol

What is this for?

Answer 15

Determining the severity of alcohol withdrawal a score >10 indicates severe.

Question 16

What are the three benzodiazapines that do not involve liver metabolism?

Answer 16

Oxazepam, Lorazepam, Temazepam

• metabolism not affected by age/hepatic insufficiency

Question 17

Is opioid withdrawal fatal?

Answer 17

No, not if it is only opioids but patients have said it is so aweful they wish they would die.

Question 18

TEST - What is the complication with methadone (high risk) treatment?

Answer 18

• deadly with benzodiazepine use
• frequently causes QTC prolongation (this is how he worded it, it is just prolonged QT interval)
• dangers increased when used with another 3A4 substance.

Question 19

If you give methadone and have to use an opioid we want to use one that is not a 3A4 substrate, what is the only one that fits this criteria?

Answer 19

Morphine - which is why so many freaking hospitals use it.

Question 20

Stimulants - Your the life of the party until your not

what are the symptoms?

Answer 20

tachycardia, papillary dilation, HTN, N/V, diaphoresis, chills, weight loss, chest pain, cardiac arrhythmias, confusion, seizures, coma, hyperthermia…

Question 21

What are the results of chronic intoxication with stimulant use?

Answer 21

psychosis - sometimes with severe paranoia

• affective blunting, fatigue, sadness, social withdrawal, hypotension, bradycardia, muscle weakness.

Question 22

MDMA (XTC or Ecstacy) what is the complications we need to worry about?

Answer 22

Extremely High Fever

• tachycardia, sweating, muscle spasms

Question 23

What is the symptom that is board relevant for overdose of PCP?

Answer 23

ataxia, dysarthria, Nystagmus (vertical and horizontal)