Clinical Approach to Substance Use Disorders Flashcards
What is a substance use disorder?
- Include name of specific substance
- Maladaptive patterns of substance use
- Impairment in occupational, physical, social functioning
- Specify as mild, moderate, severe
What is substance induced disorders?
- Includes intoxication and withdrawal
What is addiction?
- An overwhelming involvement with seeking and using drugs or alcohol and a high tendency toward relapse after substance withdrawal
What is at risk drinking in men and women?
- Men: >14 drinks per week or >4 drinks per occasion
- Women: >7 drinks per week or >3 drinks per occasion
What is defined as moderate drinking?
- Men: 2 or fewer drinks per day
- Women and people over 65: 1 or fewer drinks per day
How many hospital admissions are related to alcohol?
- 40%
What from someone’s childhood might cause them to abuse alcohol?
- Environmental stressors
- ADHD
- Conduct disorder/antisocial personality disorder
What are some causes of alcohol abuse?
- Childhood history
- Psychodynamic factors
- Social/Cultural factors
Who do we see have a high rate of alcohol abuse?
- Native americans
- Non African American races
What race has low rates of drinking problems? Why?
- Asian races
- Genetically mediated inefficiency in metabolizing and excreting acetaldehyde
What is alcohol abuse disorder?
- Problematic pattern on use leading to clinically significant impairment or distress, as manifested by at least two of the following occuring in a 12 month:
1. Alcohol taken in larger amounts over a longer period of time than was intended
2. Persistent desire or unsuccessful efforts to cut down or control use
3. Excessive amount of time spent to obtain alcohol or recover from its effects
4. Cravings
5. Recurrent use despite failures to meet obligations
What is seen in someone with alcohol use disorder?
- Continued use despite negative consequences
- Giving up social, occupational, or recreational activities because of alcohol use
- Recurrent use in hazardous situations
- Continued use despite knowing it’s a problem
What is the tolerance seen in alcohol use disorder?
- Need for increased amounts to achieve desired effect
- Diminished effect with continued use and the same amount
What are some signs of withdrawal in alcohol use disorder?
- Autonomic hyperactivity
- Increased hand tremor
- Insomnia
- Nausea/vomiting
- Hallucinations
- Psychomotor agitation
- Seizures
What is the clinical presentation of someone with alcohol abuse disorder?
- Solitary drinking and rationalization the need to drink
- Daily or frequent drinking to function
- Loss of control over drinking; inability to stop or reduce drinking. Attempts to conceal drinking
- Violence associated with drinking, defensive or hostile when confronted about drinking
- Neglect of food intake, physical appearance, and hygiene
- Nausea and vomiting, shaking in the morning, numbness and tingling in extremities, confusion
What is the screening like for alcohol use disorder?
- CAGE questions
- Have you ever felt you ought to cut down on your drinking?
- Do you get annoyed at criticism of you drinking or drug use?
- Do you ever feel guilty about your drinking or drug use?
- Do you ever take an early morning drink first think in the morning to get the day started or to eliminate the ‘shakes’?
What are some alcohol induced doisorders?
- Intoxication
- Withdrawal
- Delirium
- Dementia
- Amnestic DO
- Psychotic DO
- Mood DO
- Sexual dysfunction
- Sleep DO
What is the clinical presentation of alcohol intoxication?
- Slurred speech
- Loss of coordination
- Unsteady gait
- Nystagmus
- Impaired attention or memory
- Stupor or coma
What is the clinical presentation of mild alcohol intoxication?
- Mild: overconfidence, mood swings, increased pain threshold, nausea/vomiting
What is the clinical presentation of severe alcohol intoxication?
- Severe: hypothermia, tachycardia, dilated pupils, slow respiration, increased intracranial pressure
What is the treatment for alcohol withdrawal?
- Detox order set:
- Benzodiazepine
- Antipsychotics
- Fluids
- Vitamins
- Restraints
What is the treatment for alcohol abuse?
- Wait it out
- Give IV thiamine in ER to prevent Wernicke’s encephalopathy and Korsakoff’s syndrome
What are some alcohol induced mood disorders?
- Depression
- Get from a good history, ask about moods prior to beginning alcohol abuse or during significant period of time while sober, family history
What guides the treatment for alcohol dependence?
- Guided by severity of the condition, previous treatment response or failure, the presence or severity of co-occurring psychiatric or medical conditions, and patient preference
What is the treatment for alcohol dependence?
- Encourage complete abstinence and lifestyle modification
- Psychotherapy: why is the person drinking?
- Behavioral therapy: Cognitive behavioral therapy
- Residential care: 30-60-90 day programs
- AA
- Halfway houses
- Community rehab programs
What is acamprosate? How is it used in alcohol dependence treatment?
- Used to maintain abstinence in alcoholics following withdrawal
- Reduces the voluntary ingestion of alcohol
- Does not treat withdrawal, prevent intoxication, interact with, or less any of the harmful effects of alchol
How does acamprosate work?
- Inhibits GABA in the CNS and antagonizes the receptor in a similar way to alcohol
