[CLMD CIS] Clinical Approach to Substance Abuse Disorders [Cooley] Flashcards
What is Physical Dependence vs Addiction?
Physical Dep –> Denotes normal physiologic adaptations of the body to the presence of an opioid. (Isnt used to diagnose addiction)
Addiction –> is a primary, chronic disease of brain reward motivation, memory and related circuitry (Pathologically pursuing reward and relief by substance use)
What is reward deficiency syndrome?
A dopamine system malfunction –> leads to vulnerability and then to addiction.
(Makes them compulsive –> ADDICTION [not physical dep])
What are some other considerations besides the dopamine reward system that influence the development and maintaince of addiction?
Learning and Memory (Hippocampus)
Emotional Regulation (Amygdala)
[Neurobiological Circuitry is the ultimate common pathway for addictive behaviors]
Are there common molecular mechanisms and genetic vulnerability to compulsive behavior and additiciton?
Yes!
What are some characteristics of a Substance Use Disorder?
Using Large Amounts for a longer than intended time
Persistent Desire
Great deal of time obtaining, using, or recovering
Craving
Fail to fulfill major roles
persistent social or interpersonal problems
Use in physically hazardous situations
Tolerance
Withdrawl (not seen when using PCP)
For Substance Use Disorders what do these severities entail?
Mild
Moderate
Severe
Mild –> 2-3 Symptoms
Moderate –> 4-5 Symptoms
Severe –> 6+ Symptoms
When someone has a substance use disorder with the following specifiers what is meant?
In Early Remission
In Sustained Remission
In Controlled Environment
Early Remission –> no criteria for 3-12 Months
Sustained Remission –> no criteria for +12 months
In Controlled Environment –> access to substance restricted (Jail)
What are the guidelines for diagnosing a Substance-Induced Mental Disorder?
– Has a significant symptomatic presentation of a relevant mental disorder
– ***the disorder developed during or within 1 month of a substance intoxication or withdrawal***
– the involved substance/med is capable of producing the mental disorder
- (The last two must have History, PE, or Lab findings to prove it)*
- –* Not explained by a indep mental disorder (didnt precede the intoxication / persisted after the intoxication for at least 1 month)
– Does not occur during delirium
– causes distress/impairment in social and other areas of functioning
What is Intoxication?
Reversible substance specific syndrome due to recent ingestion of a substance
(Does not apply to tobacco)
What is Withdrawal?
Substance specific syndrome problematic behavioral change due to stopping or reducing prolonged use
(physiological and cognitive components)
What are some drugs that DONT cause withdrawal?
PCP, other Hallucinogens, Inhalants
What is Neuroadaptation?
Underlying CNS changes that occur following repeated use –> person develops tolerance and/or withdrawal
What is Tolerance?
Need to use an increased amount to achieve a desired effect
or
Markedely diminished effect with continued use of the same amount of the substance
What are some options for treating Sustance Use Disorder patients?
Hospitilazation (for high risk pts)
Residential treatment unit (for pts who need restrictions)
Outpatient program (Low/No risk pts)
When thinking of treatment options which option DOESNT work?
Which ones should you recommend in its place?
Aversion Therapies!
Alcholics Anonymous
Narcotics Anonymous
CBT
Therapeutic Comm
Motivation Interviewing in Clinic
What is a blood alcohol level that would classify a pt as Intoxicated with Alcohol?
0.08 g/dl
When a pt is going through Alcohol Withdrawal what is seen:
Early
24-48 Hrs
48-72 hrs
Early –> anxiety, irritability, tremors, HA, insomnia
24-48 Hrs –> Seizures (Grand Mal)
48-72 hrs –> Withdrawal Delirium
What is Delirium Tremens
occurs 3-10 days after last drink
Agitation, Global Confusion, Disorientation, Hallucinations, Fever, HTN, Diaphoresis, Autonomic Hyperactivity.
Can progress to CV collapse
MEDICAL EMERGENCY!!!
What is the form we use to grade alcohol withdrawal?
Treatment?
CIWA
Benzos/Anticonvulsants/Thamine
What are some medications for Alcohol Treament?
Disulfram (little evidence for use)
Naltrexone
Acamprosate
When giving Benzos and Barbituates to pts with intoxication problems what are some considerations?
The more lipophillic and short duration of action –> the more ADDICTING the drug
Can also cause withdrawal from the drugs
(BENZOS also can cause Alzhemiers and Dementia with long term use)
If needing to do a rapid taper for Intoxication disorders what are some better options than Benzos and Barbiturates?
Carbamezapine/Valproic Acid –> good for rapid taper
Gabapentin and Tizanidine (highly effective)
What are some Opiate use disorder treatment options?
CD treatment –> support, education, etc
Meds –> Methadone, Naltrexone, Buprenorphine
Methadone (an Opioid substitute) cannot be use with what?
Benzos and other CYP3A4 substrates
Cocaine abuse can lead to what from a hypermetabolic state?
Rhabdomyolysis with Compartment Syndrome
What are your treatment options for Stimulant Use Disorder?
No Medications
Narcotics Anonymous
What are some treatment options for Tobacco Use Disorder?
CBT
Agonist Substitution therapy (Nicotine Gum/Transdermal Patch)
Buproprion or Varenicline
If you have a patient who comes in with tachycardia, sweating, muscle spasms, and an extremely high fever – what substance did the person probably overdose on?
Ecstacy or MDMA
If a patient comes in with Ataxia, Dysarthria, Nystagmus (vertical and horizontal), paranoid delusions, hallucinations – what did the person probably take?
PCP
What are the 3 benzodiazepines that are only metabolized through glucoronidation in the liver?
Oxazepam, Temazepam, Lorazepam
Is Opioid withdrawal life threatning?
No
Which drug is a High Risk medication, an Opioid substitution – that can be deadly if taken with a benzo. Can cause QTC prolongation, and cant be used with any other CYP3A4 substrate?
Methadone
(it is not used to treat pain)
