Cooley Addiciton Flashcards
What is a good definition for addiction?
Primary, chronic disease of brain reward, motivation, memory and related circuits. Dysfunction in these circuits leads to characteristic biological, psychological, and behavioral dysfunction. The pursuit of the reward by whatever means, substance abuse and other behaviors, is the problem.
Reward deficiency syndrome is a result of what?
Dopamine system malfunction
Now, just because we say the dopamine system is malfunctioning, what are 2 other contributing structures and their relevance to addiction?
Hippocampus with memory and learning
Amygdala with emotional regulation
What is very different about tolerance and physical dependence?
These are normal physiological adaptations of the body in the presence of an opioid and even when people are taking it for a health condition. They are not sufficient to diagnose addiction
3 very common comorbidities in substance abuse?
Antisocial PD
Depression
Suicide
How do we classify mild, moderate, and severe substance use disorder?
Mild - 2-3 symptoms
Moderate - 4-5 symptoms
Severe 6 or more symptoms
5 diagnostic criteria for substance abuse?
- Disorder represents a clinically significant symptomatic presentation of a relevant mental disorder
- History, PE and labs show the disorder developed during or within 1 month of substance intoxication or withdrawal of a med and the med is capable of producing the mental disorder
- The disorder is not better explained by an independent mental disorder
- The disorder does not occur exclusively during the course of a delirium
- The disorder impairs the person every day life
What drug does intoxication not apply to?
What 3 drugs does withdrawal not apply to?
Tobacco
PCP, hallucinogens, inhalants
3 options of where to treat substance abuse?
Hospital
Residential treatment unit
Outpatient program
4 non pharm treatment options for substance abuse
Detox, motivational interviewing, alcoholics and narcotics anonymous, behavior therapy
What is the intoxication level of alcohol?
Intoxication signs?
Withdrawal signs?
0.08
Impaired judgement and poor coordination all the way to big time depressant of everything.
Early with anxiety, irritable, tremor, etc. to seizures to delirium
What is the most severe manifestations of alcohol withdrawal?
What is the hallmark of this manifestations?
When does it occur?
Delirium tremens
Global confusion and autonomic hyperactivity (sympathetic)
3-10 days after last drink
What total score on the clinical institute withdrawal assessment for alcohol indicates more severe withdrawal?
Over 10
3 pharm treatments alcohol withdrawal?
Benzos (gaba agonist)
Anticonvulsants, like carbamazepine and valproic acid
Thiamine
4 things for outpatient alcohol Use disorder treatment?
Alcoholics Anonymous
Disulfiram - more harmful then good
Naltrexone
Acamprosate