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Chemical Dependency > Important course concepts > Flashcards

Important course concepts Flashcards

1
Q

Controlled Substances Act of 1970

A

First measure to control drug use.

Created “schedule” system, rated based on abuse potential and medical use.

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2
Q

Schedule 1

A

high abuse potential, no accepted medical use.
Examples: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote

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3
Q

Schedule 2

A

High abuse potential, psychological or physiological dependence liability, medically used
Examples: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin

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4
Q

Schedule 3

A

Some abuse potential
Examples: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone

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5
Q

Schedule 4

A

Less abuse potential

Examples: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol

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6
Q

Schedule 5

A

Least abuse potential, over the counter drugs

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7
Q

Dispositional tolerance

A

The body speeds up the metabolism of a drug to eliminate it by up-regulating enzyme production

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8
Q

Pharmacodynamic tolerance

A

Down regulation of receptors.
Nerve cells become less sensitive to the effect of a drug. Body can also produce antagonist to the drug. For example: use of opioids causes the brain to make fewer opioid receptor sites

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9
Q

Behavioral tolerance

A

The brain learns to compensate for the effects of the drug by using unaffected parts. “overriding” the effects of the drug with will power.

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10
Q

Reverse tolerance

A

In response to destruction of tissues from prolonged use, the user becomes more sensitive and less able to handle moderate amounts of the substance.

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11
Q

Acute tolerance (tachyphylaxis)

A

Brain and body begin to adapt instantly in response to initial use of a substance.

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12
Q

Select tolerance

A

Body develops tolerance to mental and physical effects at different rates. Dose to reach emotion high is not the same as the physical level of tolerance.

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13
Q

Inverse tolerance (kindling)

A

A person becomes more sensitive to the effects of a drug as the brain chemistry and neuron pathways adapt to the drug’s effects.

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14
Q

Cross tolerance

A

Developing tolerance to one drug increases tolerance to other drugs with similar biological pathways as well

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15
Q

Non-purposive withdrawal

A

Characterized by objective physical signs that are a direct result of developing tissue dependence

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16
Q

Purposive withdrawal

A

A false portrayal of severe withdrawal symptoms by an addict to gain drugs from prescribers.
Can also be caused by psychic conversion reaction: emotional expectation of physical effects.

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17
Q

Protracted withdrawal

A

Flashback or recurrence of the addiction withdrawal symptoms triggers heavy craving even after detox is complete. Caused by environmental triggers.

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18
Q

“Levels of use” progression

A

Abstinence, initial contact, experimentation, social/recreational, habituation (integrated use), abuse (excessive use), addiction

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19
Q

Stages of recovery

A

Withdrawal, honeymoon, the Wall, adjustment, resolution

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20
Q

Withdrawal

A

0-15 days after use
Low energy, need more sleep
Difficulty concentrating, cravings, short term memory problems
Hostility, confusion, fear, depression, doubt, shame

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21
Q

Honeymoon

A

16-45 days after use
High energy, poorly directed behavior, secondary drug use
Shorter attention span, denial about relapse potential
Optimistic and overly confident
Desire to return to “normal” may cause conflicts with family members

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22
Q

The Wall

A

46-120 days after use
Low energy, apathetic, sleep disturbances, discontinuation of recovery behaviors
Romancing use, rehearsal of relapse, increased cravings
Anxiety, depression, fatigue, boredom, irritability, anhedonia
Blaming, devaluation of progress

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23
Q

Adjustment

A

121-180 days after use
Return to risky situations, decrease in recovery /abstinence promoting behaviors
reduced thoughts of use and cravings
reduced depression, anxiety and irritability but continued boredom and loneliness
Resistance to assistance with relationship problems

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24
Q

Resolution

A

181+ days after use
Emergence of other excessive use behaviors
Questions need for long term support
Emergence of emotional material, boredom with abstinence

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25
Q

Pre-treatment stages

A

Denial, ambivalence, motivation (extrinsic), motivation (intrinsic) readiness for change, readiness for treatment

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26
Q

Treatment-related stages

A

De-addiction, abstinence, continuance, integration and identity change

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27
Q

Recovery model

A

Self-directed, individualized, person-centered, empowerment oriented, holistic, non-linear, strengths-based, peer supported, respectful, emphasizes personal responsibility, and fosters hope.

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28
Q

Solution Focused

A

Builds on clients strengths, client-identified goals, assumes client is cooperating, looks for exceptions, explores hypothetical frames, looks for clues for possible solutions

29
Q

EARS

A

Elicit, Amplify, Reinforce, Start Again

30
Q

Solution focused style questions

A

What is your goal?
How did you stay clean for the time before you relapsed?
How will you know when things are going better?
Tell me about a time when you felt more in control of your drug use

31
Q

Disorders with high substance abuse comorbidity

A 
Antisocial personality disorder/conduct disorder
affective disorders
anxiety disorders
PTSD
ADHD
32
Q

Prioritizing Treatment Tasks

A

Safety&raquo_space; Stabilization&raquo_space; Law&ethics&raquo_space; Development/growth&raquo_space; Relapse prevention

33
Q

Considerations for multiple disorders

A

Safety, stabilization, and maintenance.
Which came first? What should be treated first/concurrently?
Will treatments interact? Can they be integrated?

34
Q

Prevention strategies

A

Reduce Supply: interdiction of drug supplies, legislation against use, and legal penalties for possession, distribution, and use
Reduce Demand: treating drug dependency, fostering prevention through education, emotional development, moral growth
Harm reduction: promoting temperance, providing medication replacement treatment, providing resources to lessen the consequence of abuse, and decriminalization/legalization of use.

35
Q

Primary prevention

A

Tries to anticipate and prevent initial drug use.
Programs target young people with no use experience:
promote abstinence, develop skills to refuse drugs, delay the age of first use
**receives the least amt of federal, state, local funding

36
Q

Secondary prevention

A

Seeks to stop drug use once it has begun, targets nondependent users
Prevent further experimentation, social/recreational or habitual use
Adds intervention strategies to education and skill building
Barriers: adverse effects take time to manifest, drug use is difficult to detect in the early stages.

37
Q

Tertiary prevention

A

Tries to stop further damage from habituation, abuse, and addiction and to restore abusers to health.
Drug abuse treatment and intervention/drug diversion techniques
Intensive, comprehensive treatment for dependent users

38
Q

The goals of motivational enhancement

A

Use connection with client
Assess readiness to change
Connect the pain in their life with AOD use
Explore benefits and problems of AOD use
Give feedback that is direct, but not harsh/punitive
Offer options for change

39
Q

Stages of change

A

Pre-contemplation» Contemplation» Determination&raquo_space; Action»Maintenance» Permanent Exit OR relapse back to contemplation

40
Q

Principles of motivational interviewing

A

Express empathy
Roll with resistance: use to help explore the clients ideas
Avoid argumentation
Develop discrepancy: help clients recognize discrepancies between where they are and where they want to be
Support self-efficacy

41
Q

Pre-contemplation

A

Not considering possibility of change, no acknowledgement of problems, surprise rather than defensiveness at confrontation, needs info and feedback to raise awareness about problem/need for change

42
Q

Contemplation

A

Some awareness of problem, considers change and rejects it, ambivalent about problem.
Task: tip the balance in favor of change

43
Q

Determination

A

Motivated client

Task: make change strategy that is acceptable, accessible, appropriate, and effective

44
Q

Action

A

Stage most assoc. with counseling
Person actively participates in behaviors to bring about change
Goal is to produce change in the problem areas

45
Q

Maintenance

A

Prevent relapses
Try to maintain changes made in action stage
May require different skills and strategies than those used in previous stages

46
Q

Relapse

A

Normal part of recovery

Help client avoid discouragement, continue contemplation, renew determination, and resume action/maintenance efforts

47
Q

Motivational interviewing definition

A

Non-confrontational style to involve clients in their own recovery process and helps them change ambivalence about drug use into motivation to make changes that lead to recovery
Uses: collaboration, evocation, autonomy

48
Q

De-emphasis on labels
Emphasis on personal choice and responsibility
Objective evaluation but prompts client to share own concerns
Resistance is not unidirectional, influenced by therapist’s behavior
Resistance is met with reflection
Goals and changes are negotiated

A

Motivational interviewing characteristics

49
Q

OARS

A

Open questions, Affirmation, Reflective Listening, Summarizing

50
Q

Substance Dependence Criteria

A

Tolerance, withdrawal
Substance taken in larger amounts/ over longer periods of time than intended
Persistent desire/unsuccessful efforts to cut down
Great deal of time spent in activities necessary to obtain substance/recover from effects
Important activities given up/reduced
Use continued despite physical/psychological problems

51
Q

Universal prevention

A

Applied to everyone in an eligible population, targets general public

52
Q

Selective prevention

A

Focus on individuals or subgroups of the population whose risk of developing problems of AOD dependence is above average
Distinguished by: age, gender, family history, SES, past experiences or behavior

53
Q

Indicated prevention

A

Apply to persons who exhibit specific risk factors or conditions that individually identify them as being at risk for developing AOD abuse

54
Q

Indications of CD

A

More than one DUI, AOD use taking higher priority, using more than intended, conflicts with others around AOD use, AOD use related health consequences, daily use

55
Q

Indications assessment for CD is warranted

A 
History of use reported
Suspected use reported
Signs/symptoms of substance intox./withdraw. 
Symptoms of mood disorder 
Mild hallucinations reported 
Sleep disturbances
Paranoia present 
Financial/employment problems 
Domestic violence or discord reported 
Legal problems
56
Q

Johari window

A
  1. Open self: known to self and others, public knowledge
  2. Hidden self: known to self but not to others; secrets
  3. Blind self: Known to others but not seen by self; blind spots
  4. Unknown self: subconscious, the future, dreams: unknowable to humans
57
Q

Addictive thinking

A

Having a “right”: entitlement, privileges
Blaming: not taking responsibility
Overgeneralization
Filtering: focusing on a single aspect of a situation
Emotional reasoning: “I feel therefore I am”
Heaven’s reward thinking
Control fallacy: all powerful or victim
Polarization
Needing to be right
Fallacy of fairness: things aren’t fair when they go wrong

58
Q

Cycle of addictive relationships

A

Denial: “it’s not so bad”
Discomfort/pain
Confrontation
Key to moving forward is taking responsibility to contributions

59
Q

Transitioning from addictive to healthier relationships

A

Individuation/self-differentiation
Self-resolution: “I am enough”
Us, We: two contributing members of the relationship
Developing a greater cause

60
Q

Drama triangle

A

Persecutor (bad guy): angry, critical, demanding, blames victim
Rescuer (good guy): avoids own needs in favor of those of the victim. Enables victim behavior, keeps them in dependent role.
Victim: feels angry, helpless, and incompetent. Looks for rescuer and persecutor to maintain role.

61
Q

Metabolism and half-life

A

Age, race, heredity, gender, health status, privilege, emotional state, drug interactions, body composition, hormones, enzyme inhibition

62
Q

Sobriety vs. recovery

A

Sobriety: process of completely abstaining from drugs and alcohol throughout life. Must undergo the recovery process in order to successfully maintain their sobriety.

Recovery: Process that involves restructuring life, and finding sustainable alternatives to AOD use and healthier cope mechanism. Often requires multiple rounds of treatment and continued engagement in support systems such as 12-step programs

63
Q

Treatment options

A

Medical model detox programs
Residential/inpatient treatment
Partial hospitalization/day treatment
Methadone maintenance and other replacement therapies
Social model detox programs
Therapeutic communities: 1-3 year self contained residential programs with full rehab and social services
Halfway houses
Faith-based treatment initiatives
Sober-living and transitional living programs
Harm reduction programs

64
Q

Disease model of addiction

A

The disease model of addiction describes an addiction as a disease with biological, neurological, genetic, and environmental sources of origin.
Addiction manifests in response to the confluence of predispositional vulnerability factors and stressful life experiences.

65
Q

Support groups vs. self help groups

A

Support groups are lead by a trained professional whereas self help group are peer lead

66
Q

What is the fastest route of administration?

A

Inhalation: 7-10 seconds before drug reaches brain

67
Q

How quickly does a substance reach the brain after being injected intravenously?

A

15-30 seconds

68
Q

Via which route of admin. does it take a drug 3-5 minutes to reach the brain?

A

Mucous membrane absorption

Chemical Dependency (3 decks)

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