Intro to Addiction Medicine - Zelan Flashcards
what are the comorbid issues associated with SUD?
Depression
Anxiety (esp. PTSD)
Personality disorder (esp. borderline personality disorder – BPD)
Bipolar disorder
25-60% of pts with (blank) also have SUD
BPD
What is the lifetime prevlaence of alcohol use disorder/
30%
high risk drinking 30%
prevalence higher in younger age group
What are the medical complications of SUD?
Neuro: dementia, psychosis, seizure, depression
Liver, CV, pancreas
Alocohol use correlates to violence from the standpoint of…
both perpetrator and victim
MORE THAN OTHER DRUGS
T/F: SUD leads to increased morbidity and mortality from all causes
true
what is the top two drugs prescribed in the US?
Vicodin
simvastatin
Addiction correlates to physical signs of….
dependence and tolerance
T/F: addiction can be suspected on a basis of behavioral signs of compulsive use
true
What are signs of compulsive use?
: use despite harmful consequences, use that is escalating, pervasive urges to use, high risk behaviors, failed attempts to stop or reduce use.
what are the DSM5 criteria for SUD?
Taken in larger amounts than intended. Failed attempts to control or stop. Excessive time given to use or recovery. Strong urges to use. Functional impairment. Ignoring harmful consequences. High risk behaviors. Withdrawal or efforts to avoid withdrawal. Tolerance: escalating use/ diminishing effects.
mild SUD has how many Sx?
2-3 symptoms
moderate SUD has how many Sx?
4-5
severe SUD has how many Sx?
6 or more
What is the CAGE quesitionnaire?
Cut down?
Annoyed?
Guilty?
Eye-opener?
What is sensitivity?
proportion of cases that return true positives
what is specificity?
proportion of non-cses that return true negatives
screening tests are designed for high…
sensitivity
confirmatory tests are designed for high…
specificity
What is PPV?
proportion of test positives that are true positives
What is NPV?
proportions of test negatives that are true negatives
SUD is a behavioral illness that correlates to both (blank and blank) variables
heritable and acquired
T/f: SUD is highly heritable
true
1st degree relatives have a (blank) fold risk of developing SUD
8x
T/F: environmental triggers are clinically relevant
true
Does motivation have a relationship to willpower?
nope
how do you define motivation?
defined as a history of being reinforced for a behavior
Is motivation a binary variable?
no
Motivation is relative to (blank) and must be measured on a continuous spectrum
environment
T/F: mental health tx must pass through specific stages of treatment like attachmment, pattern search, working through, and termination
false!
T/F: the expertise of the mental health professional is more important than the type of treatment
false
what is the best way to decrease behaviors you want to see less of?
validation!
what are the factors that go into the formation of motivation?
Rewards that occur quickly are more rewarding.
Rewards that you have to wait for are less rewarding.
Rewards that you have to work hard for are less rewarding.
Rewards that you don’t have to work hard for are more rewarding.
many addictive behaviors are reinforced through (positive/negative) reward
negative reward
what is emotional vulnerability?
an emotion that lasts a long time, has a high intensity, and takes a long time to resolve
what is the effect of stress on emotional vulnerability
increases it
what is the goal of Tx in addiciton medicine/
reduce the effects of emotional vulnerability
Negative reward schedules also teach…
avoidance; if you get a reward for stopping something unpleasant, you learn to avoid the unpleasant thing in the first place
As SUD progresses, the reward of use (increases/decreases) and the reward of Tx and abstince is punished (more/less)
reward of use increases and punishment for abstinence or treatment increases
Dopamine is released by what drugs?
EtOH
Cocaine
Opiates
THC
abused amphetamines are potent releasers and reuptake inhibitors of….
ALL the monoamines
T/F: amphetamines may function as MAOIs
true
ecstasy enhances prosocial behaviors through (blank) pathways
oxytocin; seen especially in teens
how does choice play into addiction?
not a factor in acquisition, but a factor in treatment
T/F: therapy interfering behavior is part of the illness
true
T/f: doctors may exhibit therapy interfering behaviors
yes, normally in response to one from the patient
What are the component of accpetance that are important to SUD treatment/
No one intervention is going to be curative.
Recovery is slow and painful.
As a part of the illness, motivation waxes and wanes (for both patient and doctor!).
Doctors have a duty to learn how to amplify motivation (in themselves and others!)
Doctors have a duty to not give up, or if they can’t avoid giving up, refer the patient to someone who hasn’t yet given up.
T/f: lack of motivation is part of the illness
true; seen in both doc and pt
T/F: drug addiction is a social, interpersonal illness more than any other disorder
true
