Introduction to substance use disorders and drugs of abuse - Dr. Lord

Question 1

what is the DSM-5 criteria for substance use disorder

Answer 1

maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by at least TWO of the following:
-substance taken for longer/higher amounts than intended
- persistant unsuccessful attempts to stop/control use
- significant time spent trying to get, use or recover from use
- craving
-recurrent use resulting in failure to fulfill role at work, school or home
- continued use despite persistent social/interpersonal problems caused or made worse by substance use
etc.

Question 2

how is the DMS-5 score quantified

Answer 2

2-3: mild (abuse)
4-5: Moderate
6 or more: Severe

Question 3

what is opioid misuse

Answer 3

formerly abuse
use of opioid pain medication for purposes other than clinically appropriate AND sanctioned (prescribed) uses

Question 4

what can increase your vulnerability to SUD

Answer 4

-genetic predisposition - a specific gene or set of genes have NOT been identified as “addition genes”

-Dysfunctional family environment -absence of one or the other parental figures, deficiency in a “nurturing” environment

-exposure to substances at early age - availability

Question 5

what are the goals of SUD treatment

Answer 5

mitigate withdrawal symptoms
dampen/eliminate cravings
- decrease reward from dysfunctional behavior
- increase reward (salience) or healthy, functional, non-destructive behavior
- decrease, eliminate and ultimately render powerless cues and triggers to using (relapse prevention)

Question 6

how are withdrawal symptoms mitigated

Answer 6

detoxification - medications aimed at the symptoms
- alpha adrenergic blockade (block result of norepi storm
- anxiolytics (short course – long acting)
- antidiarrheals, antispasmodics
- hypnotics - sleep

Question 7

what are the keys to recovery

Answer 7

stop using drugs
change everything about your life

Question 8

what are key parts of treatment

Answer 8

abstinence
medications
peer support
professional guidance
exercise
diet
ritual (support change)

Question 9

what is the role of medication for SUD

Answer 9

block initiation
mimics pre-morbid state
manage effect of environment
manage long term consequences/complications of exposure
restore and support homeostasis using detoxification, maintenance or blockade
reduce or eliminate inducement to use
re-establish free will
reduce salience of conditioned place preference
block drug reinforcement

Question 10

what is the triad of Wernicke-korsakoff syndrome

Answer 10

mental disturbance
ocular paralysis
ataxia

Question 11

what is Korsakoff psychosis

Answer 11

permanent deficit of short-term retentive memory
can be prevented or mitigated by administration of thiamine
risks increases exponentially with delay in providing thiamine in alcohol withdrawal