L10: Addiction & Substance Abuse Disorder Flashcards
General Definition of Addiction
Specific Definition of Addiction
Epidemeology of substance use disorder
- One-year prevalence of any substance use disorder in the USA is approximately 8%.
- Men > women.
what are the most commonly used substances in addiction?
- Alcohol and nicotine (are the most commonly used substances)
- Most common substance In Egypt: Nicotin, cannabis all; opiate.
Def of Acute intoxication
- Transient disturbances of consciousness, cognition, perceptions, affect or behaviors following the large amount use of a psychoactive substance.
Def of Harmful use
- Use in a manner that damage to the individual’s health and with adverse effects on family and society.
Def of Co-dependence
- Term used to refer to family members affected by or influencing the behavior of the substance abuser. Related to the term enabler, which is a person who facilitates the abuser’s addictive behavior (e.g., providing drugs directly or money to buy drugs).
Def of Dependence
Def of Withdrawal state
- physical and psychological symptoms occurring on absolute or relative (decrease dose) withdrawal of a substance after repeated, usually prolonged and/or high-dose use.
def of Tolerance
The need for increased amount of the substance to achieve the same effect.
Def of Cross-Tolerance
When tolerance develops to one drug as the result of use of another drug.
Def of Addiction
Is a slang languages used in non scientific fields.
DSM5 Classification of Substance Related Disorders
DSM 5 Criteria of Substance Use Disorder
what are other addictive disorders in DSM5?
Signs of Drug Intoxication
Why Do Some People become addicted while others Don’t?
Continuum of Drug Use
Drugs Wheel
Stimulants Vs Depressants
…
Epidemeology of Alcohol Dependence
Standard Drinking of alcohol
How much alcohol can you drink at a safe level ?
Clinical Presentation of alcohol intoxication
Types of alcoholism
- Alpha
- Beta
- Gamma
- Delta
- Epsilon
Alpha alcoholism
Earliest stage, to relieve pain, can control drinking
Beta alcoholism
Heavy drinkers, drink daily, physical symptoms, no addiction, can quit, no withdrawal symptoms
**
Gamma alcoholism
Loss of control in drinking, physical dependence, can quit, withdrawal seen
Delta alcoholism
Physical dependence, withdrawal seen, cant quit
**
Epsilon alcoholism
Final stage of drinking, continual and insatiable urge to drink (craving), compulsive drinking.
what are drinking patterns?
- Moderate Alcohol Consumption
- Low-Risk Drinking and Alcohol Use Disorder (AUD)
- Binge Drinking
- Extreme Binge Drinking
- Heavy Drinking
Moderate Alcohol Consumption
Defined as up to 1 drink/day for women and up to 2 drinks/day for men
Low-Risk Drinking and Alcohol Use Disorder (AUD)
- For women, no more than 3 drinks/day and < 7 drinks/week.
- For men, <4 drinks /day and <14 drinks /week.
Binge Drinking
- A pattern of drinking that brings blood alcohol concentration to 0.08 grams per deciliter (0.08%) or higher.
- Woman consumes 4 drinks or a man consumes 5 drinks in a 2-hour time frame
Extreme Binge Drinking
- Drinking at levels far beyond the binge threshold, resulting in high peak blood alcohol concentrations. (i.e., 10 or more standard drinks for men, and 8 or more for women)
Heavy Drinking
- Heavy drinking as binge drinking on each of 5 or more days in the past 30 days
Types of drinkers
- Social Drinker
- Alcohol Abuser
- Alcoholic
Alcohol Abuser
- An alcohol abuser’s drinking habit may become physically harmful to themselves and others around them.
- They may begin to drive under the influence and could be arrested for DUI at least once.
- Along with legal problems, an alcohol abuser may begin to put work and family obligations to the side.
- Alcohol may begin to occupy their thoughts; the abuser may begin to feel like they need to have a drink more often.
- Till now they not developed tolerance and withdrawal.
Social Drinker
- A social drinker is a person who drinks on an occasional basis.
- Whenever they do drink, a social drinker will not have any problems or negative consequences.
- Friends or family do not complain about a social drinker’s consumption.
Alcoholic drinker
- An alcoholic means that a person has an addiction to alcohol. When a person becomes an alcoholic, they are unable to control or set limits for their consumption.
- An alcoholic will have developed a tolerance and full-fill all criteria of dependance.
Dx of Alcohol Dependence
MOA of Alcohol
Alcohol Metabolism
Enzyems Related To Metabolism of Alcohol in Heavy Drinkers & Asians
Timeline of Alcohol Withdrawal Symptoms
usually begin in 6-24 hours and last 2-7 days.
Symptoms of Alcohol withdrawl
Characters of Delirium tremens (DTs)
Complications of Alcoholism
- Wernicke’s encephalopathy
- Korsakoff syndrome
What causes Wernicke’s encephalopathy?
Caused by thiamine (vitamin B1) deficiency resulting from poor nutrition.
Prognosis of Wernicke’s encephalopathy
- Acute and can be reversed with thiamine therapy.
- If left untreated, Wernicke’s encephalopathy may progress to Korsakoff syndrome.
Symptoms of Wernicke’s encephalopathy
Ataxia (broad-based), confusion, ocular abnormalities (nystagmus, gaze palsies).
Def of Korsakoff syndrome
Chronic amnestic syndrome.
prognosis of Korsakoff syndrome
Reversible in only about 20% of patients.
Symptoms of Korsakoff syndrome
Impaired recent memory, anterograde amnesia, compensatory confabulation (unconsciously making up answers when memory has failed).
TTT of Alcohol Withdrawal
Medications used in Alcohol Use Disorder
First-line treatments:
- Naltrexone (Revia, IM-Vivitrol)
- Acamprosate (Campral)
Second-line treatments:
- Disulfiram (Antabuse)
- Topiramate (Topamax)
MOA of Naltrexone (Revia, IM Vivitrol)
- Opioid receptor blocker works by decreasing desire/craving associated with alcohol.
Uses of Naltrexone (Revia, IM-Vivitrol)
Maybe greater benefit is seen in men with a family history of alcoholism.
SE of Naltrexone (Revia, IM-Vivitrol)
In patients with concurrent opioid dependence, it will precipitate withdrawal.
MOA of Acamprosate (Campral)
Thought to modulate glutamate transmission.
Use of Acamprosate (Campral)
- Should be started post-detoxification for relapse prevention in patients who have stopped drinking.
- Major advantage is that it can be used in patients with liver disease.
SE of Acamprosate (Campral)
- Contraindicated in severe renal disease.
MOA of Disulfiram (Antabuse)
Blocks the enzyme aldehyde dehydrogenase in the liver and causes aversive reaction to alcohol (flushing, headache, nausea/vomiting, palpitations, shortness of breath).
SE of Disulfiram (Antabuse)
- Contraindicated in severe cardiac disease, pregnancy, psychosis.
- Liver function should be monitored.
when is Disulfiram (Antabuse) best used?
- Best used in highly motivated patients, as medication adherence is issue.
MOA of Topiramate (Topamax)
- Anticonvulsant that potentiates GABA and inhibits glutamate receptors.
Use of Topiramate (Topamax)
Reduces cravings for alcohol and decreases alcohol use.
Characters of Benzodiazepines
Symptoms of acute intoxication of Benzodiazepines
Symptoms of Sedative & Hypnotics Withdrawal
TTT of Sedative Abuse
THC content of different preparations of cannabis
Hashish Vs Marijuana
- Introduction
- legality
- Derived From
- Ingestion
- Active Ingredient
- Form
Cannabis intoxication diagnostic criteria
Cannabis Withdrawal diagnostic criteria
Marijuana legalization
Neurochemistry of Opiods
- Opioid works via interactions with the mu and delta receptors which result in:
A. Increased activity in the mesolimbic system
B. Increased dopamine released (by inhibits the release of GABA which have inhibitory effect on the dopaminergic neurons)
Route of adminstration of Opiods
- Opium would be commonly smoked.
- Heroin is usually injected
Signs of intoxicaion & tolerance of Opiods
DSM 5 Criteria of Opiods use disorder
Physical complications associated with opioid misuse
Epidemiology of opiates dependence
- 10% of opiate misusers become dependent (10% of them ever seek help)
- 2-3% die annually.
- 25% are abstinent at five years and 40% at 10 years.
Early withdrawal symptoms of opiods
- Tolerance and withdrawal develop quickly.
- Early withdrawal symptoms (24-48 hours) include craving, flu-like symptoms, sweating and yawning. Mydriasis (dilation of the pupil), abdominal cramps, diarrhoea, agitation, restlessness, piloerection (‘gooseflesh’) and tachycardia occur later (7-10 days).
reatment of opiates dependence
- Methadone
- Buprenorphine
- Naltrexone
Pros of Methadone
- Administered once dally.
- Significantly reduces morbidity and mortality in opiold-dependent persons.
Cons of Methadone
- Restricted to federally licensed substance abuse treatment programs.
- Can cause QTc Interval prolongation: screening electrocardiogram is indicated, particularly in patients with high risk of cardiac disease.
MOA of Methadone
Long-acting opiold receptor agonist
MOA of Buprenorphine
- Partial opioid receptor agonist—can precipitate withdrawal if used too soon after full opioid agonists
Pros of Buprenorphine
- Sublingual preparation that is safer than methadone, as its effects reach a plateau and make overdose unlikely.
Comes as Suboxone, which contains buprenorphine and naloxone; this preparation prevents intoxication from intravenous injection.
Cons of Buprenorphine
- Only available by prescription from specially licensed office-based physicians.
MOA of Naltrexone
- Competitive opioid antagonist, precipitates withdrawal if used within 7 days of heroin use
Pros of Naltrexone
- Either daily oral medication or monthly depot injection.
- It is a good choice for highly motivated patients such as health care professionals.
Cons of Naltrexone
- Compliance is an issue for oral formulation.
what are examples of stimulants?
Examples:
- Cocaine
- Caffiene
- Cannabis
- Amphetamine
- Tobacco
Effects:
* Racing speech and thoughts
* Physically strong
* Loss of apetite
* Alert, confident and energetic
* Paranoia and a low or crash
Method of adminstration of Cocaine
sniffed, chewed or injected intravenously.
Method of adminstration of Crack
Crack (a purified, very addictive form of cocaine) is smoked.
Characters of Crack
The crack (high) is extremely short and, on withdrawal, persecutory delusions are common.
Effects of Cocaine
- Restlessness, increased energy, abolition of fatigue and hunger resemble hypomania and last about 20 minutes.
- Visual/tactile hallucinations of insects (formication) and paranoid psychoses occur.
- Post-cocaine dysphoria, with sleeplessness and intense depression, precedes withdrawal (depression, insomnia and craving).
Effects of Crack
effects of Amphetamine
- Uneven heartbeat, rise in blood pressure, physical collapse, stroke, heart attack, and death
- cause euphoria, increased concentration and energy, mydriasis, tachycardia and hyper-reflexia, followed by depression, fatigue and headache. Acute use may cause psychosis.
effects of methamphetamine
- Memory loss, damage to heart and nervous system, seizures, and death
Effects of Cocaine
- Damage to nose lining and liver, heart attack, seizures, stroke, and death
Effects of Crack
Damage to lungs if smoked, seizures, heart attack, and death
MOA of amphetamines Speed
Taken orally or intravenously
Charactesr of Methamphetamines
Chemically related but more potent, long lasting and harmful; it can be ingested, snorted or smoked (as crystal meth).
Characters of Naphyrone and mephedrone
Closely related to amphetamines. They were originally manufactured as legal highs’ but are now class B drugs.
Characters of Khat
- Used particularly by men from Somalia and Yemen;
- Contains cathinone, an amphetamine-like stimulant causing excitement and euphoria
Stimulant withdrawal diagnostic criteria
Lobacco Withdrawal diagnostic criteria
Done
✅
Stimulant intoxication diagnostic criteria
What are substances with variable effect?
- HALLUCINOGENS/ PSYCHEDELICS & DISSOCIATIVE DRUGS
- EMPATHOGENS
Examples of HALLUCINOGENS/ PSYCHEDELICS & DISSOCIATIVE DRUGS
Phencyclidine (PCP - Angel Dust)
MOAd of Phencyclidine
Phencyclidine (PCP - Angel Dust) is usually smoked.
Effects of Phencyclidine
Empathogens
Inhailants & Volatile Drugs & Solvents
MOAd of Solvents
sniffed,
Age of using Solvents
principally by boys (aged 8-19 years)
Sign of abuse of Solvents
red rash around the mouth
and nose may be a sign of abuse).
Effects of Solvents
Initial euphoria is followed by drowsiness.
Dependence in Solvents
Psychological dependence is common but physical dependence is rare.
Examples of Solvents
Amyl nitrite and butyl nitrite and isobutyl nitrite (called ‘poppers’)
Characters of Solvents
- Sniffed from small bottles.
- They deliver a short, sharp high.
- Side effects include severe headache and feeling faint.
- They are toxic and can be fatal if swallowed
Chronic abuse of Solvents
weight loss, nausea, vomiting, polyneuropathy and cognitive impairment.
Toxic effects of Solvents
bronchospasm, arrythmias, aplastic anemia, hepatorenal and cerebral damage
How do people misuse Anabolic Steroids?
to increase muscle growth and body bulk.
MOAd of Anabolic Steroids
swallowed or injected.
AE of Anabolic Steroids
- gynecomastia in men and clitoral enlargement in women
- bone hypertension
- cardiac disorders
- liver (e.g. drug induced hepatitis)
- renal impairment
- shrinking of testicles and priapism
Infertility - aggression and irritability.
Course of addiction and substance use disorder
- Addiction (with or without treatment)
- Remission
- relapse
Outcome of addiction and substance use disorders
- Chronicity
- Natural recovery
- Morbidity
- Death
Steps of TTT of addiction
Infection (HIV and hepatitis C) is the greatest risk associated with injecting drug use; harm reduction strategies aim to minimize infection (e.g. needle exchange and improve safety.
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