module 8 substance use and personality disorders Flashcards
Repeated use of a substance with or without physical dependence
Dependence
Use that is inconsistent with socially accepted patterns
Abuse
Usually applies to prescribed substance
Misuse
Reversible syndrome caused by a specific substance affecting memory, judgement, behavior, etc.
Intoxication
Substance-specific symptoms that occur after stopping or reducing use
withdrawal
needing more of the substance to get the desired effect
Tolerance
Two theories of etiology of substance use
psychodynamic
biological
Psychodynamic theory of substance use disorder
- Oral-stage fixation
- Gratification through oral behaviors
- Dysfunctional family patterns
- Sociocultural factors
Biological theory
Genetic loading
Neurobiological
(Reinforcement, neuroadaptation)
Reinforcement
Brain-based changes lead to addictive behavior
Neuroadaptation
Brain-based changes lead to tolerance and withdrawal
Positive and negative rewards
“feel good” “feel bad”
Reinforcement
Alterations in normal neurotransmitter function occurs as the body adapts to the chronic presence of substance
neuroadaptation
Substance use most common in what age
18-24
Person with bipolar is ____ times more likely to have substance use disorder
5
CAGE questionnaire
Cut back?
Annoyed?
Guilty?
Eye opener?
mild to moderate risk cage score
2
high risk cage score
3-4
CIWA scoring
0-9 = absent or very mild
10-15 = mild
16-20 = moderate
21-67 = severe & possible DT
CIWA tests what symptoms?
Tremors
A/V/T hallucinations
anxiety
agitation
diaphoresis
N/V
headaches
altered sensorium
Do not administer until person has been without alcohol for 12 hours or more
Disulfram (Antabuse)
Aversion treatment for alcohol use disorder
Disulfram (Antabuse)
Medications that decrease cravings for alcohol
Naltrexone
acamprosate
ondansetron
buprenorphine
Disulfram (Antabuse) considerations
- Pt must avoid all alcohol
- Test LFTs
- May induce mania in bipolar disease
