Substance abuse

Question 1

Dependence

Answer 1

repeated use of a substance, it can be psychological and/or physical

Question 2

Abuse

Answer 2

Use that is inconsistent with social use patterns

Question 3

Misuse

Answer 3

Applies when a the substance is prescribed

Question 4

Neurobiological processes of substance abuse

Answer 4

Brain based changes can occur with any substance of abuse

When the substance is not used and people feel anxious/dysphoric, this is mediated by GABA

Question 5

The Reward Center

Answer 5

The Reward Center includes the ventral tegmental area and the nucleus accumbens.
Even more DA is released in the Reward Center by “natural morphine” which are called neuropeptides (enkephalins and beta-endorphins)

Question 6

How long do neuroadaptive changes from substance use last?

Answer 6

They can last for years. This is why people might relapse years later, and also it’s why people might still have a high tolerance even after not using the substance for years

Question 7

Incidence of substance abuse (substances in general)

Answer 7

18 to 24 year olds have the highest

The U.S. has the highest rates

More than 50% of psych patients also have a substance abuse (bipolar people are 5x more likely than the general pop; schizophrenia is 4x more likely)

Question 8

Incidence of alcohol abuse

Answer 8

African Americans/Hispanic/Native American are most common ethnicity, lowest is Asian

Lifetime risk for the U.S. population is 15%

Question 9

Fetal alcohol syndrome

Answer 9

1/3 of infants born to mothers with alcohol use disorder

Low weight and height, microphthalmia, short palpebral fissure, mdiface hypoplasia, smooth or short philtrum, thin upper lip

Question 10

AUDIT

Answer 10

Alcohol use disorder identification test

Question 11

S-MAST

Answer 11

Geriatric alcohol screening (Short Michigan Alcoholism Screening Test)

Question 12

CRAFFT

Answer 12

alcohol screening for under 21

Question 13

Criteria for substance abuse

Answer 13

Maladaptive use for 12 months. It’s maladaptive because it causes you fail at major role obligations, accompanied by dangerous situations (drinking and driving for example), and causes major problems like legal/social problems.

3 or more symptoms are present:

• Tolerance
• Withdrawal
• Using larger amounts than intended
• Craving or Unable to cut down
• Spending a lot of time getting/using/recovering
• Giving up or decreasing other activities because of use
• Using despite consequences

It is synonymous with addiction

Question 14

Physiological dependence can mean

Answer 14

Tolerance and withdrawal

Question 15

Are tolerance and withdrawal physical or psychological?

Answer 15

Can be either or both

Question 16

Moderate withdrawal verse Mild/No withdrawal

Answer 16

Moderate- stimulants, nicotine, cannabis

Mild/No withdrawal- Hallucinogens/PCP

Question 17

Criteria for alcohol withdrawal

Answer 17

Reduced use after heavy/prolonged use

2 or more symptoms that start hours or days after reduction:

• Tremor
• Insomnia
• Autonomic hyperactivity
• Nausea
• Hallucinations/Illusions
• Psychomotor agitation
• Anxiety
• Seizures

Question 18

When there is a cluster of these Physical symptoms, it should make you suspicious of some type of addiction

Answer 18

Abdominal pain
Nausea
Weight Loss
GI bleed
HTN
Anxiety
First-episode seizure as an adult

Question 19

Physical findings of alcohol abuse

Answer 19

Mood/behavior changes
Poor oral health
HTN, cardiomyopathy, tachycardia
Liver disease, cirrhosis, peptic ulcer, esophageal malignancies
Tremor, cognitive, peripheral neuropathy, Wernicke-Korsakoff syndrome
Hyperlipidemia

Question 20

Lab findings for alcohol abuse

Answer 20

AST is more than twice the ALT
Elevated GGT (glutamyltransferase)
Decreased magnesium, calcium, potassium, BUN, H and H, platelets, albumin

Question 21

Alcohol abuse, differential dx

Answer 21

Cushing’s
Seizure
MI
Personality disorder

Question 22

who receives Treatment of Alcohol abuse

Answer 22

Note that 80 or 90% of people who need treatment don’t get it (because they don’t get dx, don’t get referral, etc)

Question 23

Sign of severe alcohol withdrawal

Answer 23

ophthalmoplegia (crazy googely eyes)
decreased short term memory
irregular pulse
agitation
disorientation
hallucinations

Question 24

When is withdrawal and DTs most likely to occur

Answer 24

24 to 72 hours

Question 25

CIWA scores

Answer 25

0-9 none or very mild

16-20 moderate

Question 26

Besides benzos, medication classes you might use for withdrawal

Answer 26

SSRIs
Opioid antagonists (like naltrexone)
NMDA agonists
Antiseizure meds to prevent seizures (carbamazepine, valproic acid)

Question 27

Anti craving medications

Answer 27

Naltrexone
Acamprosate
Ondansetron
Buprenorphine

Question 28

Medication treatment for maintaining sobriety (they’re already sober)

Answer 28

Disulfiram (don’t give it until at least 12 hours after they are alcohol free)

Question 29

Side effects of disulfiram to watch for

Answer 29

Elevated LFTs

Possibly induce mania in someone who is BP

Question 30

Non medication treatment for withdrawal

Answer 30

Usually need to be hospitalized

Maintain a quiet space

Put them near the nurses station

Do not use restraints

Make sure they get enough fluids and watch out for anticholingeric effects of benzos

Question 31

Life span considerations of alcohol abuse

Answer 31

The most common time to start is child/adolescence

30 or 40% of teens drink frequently, 50% have used drugs

For older adults, the treatment should include dealing with loss.