substance abuse Flashcards
1
Q
alcohol, tobacco, illicit drugs or improperly used medication are considered what?
A
substances
2
Q
sporadic consumption with no major adverse consequences is called ?
A
substance use
3
Q
consumption that risks major adverse consequences is called ?
A
At-Risk Substance Use
4
Q
condition characterized by an individual who is significantly affected by another person’s substance use or addiction
A
codependency
5
Q
_____: maladaptive use causing impairment or distress over a 12-month period where 1+ has occurred:
A
substance abuse
1. Failure to fulfill major role obligations
2. Use of drugs in hazardous situations
3. Recurrent legal problems due to substance use
4. Continued drug use despite persistent social or interpersonal problems because of use
6
Q
state of adaptation manifested by a substance class-specific withdrawal syndrome
A
dependence
7
Q
dependence can be produced by?
A
- Rapid dose reduction or cessation of a substance
- Administration of an antagonist
- Tolerance to the substance
8
Q
2 types of dependence that patients may manifest
A
- psychological dependence
- physiologic dependence
9
Q
Primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations
A
addiction
10
Q
addiction can be characterized by behaviors including:
A
- Impaired control over substance use
- Compulsive substance use
- Continued substance use despite harm
- Craving for substance
11
Q
difference between substance use and dependence/addiction
A
- Substance use - pts retain control of their use
- Control can be affected by poor judgement, social factors, environment - Dependence and Addiction - No longer have full control
- Brain is “hijacked” by substance - need as powerful as thirst or hunger
- Users may still have some degree of conscious control
12
Q
___: often predate the initial substance use, thought to be genetically predisposed
A
Measurable brain abnormalities
- Substance use → changes that affect dopamine level in mesolimbic system
- Changes are often permanent - account for relapses
13
Q
Patients 12 yrs and up with any illicit drug use in the past 1 month: ?%
A
14% - 1 in 10
About half (49%) of people over their entire lifetime
14
Q
Almost ___% are unaware that they have a substance abuse problem
Often goes unrecognized in clinical practice!
A
95%
15
Q
who is the highest age of risk of substance abuse
A
late teens and early 20s
16
Q
↓ age at first use = ?
A
↑ risk of later addiction
17
Q
- Lifetime prevalence of ETOH - __% of pts 12+
- ETOH within past 12 months - __%
- ETOH within past 12 months, ages 12-20 - __%
A
4/5 (78%)
2/3 (62%)
1/10 (15%)
18
Q
who is nearly twice as likely to engage in binge drinking
Almost three times as likely to engage in heavy drinking
A
males
19
Q
Cigarettes or Vaping:
__% - Lifetime, pts 12 and up
__% - Past 1 yr, pts 12 and up
A
1/2 (58%)
1/5 (26%)
20
Q
who are are more likely to use vaporized cigarettes (vapes)
A
young adults
21
Q
what is the #1 substance for dependence and abuse in US (17.3 million)
A
alcohol
22
Q
substance abuse costs over ? annually in costs related to crime, work productivity and healthcare
A
$800 billion
1. tobacco
2. alcohol
3. illicit drugs
4. Rx opiates
23
Q
what is the leading preventable cause of death in the US
A
tobacco
24
Q
what is involved in up to 50% motor vehicle fatalities?
A
illicit drugs or alcohol
25
substance use has an effect on social, physical, mental and public health problems, including:
1. Medical Conditions
- Hepatitis
- Cirrhosis
- HIV/AIDS
- STIs
- Motor vehicle crashes/fatalities
2. Social Conditions
- Teenage pregnancy
- Domestic violence
- Child abuse
- Physical fights
- Overall crime
- Homicide/Suicide
26
what are the risk factors for substance use?
1. Substance Factors
- Early onset tobacco use
- Early experimentation with substances
- Type of substance tried
2. Societal Influence
- Family
- Peer groups
- Religious groups
- Cultural and societal norms
3. Patient Personality Traits
- Risk-takers, thrill-seekers, novelty seekers
- Poor impulse control or emotional control
- Difficulty relating to others
4. Associated Psychiatric Disorders
- Conduct disorder
- MDD or Bipolar disorder
- ADHD
- Antisocial personality disorder
5. static patient demographics
- male
- black, AI/AN or NHOPI ethnicity
- gay or lesbian
- genetic predisposition
6. modifiable patient demographics
- low socioeconomic status
- single or divorced
- low educational level
- violent or high-crime neighborhood
- personal history of abuse
27
why do ppl use substances?
1. feel good
2. feel better
3. fit in
28
Chemical structure of many drugs is similar to ?
neurotransmitters
allows them to be recognized by neurons and alter brain messages
29
Neurotransmitter involved in regulation of pain, appetite, memory, mood
Anandamide
30
active ingredient in marijuana
THC
31
NT that involves movement, motivation, reward,
addiction, well-being
dopamine
32
NT involved with mood, memory, sleep, cognition
serotonin
33
NT involved with learning, memory
glutamate
34
NT involved with lessening pain/euphoria
endorphins
35
NT involved with relaxation, anxiolytic
GABA
36
what are the three C's of addiction?
1. Control
- Early social & recreational use
- Eventual loss of emotional & behavioral control
- Cognitive distortions (denial and minimization)
- Tolerance and withdrawal
2. Compulsion
- Drug-seeking activities and craving → addiction
- Continued use despite adverse consequences
3. Chronicity
- Natural history of multiple relapses preceding stable recovery
- Possible relapse after years of sobriety
37
the attempt to alleviate symptoms of mental illness
self-medication
38
May increase vulnerability to mental illness are called ?
casual effects
39
Same/similar risk factors for substance use and mental illness are called ?
correlated causes
40
Up to what percent of substance abuse pts also have a mental disorder?
50%
41
Up to 40% have comorbid substance abuse disorder aka what disorder?
mood disorder
42
Up to 59% of women in addiction treatment have what? Where they are 2-3x than males?
PTSD
43
what sex is more likely to have more alcoholics to have some comorbid mental illness
women
44
What do the NT do during intoxication?
1. Dopamine: euphoria
2. Opioid Peptides: analgesia, relaxation
3. Serotonin: elevated mood
4. Glutamate: relaxation
5. GABA: decreased anxiety, less panic, relaxation
45
what do the NT do during withdrawal?
1. Dopamine: dysphoria
2. GABA: anxiety, panic attacks
3. Opioid Peptides: increased pain
4. Glutamate: hyperexcitability
5. Serotonin: dysphoria
46
Every process that is either pleasant or unpleasant has a secondary “opponent” (opposite) process that sets in after
Opponent-Process Theory
47
With repetition, the primary process becomes ____ while the opponent process is ____
weaker, strengthened
48
result of pairing emotional pleasure (with substance use) and displeasure (with withdrawal)
drug addiction
49
describe the process during drug addiction
1. Early in substance use - high pleasure, low withdrawal
2. Over time - pleasure decreases, withdrawal increases
3. Attempt to treat addiction by interfering with cycle
50
about how many US adults use alcohol in a risky manner and are at risk for substance use issues?
3 in 10
51
repetitive use of alcohol, often to alleviate emotional problems
at-risk drinking
52
how many oz is a "drink"
~0.5-0.6 oz
53
what has the most % alcohol and what has the least?
hard liquor - 1.5 oz, 40% alc
beer - 12 oz, 4% alc
54
liver can process about how much of alc?
0.5 oz/hr
55
faster timeline from first drink to alcohol dependence
telescoping effect
56
telescoping effect is usually seen in who?
women
- Lower EtOH dehydrogenase
- Lower total body water
- Smaller volume of distribution
- Drink like partner
57
recurrent use of alcohol despite disruption in social roles, alcohol-related legal problems, or taking safety risks
alcohol addiction
58
who is at risk for alcohol dependence
1. Male gender
2. White or Native American
3. Younger age (18-29)
4. Being single
5. Lower income
6. Past exposure to adverse events
7. Genetic predisposition
8. Significant disability
9. Other psych disorders
- Other SUD, depression, BPD, personality d/o
59
What is CAGE?
Widely used substance use screening tool for at-risk patients
1. Have you felt you ought to *Cut* down on your drinking or drug use?
2. Have people *Annoyed* you by criticizing your drinking or drug use?
3. Have you felt *Guilty* about your drinking or drug use?
4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover or to get the day started? *(Eye-opener)*
2+ yes questions - more in-depth assessment
Even 1 yes - “red flag” - possible substance use problem
60
MOA of alcohol
- Suppression of inhibitory control systems
- Acts as a sedative-hypnotic substance
- Affects CNS receptors - GABA, NMDA (glutamate), 5HT-3 (serotonin)
- Facilitates dopamine release (reward system)
61
effects of acute intoxication
1. Psychomotor dysfunction
2. Disinhibition
3. Dysarthria, ataxia, nystagmus
4. Memory lapses
5. Nausea and vomiting
6. Drowsiness; fragmented sleep
7. Respiratory depression
8. Hypoglycemia
9. Severe - stupor, coma, death
62
what medication has effects on GABA receptors
Benzodiazepines
63
Effects of alcohol withdrawals
1. Decreased cognitive function
2. Tremulousness
3. Anxiety, irritability, and hyperreactivity
4. Nausea and vomiting
5. _Delirium Tremens_
- Prolonged ETOH consumption → **fewer GABA receptors**
- Unopposed sympathetic nervous system activity
- Neuro - confusion, tremor, seizures, sensory hyperacuity, hallucinations, hyperreflexia
- Psych - anxiety, agitation, panic attacks, paranoia
- Diaphoresis, dehydration, electrolyte abnormalities
- Cardiovascular abnormalities
64
effects of chronic alcohol use?
1. Wernicke Encephalopathy
- Triad - Confusion, ataxia, ophthalmoplegia
- Other s/s - impaired vision/hearing, psychological dysfunction, memory deficit, hypothermia, hypotension
2. Korsakoff Psychosis
- Amnesia - anterograde and retrograde
- Aphasia, apraxia, agnosia
3. Gastrointestinal
- Liver - Fatty liver, alcoholic hepatitis, cirrhosis
- Vascular - Portal hypertension, varices
- Pancreas - pancreatitis, pancreatic insufficiency, cancer
- GI tract - Esophagitis, gastritis, gastric ulcers, cancers
- Labs - Increased GGT, AST:ALT
4. Other Body Systems
- Cardiac - HTN, increased HR, increased myocardial O2 consumption
- Cancer - head/neck, esophageal, liver, breast, colorectal, pancreas
- Endocrine - dysregulation of lipoproteins and triglycerides
65
which can only be reversed by 20% with treatment via thiamine and other B vitamins
Korsakoff Psychosis
66
which can be completely reversed with thiamine and other B vitamins
wernicke encephalopathy
67
Withdrawal onset is about ___ after last drink
8-12 hrs
Peak intensity of symptoms - 48-72 hours
68
mainstay tx for alcohol withdrawal
**Benzodiazepines (BZDs)**
- Medium to long-acting BZDs like diazepam (Valium), lorazepam (Ativan) or chlordiazepoxide (Librium) usually preferred
69
what is comparable to BZDs and used for very mild cases of withdrawal
Gabapentin or carbamazepine (Tegretol) orally
70
what tx is used for CV and anxiety s/s from alcohol withdrawal
**Anti-hypertensives**
- Clonidine
- Atenolol
71
what general nutritious diet and vitamin supplementations can help with alcohol withdrawal
1. B vitamins (thiamine, pyridoxine, folic acid), vitamin C (ascorbic acid)
2. Do not give IV glucose before giving thiamine supplementation
3. Fluid replacement if indicated
72
what is used to help assess withdrawal severity
CIWA scoring
Tx often begins at score of 8-10 (mild) or higher
73
short course of tapering BZD is considered for what level severity
mild
74
inpatient (hospital) treatment with regular BZD until stable
- diazepam orally 5-10 mg per hour depending on clinical need
- Monitor vitals and electrolytes
is for what level of severity
moderate
75
inpatient (hospital) treatment, regular BZD until stable
- diazepam IV till sedated, then may give orally every 8-12 hrs
- Reduce dose by 20% per 24 hrs - taper usually takes 1+ wks
is for what level of severity
severe
76
what types of consult must be included for alcohol withdrawal?
social work and psych
77
what is the tx for chronic alcohol use? SE?
Thiamine - Vitamin B1
low blood pressure, may affect glucose metabolism, rarely see anaphylaxis, bronchospasm
78
what must you give before glucose for alcoholism tx?
thiamine
79
the FDA-approved, 1st line tx for chronic alcohol use
Blocks the release of dopamine in the brain
Naltrexone (ReVia, Vivitrol)
- Antagonist at mu receptors in brain - ↓ craving, ↓ reward
80
naltrexone has better efficacy if given with what?
behavioral therapy, acamprosate, or SSRI
81
what medication tx can be given to a person while they are still drinking?
Naltrexone
No need to dose-adjust for mild-moderate renal or hepatic impairment
82
SE and BBW for Naltrexone
1. Black-Box Warning - hepatocellular injury, hepatotoxicity
2. SE - N/V/D/C, abd pain, dizziness, HA, anxiety, fatigue
- Can precipitate opioid withdrawal
83
CI for naltrexone
hx of hypersensitivity, opioid dependence or current use
84
DI with naltrexone
opiates
85
what must you monitor while taking naltrexone?
liver function tests
86
1st line therapy for chronic alcohol use (Not FDA approved)
Works to restore normal glutamate action
Acamprosate (Campral)
- Interferes with glutamate release thereby stopping excitation that happens with withdrawal
- Affects GABA neurotransmitter system as well
- Same rates of return to drinking/return to heavy drinking as naltrexone
87
what medication tx for chronic alcohol use is recommended to start after pt has been abstinent
Acamprosate (Campral)
88
who must you adjust the dosing for when taking Acamprosate (Campral)
renal - if CrCl 30-50 mL/min
no hepatic adjustment
89
SE of Acamprosate (Campral)
_diarrhea_, nausea, abd pain, fatigue, HA, amnesia
_monitor mood:_ anxiety, depression, suicidality
90
what must you monitor when taking acamprosate
Monitor mood - anxiety, depression, suicidality
91
CI for acamprosate
Severe renal impairment (CrCl < 30 mL/min)
92
Second-line therapy for chronic alcohol use
Inhibits enzyme aldehyde dehydrogenase
Causes acetaldehyde to accumulate → sweating, headache, dyspnea, lowered BP, flushing, palpitations, N/V
disulfiram (antabuse)
93
which tx does NOT influence motivation/withdrawal directly and has no proven long-term efficacy in alcohol abuse
disulfiram
94
if a pt is using “hidden” ethanols (e.g., mouthwash), what medication must you avoid?
disulfiram
95
SE of disulfiram
often related to intentionally caused sx; metallic taste
Monitor for hepatotoxicity
96
DI with disulfiram
metronidazole, warfarin, amitriptyline
97
CI with disulfiram
severe heart disease or CAD, acute intoxication
98
what are the other second-line tx for chronic alcohol use?
1. Anticonvulsants - topiramate (Topamax), gabapentin (Neurontin)
2. Muscle relaxants - baclofen
3. Antidepressants - SSRIs
- If comorbid psychiatric disorder present
4. Antinausea - ondansetron (Zofran)
- If early-onset (<25 y/o) problem drinking
- Greater serotonergic abnormality in this group
99
what are the psychosocial tx for chronic alcohol use?
1. Motivational Interviewing - helps patient explore and resolve ambivalence about stopping alcohol use
2. Cognitive Behavioral Therapy - explore how thought processes contribute to behavior
3. Peer Support Groups - Alcoholics Anonymous
100
someone who has been drinking has thought, judgement, and restraint loosened, what could be their BAC %?
0.05% BAC
101
someone's voluntary motor actions become clumsy after drinking, what could be their BAC %?
0.1% BAC
102
someone whose been drinking has depression of motor control and emotional control areas of brain
what could be their BAC %?
0.2% BAC
103
someone whose been drinking has confusion, stupor
what could be their BAC %?
0.3% BAC
104
someone who has been drinking recently fell into respiratory depression and led to a coma
what could have been their BAC %?
0.4-0.5% BAC
