Substance Abuse

Question 1

• a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress. - A person with this disorder will often continue to use the substance despite consequences.

-The person must have at least two of the following for a given substance within the same
12-month period:
1. Taking the substance in larger amounts or for longer than the you meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what you should at work, home, or school because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational, or recreational activities because of substance
use
8. Using substances again and again, even when it puts you in danger
9. Continuing to use, even when you know you have a physical or psychological problem
that could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the
substance.

Answer 1

Substance Use Disorder

Question 2

The development of a reversible, substance-specific syndrome as a result of the recent ingestion of a substance; must include maladaptive behavior or psychological changes and specific signs of the substance’s effects on the nervous system.

Answer 2

Substance Intoxication

Question 3

A substance-specific maladaptive behavioral change with physiological and cognitive correlates, due to cessation or reduction of heavy or prolonged substance use.

Answer 3

Substance Withdrawal

Question 4

inappropriate sexual or aggressive behaviors; impaired judgment; slurred speech; emotional lability; incoordination; unsteady gait; involuntary, rhythmic movement of the eyes; impaired attention or memory; stupor; coma

Answer 4

Signs of Alcohol Intoxication

Question 5

sweating; tachycardia; hand tremor; insomnia; nausea or vomiting; transient illusions or hallucinations; anxiety; psychomotor agitation; grand mal seizures; delirium
tremens (DT’s).

Answer 5

Signs of Alcohol Withdrawal

Question 6

• is an acute, life threatening (but reversible) condition that requires emergency treatment. It results from severe acute deficiency of thiamin.
• Individuals may
  experience confusion, loss of muscle coordination (leg tremors), and vision changes (abnormal eye movements, double vision, eyelid drooping). The prognosis is good if treated accordingly.
• often co-occurs with Wernicke-Korsakoff syndrome
• both are due to brain damage caused by a lack of vitamin B1 (thiamine).

Answer 6

Wernicke-Encephalopathy

Question 7

a chronic memory disorder caused by severe deficiency of
thiamine (vitamin B-1). The individual may attempt to compensate for memory loss by
fabricating memories. It can cause hallucinations and can also lead to personality changes. The prognosis for Wernicke-Korsakoff syndrome is generally poor

Answer 7

Wernicke-Korsakoff syndrome

Question 8

Signs of Intoxication: euphoria; anxiety; hyperactivity; grandiosity; confusion; anger; paranoia; auditory hallucinations; tachycardia; elevated or lowered blood pressure; dilated pupils;
perspiration or chills; nausea or vomiting; weight loss; psychomotor agitation; muscular weakness; confusion; seizures.

Signs of Withdrawal: dysphoric mood; fatigue; vivid and unpleasant dreams; insomnia or hypersomnia; increased appetite; psychomotor agitation or retardation

Answer 8

Amphetamines/Cocaine

Question 9

Signs of Intoxication: restlessness; nervousness; excitement; insomnia; flushed face; diuresis; gastrointestinal disturbance; muscle twitches; rambling flow of thought and speech; tachycardia
or arrhythmia; periods of inexhaustibility; psychomotor agitation.

Signs of Withdrawal: headache (most common); changes in mood (such as depression and
anxiety); difficulty concentrating; fatigue; increased appetite.

Answer 9

Caffeine

Question 10

Signs of Intoxication: impaired motor coordination; euphoria; anxiety; sensation of slowed time; impaired judgment; social withdrawal; conjunctival injection (redness of the eyes); increased appetite; dry mouth; tachycardia.

Signs of Withdrawal: irritability; anger or aggression; nervousness or anxiety; sleep difficulty (insomnia); decreased appetite or weight loss; restlessness; depressed mood; stomach pain; shakiness/tremors; sweating; fever, chills, and/or headache

Answer 10

Cannabis

Question 11

Signs of Intoxication: perceptual changes; anxiety; depression; ideas of reference; paranoid
ideation; pupillary dilation; tachycardia; sweating; palpitations; blurred vision; tremors; incoordination.

Answer 11

Hallucinogens

Question 12

Following the cessation of use, the reexperiencing of one or more of the perceptual symptoms that were experienced while
intoxicated with the hallucinogen; this reexperiencing causes significant distress or impairment in social, occupation, or other important area of functioning

Answer 12

Hallucinogen Persisting Perception Disorder (Flashbacks)

Question 13

Signs of Intoxication: initial euphoria followed by apathy or dysphoria; pupillary constriction; drowsiness or coma; slurred speech; impairment in attention and memory.

Signs of Withdrawal: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or
rhinorrhea (runny eyes & nose); pupillary dilation; diarrhea; yawning; fever; insomnia.

Answer 13

Opioids

Question 14

means that the primary area of concern is the use of a substance; it isn’t causing another disorder to occur.

Answer 14

Substance Use Disorder

Question 15

• disorders that are caused by taking (or ceasing taking) drugs
  or alcohol
• So a substance induced mood disorder could look like depression that starts after a
  person begins heavy abuse of alcohol on a regular basis. The depression is induced
  (caused) by the substance use.

Answer 15

Substance Induced Disorder

Question 16

are almost always part of addiction treatment and are based on a disease model (the idea that alcoholism is a disease that cannot be cured but only
controlled).

Answer 16

12 Step Programs (AA, NA, etc.)

Question 17

1. Dependent: the alcoholic family member
2. Enabler: often the spouse; the person who does everything to get the dependent to stop
   drinking except what might actually work (confrontation or leaving the relationship)
3. Hero: the family member who is aware of what is going on and tries to assume
   responsibility for the family by being successful (often the oldest child)
4. Scapegoat: the family member who rejects the family system (often the 2nd child)
5. Lost Child: the member who quietly withdraws from the family system (often the 3rd
   child)
6. Mascot: the member who “plays the clown” in order to relieve family tension or their own pain (often the youngest child)

Remission: The following specifiers are used only after NO criteria for Substance Use Disorder except cravings have been met for at least 3 months. (These specifiers do not apply if the person is on agonist therapy [e.g., methadone] or in a controlled environment, [e.g., locked hospital unit].)

● Early Full Remission: None of the criteria for Substance Use Disorder except cravings are
met for at least 3 months but less than 12 months.
● Sustained Full Remission: None of the criteria for Substance Use Disorder except
cravings have been met for at least a 12-month period (or longer).

Answer 17

The Alcoholic Family

Question 18

• The CAGE questionnaire is a quick screening tool used to assess for alcohol problems
  specifically. This screener helps determine whether a person drinks in excess and may benefit from alcohol treatment. - The CAGE questionnaire asks the following questions:
  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
  *Two or more “yes” responses indicate the individual may have a problem with alcohol and
  necessitates further assessment

Answer 18

Screening Tool

Question 19

For alcohol: Naltrexone, Disulfiram (Antabuse), and Acamprosate are the most common drugs
used.
● Naltrexone is what we see come up most commonly on the exam (it blocks the euphoric
effects and feelings of intoxication).
● Disulfiram (Antabuse) works by creating an unpleasant reaction to alcohol. Use of
disulfiram requires medical supervision.
● Acamprosate can reduce the desire to drink alcohol by stabilizing chemical signaling in
the brain that could otherwise be disrupted during withdrawal from alcohol.
For opioids: Methadone, Naltrexone, and Buprenorphine can be used.
● Methadone is most often used. It works by reducing cravings and withdrawal and blunts
or blocks the effects of opioids.
● Naltrexone can also be used for opioid use disorder. While it’s used in pill form for
alcohol, for opioid use disorder it’s available as an extended-release injectable. Like its
use with alcohol use disorder, it blocks the euphoric effects and feelings of intoxication.
● Buprenorphine: suppresses and reduces cravings for opioids.

Answer 19

Medication Interventions

Question 20

Motivational Interviewing is a treatment model that focuses on resolving ambivalence and using the person’s own values and concerns to elicit change (rather than imposing or “coercing” a person to change behavior). It helps individuals move from a place of indecision regarding making change to a place of motivation towards making change and meeting their goals. While it can be used for a number of presenting problems, it is a common treatment approach for
individuals engaging in substance abuse.

Answer 20

Motivational Interviewing

Question 21

1. Pre-contemplation: In this stage, the client is not yet thinking about change.
2. Contemplation: During this stage, the client is thinking about and talking about change. They
   are considering whether or not to work towards change.
3. Preparation: The client is actively planning out steps to take in order to make change happen
   during this stage.
4. Action: During this stage, the client is taking positive steps to put the plan from the previous
   stage into practice.
5. Maintenance: During this stage, the client is maintaining the change that has been made.
   ● Some models add an additional stage for ‘relapse’. This is to acknowledge that relapse
   often occurs and can be viewed as another step in the process as opposed to a failure in
   the treatment process.

Answer 21

The stages of change in Motivational Interviewing

Question 22

Harm reduction is an intervention that aims to reduce the negative effects of alcohol and drug use. It acknowledges that despite prevention and abstinence efforts, some clients will continue to engage in alcohol and drug use. Harm reduction includes things like:
● limiting the number of days you drink per week
● limiting the number of drinks you consume in one sitting
● having a designated driver
● utilizing needle exchange sites
● utilizing injection sites

Answer 22

Harm Reduction

Question 23

a type of behavioral therapy that uses incentives to help clients abstain from drugs and alcohol. Clients are encouraged to engage in sobriety and engage in behaviors supporting sobriety. As goals are achieved and behaviors are modified (for example, a clean drug

Answer 23

Contingency Management