substance abuse

Question 1

substance dependence

Answer 1

-maladaptive pattern of use, leading to impairment
-3 (or more) of following, occurring at any time in same 12-month period:
-tolerance
-withdrawal
-the substance is often taken in larger amounts or over a longer period than was intended
-persistent desire or unsuccessful efforts to cut down or control substance use

-a lot of time spent trying to obtain substance, use substance, or recover from its effects
-important social, occupational, or recreational activities are given up or reduced because of substance use
-substance use is continued despite knowledge of having recurrent physical or psychological problem

Question 2

substance use disorder signs

Answer 2

-Taking substance in larger amounts or for longer thanyou’remeant to
-Wanting to cut down or stop using the substancebut not managing to
-Spending a lot of time getting, using, or recovering from use of the substance
-Cravings and urges to use substance
-Not managing to do what you should at work, home,or school
-Continuing to use, even when it causes problems in relationships
-Giving up important social, occupational, or recreational activities because of substance use
-Using substances again and again, even when it puts you in danger
-Continuing to use, even when you know you have a physical or psychological problem
-Needing more of substance to get the effect you want (tolerance)
-Development of withdrawal symptoms

Question 3

alcohol dependence

Answer 3

-Important social, occupational, or recreational activities are given up because of alcohol
-Recurrent alcohol use in situations in which it is physically hazardous.[drinking in risky settings, or doing risky things while drinking?]
-Alcohol use is continued despite knowledge of having recurrent physical or psychological problem[Do you know drinking isn’t good for you, but you do it anyway?]
-Tolerance
-Withdrawal, drinking alcohol (or taking a benzodiazepine) to relieve or avoidalcohol withdrawal symptoms

Question 4

alcohol dependence criteria

Answer 4

-2 of symptoms from following in past year -> AUD:

-Alcohol taken in larger amounts or over a longer period than was intended.[Do you drink more than you mean to?]
-persistent desire or unsuccessful efforts to cut down
-a lot of time spent trying to obtain alcohol, use alcohol, or recover from its effects.[Is drinking taking over your life?]
-Craving or urge to use alcohol.[If you can’t drink, are you thinking about drinking?]
-Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home
-Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.[Is drinking getting in the way of your relationships?]

Question 5

opiate dependence

Answer 5

-taken in larger amounts or over a longer period than intended.
-persistent desire or unsuccessful efforts to cut down
-a lot of time spent trying to obtain opioid, use the opioid, or recover from its effects.
-Craving, or urge to use opioids.
-failure to fulfill major role obligations at work, school, or home
-use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
-Important social, occupational, or recreational activities are given up or reduced because of opioid use.
-Recurrent opioid use in situations in which it is physically hazardous.
-Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
-Exhibits tolerance
-Exhibits withdrawal

Question 6

CAGE

Answer 6

-Have you ever felt like you should CUT down on your drinking?
-Have people ANNOYED you by criticizing your drinking?
-Have you ever felt bad or GUILTY about your drinking?
-Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (EYE OPENER)?

Question 7

alcohol withdrawl tx

Answer 7

-Supportive Care, Quiet environment
-Hydration- may have 6 L volume deficit with DT
-Electrolyte correction
-Thiamine-reduces risk of Wernicke’s dementia
-Nursing care (reassurance/orientation)
-Monitor for signs/symptoms of withdrawal
-Reduction of symptoms -> Benzodiazepines, Antipsychotics, Clonidine

Question 8

opiate withdrawal sx

Answer 8

-Insomnia and disturbed sleep
-Dilated pupils
-Cramps
-Pilo-erection- goose bumps
-Intense craving for opioids
-Muscle twitching (particularly restless legs while lying down)
-Vomiting
-Diarrhea

Question 9

treatment options for opiods

Answer 9

-Methadone, Suboxone
-Clonidine
-Ultra rapid detox- Naltrexone (opiate antagonist) administered under general anesthesia
-Methadone maintenance
-Supportive measures
-Ultrarapid-under anesthesia usually for 6 hours and opoid antagonist naltrexone administered.