Substance Abuse

Question 0

alcohol use and SI

Answer 0

• alcohol use has increased risk for SI in all age groups
• older males widowed or unmarried that have alcohol abuse are more likely to have SI than women
• SI in older adults 6x national rate

Question 1

epidemiology of substance abuse
adolescents
and adults

Answer 1

• 47-86% dx with a psychotic d/o have substance abuse
• 9% of US population
• In adolescent females depression and substance correlations are strong
• drug problems with those adolescents living on the street especially males
• over havel (62%) of adolescents living on street have a comorbidity mental health illness
• CD has a high risk of substance abuse ages 13-15
• adolescent girls w/ anxiety have high risk and males with MDD have high risk
• evidence shows that the longer a adolescent does not abuse alocohl the less likely to become alcohol dependent in later years
• ages 15-21 are at increased risk for using substances, relapsing, suffer severe anxiety and at risk for SI
• there has been evidence of more women with co-occuring mental illness and hospitalizations with alcohol
• more frequent dx of mood d/o in women where as men had substance abuse d/o
• 70% of alcohol and rx drug abuse in older adults

Question 2

SI in older adults

Answer 2

-National institute of aging recommends that older adults have no more than one drink per day because they are at increased risk for SI in this age group

Question 3

substance abuse etiology: what came first?

Answer 3

theories

• psychiatric illness sx lead to abuse
• substance use lead to psych sx
• or they both coexist

Question 4

compartmentalized approach to tx

Answer 4

• is associated with non-adherence
• pts get impatient to wait for treating their “secondary” px
• many barriers
• we want dual dx tx/integration

Question 5

integrated approach to tx

Answer 5

-uses interactive disease model vs primary/secondary
-both dx are primary
-high success rates
-improves px and quality of life
-decreases involvement of legal systems
-

Question 6

substance abuse etiology

Answer 6

child abuse, enviornmental px, neurodevelopment, neurological px, medical illness/dx
-medical/neurological px: frontal lobe px that result in px with executive fx and other cognitive domains (impaired memory and judgement the most significant)

Question 7

hereditary and genetic fx in substance abuse

Answer 7

• alcoholism has high heritability
• genetic factors tend to be multifactorial
• no evidence that psychosis and substance abuse have genetic component

Question 8

biological markers

Answer 8

• children of alcoholic parents have abnormal EEG’s with alcohol infusions
• CSF shows low SE, GABA, DA and other metabolites
• D2 receptors may be involved in heritability factors of alcoholism
• on PET scan of those with alcohol dependence it shows abnormal cortical involvement
• tryptophan depletion is associated with mood and urge to drink and SE is associated with drinking as well

Question 9

Prenatal exposures

Answer 9

• there are deficits as a result of drug abuse and alcohol abuse
• males tend to be more vulnerable; females are more biologically resistant
• FAS linked to attention d/o’s, low IQ, intellectual disabilities

Question 10

co-occuring psych and substance d/o presentation

Answer 10

• will have more distressing sx
• more at risk for increased hospitalization rates, instability of housing, med/tx non adherence, more disabiled and poorer outcomes and are more likely to die of accidents than general population

Question 11

SSRIs and COD and SUD

Answer 11

• sertraline has been associated with decreases in drinking even in absence of mood d/o
• fluoxetine has been associated with decreases use of marijuana and alcohol use in those with anxiety and depression
• paroxetine has been shown to be useful in tx social anxiety and alcohol use
• venlafaxine has been shown to decrease cocaine use in those with depression
• bupropion has been shown to decrease cocaine cravings and use in adults with co morbid ADHD and opiod dependence but no evidence in alochol use
• lithium effective in bipolar pts with substance d/o; drug of choice being marijuana and alcohol commonly
• clozapine has a direct effect at decrease substance abuse in those with COD

Question 12

disulfram

Answer 12

• interferes with alcohol metabolism via alcohol dehydrogenase and acts as dopamine beta-hydroxylase inhibitor
• occasionally evokes psychosis, necessitating an adjustment in antispychotic meds

Question 13

naltrexone

Answer 13

• decreases cravings for alcohol
• about 80% of pts treated with it maintained compliance for about 8 wks and curbed alcohol use for significant period;
• SE insomnia, HA, n/v, muscle aches and liver px
• used and effective to prevent opiod dependence relapse

Question 14

acomprasate

Answer 14

• lowers neuronal excitability
• has inhibitory effect
• modulates glutamate and GABA which decreases urge to drink
• it is said to be safe since pts don’t get sick if they drink while taking it
• combining acomprasate and naltrexone together is said to be more effective than either alone

Question 15

Methadone

Answer 15

• widely prescribed and mainstay tx for opiate dependence
• synthetic opiate with actions resembling heroin and morphine
• is regulated by federal government and is sucessful in opiate addiction

Question 16

levo-alpha-accetyl-methadol

Answer 16

• synthetic compound resembling methadone, but with longer duration of action
• goal of tx for narcotic addictio is substitute methadone or LAAM for drugs with a shorter duration of action such as heroin or other narcotics

Question 17

treatment contract in substance abuse

Answer 17

• need to have signed contract for adherence to all appts, random urine testing, substance abuse counseling/groups, 12 step or recovery meetings, proper use and storage of meds and random spot checks of meds in bottles
• goal is to keep individual in tx

Question 18

suboxone (buprenorphine/naloxone) and subutex (buprenorphine alone)

Answer 18

are sublingual preparations and only meds approved by FDA for office-based opiate addiction tx

• buprenorphine in combo with naloxone is partial opiate receptor agonist that has been found to be safe in office based settings; it controlls opiate cravings and has been shown that a high percentage of those who take med have drug free urines after one year
• suboxone maintinas pts who abused both opiates and cocaine have shown improvements in depressive sx when tx with desipramine in addition to buprenorphine but if their depression had not been chronic or life long; other studies have mixed results with that antidepressant or other antidepressants
• the drugs may interfere with systems that metabolize psychotropics

Question 19

bipolar d/o and COD

Answer 19

• bipolar d/o is associated with the highest rates of substance abuse than any other psych d/o
• substance abuse contriblutes to rapid cycling, may worsen course, severity and prognosis; it is reported that those pt are significantly more impaired as compared to individuals with other psych illnesses and SUD
• pt report relapse of prodromal of heightened anxiety, sleep px, irritability leading to med non adherence and drug/alcohol relapse or both