Substance Abuse Flashcards
alcohol use and SI
- 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
epidemiology of substance abuse
adolescents
and adults
- 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
SI in older adults
-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
substance abuse etiology: what came first?
theories
- psychiatric illness sx lead to abuse
- substance use lead to psych sx
- or they both coexist
compartmentalized approach to tx
- is associated with non-adherence
- pts get impatient to wait for treating their “secondary” px
- many barriers
- we want dual dx tx/integration
integrated approach to tx
-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
-
substance abuse etiology
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)
hereditary and genetic fx in substance abuse
- alcoholism has high heritability
- genetic factors tend to be multifactorial
- no evidence that psychosis and substance abuse have genetic component
biological markers
- 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
Prenatal exposures
- 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
co-occuring psych and substance d/o presentation
- 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
SSRIs and COD and SUD
- 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
disulfram
- interferes with alcohol metabolism via alcohol dehydrogenase and acts as dopamine beta-hydroxylase inhibitor
- occasionally evokes psychosis, necessitating an adjustment in antispychotic meds
naltrexone
- 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
acomprasate
- 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
