Substance Abuse

Question 1

Opioid vs illegal drug vs MVAs: mortality

Answer 1

Opioid deaths exceed deaths from illegal drugs and from MVAs

Question 2

DSM5 criteria for Dx of substance use d/o

Answer 2

2 or more in the prior 12mo

2-3 = mild, 4-5 = moderate, 6+ = severe

• hazardous use
• social/interpersonal problems r/t use
• neglected major roles to use
• withdrawal
• tolerance
• used larger amounts/longer
• repeated attempts to quit/control use
• much time spent using
• physical/psychological problems r/t use
• activities given up to use
• craving

Question 3

Role of provider

Addiction vs at-risk vs little/no use

Answer 3

• Addiction: treatment
• At-risk: brief intervention
• Little/no use: prevention

Question 4

Method for screening for substance abuse

Answer 4

• SBIRT
• Screening: ID and assess severity
• Brief intervention: increase motivation for behavior change
• Referral to Tx

CAGE (cut down, annoyed, guilty, eye opener)

AUDIT, MAST

Question 5

What defines at-risk etoh use

Men vs women vs all >65yo?

Answer 5

• Men: >4/day, >14/week
• Women: >3/day, >7/week
• >65: >3/day, >7/week

at risk is not same as addicted!

Question 6

1 drink = ? beers, malt liquor, table wine, spirits?

Answer 6

• 12 fl oz regular beer
• 8-9 fl oz malt liquor
• 5 fl oz table wine
• 1.5 fl oz shot of 80 proof spirits

Question 7

NIAAA single item screen for unhealthy etoh use

And what would constitute unhealthy etoh use?

Answer 7

How many times in the past year have you had 5 or more drinks in a day (men) or 4 or more drinks in a day (women)?

Unhealthy etoh use = one ore more heavy drinking days in the past year.

Document weekly avg, assess for probs r/t etoh use, etoh use d/o

Question 8

Single Q for screening for drug use

Answer 8

How many times in the past year have you used an illegal drug or used a prescription med for non-medical reasons?

Pos: at least one time

Document weekly avg

Assess for severity of drug use d/o

Question 9

4 components of an effective brief intervention

Answer 9

• Raise the subject
• Provide personalized feedback
• Enhance motivation – utilize the readiness to change scale
• Negotiate a goal, develop a pt centered plan, follow up w/the pt

Question 10

FDA approved pharmacotherapies for addiction tx

Answer 10

Tobacco: nicotine replacement, bupropion, varenicline (Chantix)

Etoh: disulfiram, acamprosate, naltrexone

Opioids: methadone, buprenorphine, naltrexone

*none requires special training/tx, except buprenorphine, which requires MDs to complete training course and apply to DEA for a license to Rx, and methadone: only through addiction tx facility for opioid use d/o

Question 11

Tx for acute etoh detoxification

Answer 11

Benzos, fixed dosing or symptom triggered dosing

Question 12

How does disulfiram work?

Answer 12

Inhibits aldehyde dehydrogenase, leading to increased levels acetaldehyde and an unpleasant reaction after consuming ethanol: flushing, HA, nausea, dizziness, palpitations