substance abuse Flashcards
what are the 3 Cs for the nature of addiction?
A COMPULSION to seek and take the chemical
An inability to CONTROL the use of the chemical
CRAVING for the chemical and the emergence of a negative emotion such as dysphoria, anxiety when access to the chemical is denied
**A chronic relapsing disorder
pattern of addiction: Addiction has its roots in _______ and _______ behavior.
impulsive and compulsive
individual moves from impulsive to compulsive as addiction progresses
impulsive behavior: how do they feel before the act, during and after ?
Before:excitement and tension.
During: pleasure or gratification.
After: self-reproach, guilt, or regret.
compulsive behavior: how do they feel before the act, during and after ?
Before: anxiety and stress.
During: relief.
After: guilt and regret.
in addiction, as impulsive behavior moves to compulsive, reinforcements changes how?
from positive reinforcer to negative reinforcer
what are the neurobiological factors in addiction?
ventral tegmental area nerve bodies stimulated –> message to nucleus accumbens –> release dopamine = pleasure and satisfaction
what does the nucelus accumbens do?
Motivation, reward center, pleasure seeking activities
what does the amygdala do?
Identifies and control emotions, react to pleasurable and aversive experience
what does the prefrontal cortex do?
Complex processing of information, making judgment, controlling impulses, foreseeing consequences of one’s action, setting goals and plans
adverse childhood experiences that cause addiction
(10 ACEs)
Childhood emotional abuse Childhood physical abuse Childhood sexual abuse Witnessing Domestic violence Parental separation or divorce Childhood neglect Parental mental illness Parental incarceration Parental substance abuse Death of a parent
Several studies have demonstrated that ____ ACES in a child’s life has a significant association with developing an addiction as an adult.
4 or more
criteria for substance abuse
Significant impairment or distress, one or more , within a 12-month period: Major role failure Arrest /recurrent legal problems Physically hazardous use Social/interpersonal problems
DSM V definition for substance use disorder
A Pathological pattern of behavior related to the use of the substance in the past year; there are 11 criteria that fit into four groupings. Impaired control Social impairment Risky use Pharmacological criteria
DSM V criteria: mild vs moderate vs severe substance abuse
Mild: 2 to 3 criteria
Moderate: 4 to 5 criteria
Severe: 6 or more.
alcohol abuse: genetics accounts for ___ - ___% of risk, what are the strongest transmissions?
Genetics account for 40-60% of alcoholism risk
Strongest transmission is from father to son and mother to daughter
alcoholism: comorbid pyschopathology: kids and teens
ADHD, Conduct disorder, mood disorder
alcoholism: comorbid pyschopathology: adults
Anxiety disorder, depression, bipolar disorder, substance use disorder
FDA alcohol limits men vs women
Men: <14 per week or < 4 max/day
Women: <7 per week or < 3 max/day
alcohol morbidity and mortality: what is the annual cost to the US economy? how much are the costs in healthcare?
Annual cost to US economy: $184.6 billion
$26.3 billion health care
when do signs of alcohol withdrawal start?
6-8 hrs after last drink
significant signs of alcohol withdrawal
hand tremors, high BP and HR, sweating, grand mal seizures, visual and audio hallucinations
what is Delerium Tremens? when does it occur?
severe alcohol withdrawal: 2 to 4 days after last drink, a medical emergency
Characterized by : Agitation, Disorientation
Elevated blood pressure, pulse and temperature.
Confusion
Hallucinations and delusions
if untreated, delerium tremens has a mortality of __%
20%
two drugs to txt alcohol withdrawal after pt has stabilized
benzos or anti-convulsants
not sure why…..?
what is the CAGE questionnaire?
- Have you ever felt the need to 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?
what are “positive” results of the CAGE questions?
2+ positive answers = person is 7x more likely to be alcohol dependent than the average person.
what is the TWEAK alcohol screening test?
Tolerance: How many drinks does it take to make you feel high?
Worry: Have close friends or relatives worried or complained about your drinking in the past year?
Eye opener: Do you sometimes take a drink in the morning when you first get up?
Amnesia: Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
Cut down: Do you sometimes feel the need to cut down on your drinking?
what is the scoring of the TWEAK test?
A total score of two or more on the test is an indication of harmful drinking and further evaluation is indicated
(first two questions count for 2 each)
what is the screen of an “at-risk” drinker: Binger
≥5 for men or ≥4 for women/anyone 65+)
what is the screen of an “at-risk” drinker: over the regular limits
Men: 2/day or 14/week
Women/anyone 65+: 1/day or 7/week
what do you do if someone screens positive for “at-risk” drinker?
Screen for maladaptive pattern of use and clinically significant alcohol impairment using AUDIT.
3-part pyschosocial txt for alcoholism
Cognitive behavioral therapy
Alcoholic Anonymous (AA)
Behavioral family therapy
pharm txt for alcoholism
naltrexone
disulfiram
acamprosoate
Prochaska’s Model of Stages of Change
precontemplation contemplation prep action maintenance
what are the two types of alcohol-induced amnesic disorder? txt for both?
wernicke’s encephalopathy
korsakoff’s syndrome
Txt: thiamine
what is wernicke’s encephalopathy?
Impaired short term memory due to prolonged/heavy alcohol use
Thiamine deficiency poor nutrition or malabsorption
Reversible with treatment
Triad: ataxia, mental disturbance , opthalmoplegia
what is korsakoff’s syndrome?
Chronic condition, anterograde amnesia in alert, responsive patient with or without confabulation
what does fetal alcohol syndrome cause?
Poor growth both in uterus and after birth Decreased muscle tone and coordination Developmental delay Cardiac birth defects Facial abnormalities:
Teens who have smoked cigarettes are __ times likelier to use ______ than teens who have never smoked
11, marijuana
nicotine withdrawal
(overall: opposite of nicotine effects) Depressed mood Anxiety Insomnia Irritability Difficulty concentrating Decreased heart rate Increase appetite
4 major health consequences of tobacco use
cancer
pulmonary disease
cardiovasc.
reproductive effects
3 types of FDA approved drugs for txt nicotine dependence
- nicotine replacement (gum, lozange, patch)
- bupropion (Zyban)
- Chantix
routes of administration: smoking vs eating marijuana
Smoked marijuana: reaches the brain in minutes, effects last 1-3 hours, delivers lot of THC into the blood stream
Eating or drinking
Takes ½-1 hour to have an effect, last up to 4 hrs, delivers significantly less THC in blood stream
physiological effects of marijuana
tachycardia
conjunctival injection (red eyes)
appetitive increase
dry mouth
what is “hemp insanity” ?
Acute psychotic episodes tend to occur when high dose of cannabis is consumed as food or drink
management of mairjuana high: acute
Euphoria, sensory stimulation, pupillary constriction, conjuctival injection., photophobia, diplopia, increased appetite, autonomic dysfunction
= Reassurance and Observation
management of marijuana high: chronic
reactive airway disease, decreased sperm count, weight gain, lethargy
=discontinuation of use , symptomatic treatment/care bronchodilators for wheezing
management of marijuana high: intoxication
panic delirium, psychosis
=Neuroleptics medication
what is the main txt for marijuana withdrawal?
reassurance - symptoms go away in 3-4 days
toxicology use for marijuana: casual use: urine vs hair
Up to 10 days in urine
50% positive in hair samples
toxicology use for marijuana: heavy use: urine vs hair
Up to 30 days in urine
85% positive in hair samples.
what are the two marijuana medication formulations? what are they each used for?
Dronabinol(Marinol): treatment of anorexia with AIDS, Nausea, vomiting, cancer chemotherapy
Nabilone (Cesamet)
nausea and vomiting associated with cancer chemotherapy, who failed to adequately respond to conventional antiemetic.
what group specifically abuses methamphetamines most? least?
most: Gay men in US metropolitan areas, particularly affected.
least: african americans
what are the effects of cocaine/amphetamine intoxication ?
Tachycardia, bradycardia, high or low BP
dilated pupils, sweating
N/V, weightloss
Psychomotor agitation or retardation
Muscular weakness, respiratory depression, chest pain or cardiac arrhythmias
Confusion, seizures, dyskinesias, dystonia or coma.
what are the 3 main physiological changes from cocaine?
- Local anesthetics: Blocks membrane sodium channels
- Stimulates CNS: Blocks presynaptic neurotransmitter reuptake of dopamine, norepinephrine, serotonin
- Stimulates sympathetic nervous system
All of these are effects from what?
- Paranoia/hallucinations
- Changes in brain structure and function, memory loss
- Mood disturbances, aggressive, violent behavior
- Severe dental problems
- Increased infectious disease transmission HIV, hepatitis
longterm stimulants
cocain/meth withdrawal includes what?
Dysphoric mood and 2 or more of the following Fatigue Vivid, unpleasant dreams Insomnia or hypersomnia Increased appetite Psychomotor retardation or agitation
what to txt for acute stages of cocaine/meth
Symptomatic management: hypertensive crisis, MI, agitation
longterm pyschosocial txt for cocaine/meth ?
cognitive behavioral therapy, desensitization and cue extinction.
Contingency management: rewarding clean urines with some form of positive reinforcer.
Alcohol and cocaine forms what? what is the dangers of this?
Alcohol and cocaine forms cocathylene
Longer half life, more toxic to heart, and violence potential.
The addition of alcohol to cocaine increases the risk of sudden death __-fold.
25
4 facts about those who are more likely to abuse prescription opiates?
- are more likely to have complaints of pain
- are more likely to be in psychiatric treatment
- have greater social stability compared to heroin addicts
- are less likely to use other illicit drugs compared to heroin addicts
1in __ teens have used prescription drugs to get high
1:5
what is the half life and duration of heroin?
Half-life of 30 minutes, duration of action 4-5 hrs
active metabolites, including Morphine .
what is the solubility of heroin?
Most lipid soluble than other opioids, allowing it to rapidly cross the blood-brain barrier (within 15 to 20 seconds) .
routes of administration of heroine? (which is the best high, what do people normally progress to?)
Intranasal insufflations more common due to the purity of the heroin.
IV administration - best high
Individuals starts with snorting then to IV
Dx of recent opiod use and intoxication
Maladaptive behavior (euphoria followed by apathy, dysphoria, psychomotor agitation/ retardation, impaired judgment)t
Pupillary constriction and one or more:
Drowsiness
Slurred speech
Impaired attention and memorymanagement of opiod use: acute ( Dx and txt)
euphoria, miosis, respiratory depression, decrease gag reflex, bradycardia, hypotension, constipation
Txt: Airway protection, use of naloxone
management of opiod use: acute (Dx and Txt)
Complication of IV use, Hepatitis B, HIV, endocarditis, brain abscess
Txt: Discontinue use, Medical care for infectious complications
management of opiod use: intoxication (Dx and Txt)
Intoxication/ Overdose: respiratory arrest and death
Txt: Intubation and ventilation, naloxene
what is this? ... Three or more of the following Dysphoric mood Nausea or vomiting Muscle aches Lacrimation or rhinorrhea Pupillary dilatation, piloerection or sweating Diarrhea Yawing Fever Insomnia
opioid withdrawal
management of opiod withdrawal: meds to use for HA, nausea, loose stool
HA: acetaminophen or tylenol
nausea: phenergan & metoclopramide
loose stools: imodium
define “impaired control” of drugs
- take the substance in larger amounts or for longer periods of time than originally intended.
- unsuccessful in cutting down or regulating the use of the substance.
define “impaired control”
- take the substance in larger amounts or for longer periods of time than originally intended.
- unsuccessful in cutting down or regulating the use of the substance.
what meds can you give for opioid withdrawal?
clonidine or lofexidine (both alpha 2 agonists)
- suppress autonomic-mediated symptoms
what do you do for a pregnant pt on opioids?
Treatment is either Methadone maintenance or
Buprenorphine maintenance.
Avoid having patient experience severe withdrawal, since it can cause premature labor.
what meds can treat opioid addiction?
- methadone: synthetic opioid agonist
- buprenorphine (buprenorphine-naloxone “suboxone”) - mu opioid agonist/ mixed agonist/antagonis kappa opioid receptor
- naltrexone or naltrexone XR - pure opioid blocker
what diseases should heroin users be screened for?
HIV and hepatitis A, B, and C.
opioid use disorder: what types of pyschosocial txt do they need? what if they relapse?
Group therapy
Individual therapy
Family therapy
If patient relapses must intensify rather than discharge.
anabolic steroid use: negative effects
- Severe acne face and back
- Gynecomastia, shrinkage of testicles\High blood pressure and heart disease
- Mood swings, aggressive behavior, agitation , depression psychotic reaction can occur
anabolic steroid use: withdrawal symptoms
Mood swings, depression, suicidal behavior, aggression, violence, dramatic reduction size and strength
anabolic steroid use: txt/management
Endocrinologist , discontinue use
what drug was developed in 1950s as iv anesthetic?
PCP (angel dust)
what are the signs of PCP use?
maladaptive behavior(belligerence, agitation, assaultiveness, impulsiveness, impaired judgment)
what drug intoxication is this?
2 or more of the following:
vertical or horizontal nystagmus, hypertension or tachycardia, numbness or diminished response to pain, ataxia, dysarthia, muscle rigidity, seizure or coma, hyperacusis
PCP
PCP: acute use: symptoms and txt
perceptual distortion, hallucinations
txt: Reassurance and observation. Diazepam for
seizure.
PCP: chronic use: symptoms and txt
flashbacks hallucinogen persisting perception-(geometric shapes, false perception of movement in peripheral visual fields, flash of colors, trails of images of moving objects) txt: Discontinue use
PCP: intoxication: symptoms and txt
psychosis
txt: close observation in quiet room , benzodiazepams
PCP: withdrawal: txt
supportive
bath salt MOA
similar to amphetamines
signs and symptoms of bath salts high
Tachycardia, hypertension, chest pain, agitation, aggressive behavior, paranoia, hallucinations, self inflicted aggression,confusion, and in rare cases - seizures.
synthetic cathinone has longer or shorter effects than amphetamines?
longer
how are hallucinations different for bath salts from amphetamines or synthetic catheinone
dont have tachycardia and HTN along with it
what are 2 treatments for patient with agitation from synthetic cathinone?
IV lorazepam, or IV diazepam,
Substance use disorder (SUD) is an acute or chronic illness?
chronic
