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:
