Substance Abuse Across The Lifespan Flashcards
What is a significant barrier to substance use and trying to treat it?
The patients denial
What is the DSM-V criteria for substance use disorder?
A problematic pattern of use leading to clinically significant impairment or distress manifested by two or more criteria within a 12 month period
How many classes of drugs are on the DSM-V for substance use disorder?
10 classes of drugs
What are some important criteria for substance use disorder?
- Wanting to cut down or stop using the substance but not managing to
- Needing more of the substance to get the effect you want (tolerance)
- Development of withdrawal symptoms
What are some risk factors of substance use?
- Family history (most powerful)
- Male>Female
- Longer work hours
Which profession is valuable for the treatment of substance abuse?
Social workers
Is severe alcohol use disorder an acute or chronic disease?
Chronic disease
What are the standard drink ounces and % of alcohol?
5oZ of wine (12%)
8oz of malt liquor (7%)
12oz of beer (5%)
1.5 oz 80 proof (40%)
What is moderate drinking?
Men: 2 drinks a day
Women: 1 drink a day
What is heavy drinking?
Men: >15 drinks a week
Women: >8 drinks a week
*highest consequences of impaired driving
What is excessive drinking?
Includes binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21
What is binge drinking?
Pattern of alcohol consumption that brings the blood alcohol conc. To 0.08% or more
*Men: 5 or more drinks within 2 hours
*Women: 4 or more drinks within 2 hours
What is the most common, costly and deadly pattern of excessive alcohol use in the US?
binge drinking
*most people who binge drink do not have severe alcohol disorder
What are short term health risks of alcohol use?
Injuries
Violence
Alcohol poisoning
Risky sexual behaviors
miscarriage and stillbirth
What are long term risk of alcohol use?
HTN, Heart disease, Liver disease
Cancer (any type)
Learning and memory problems
Depression and anxiety
Social problems
Alcoholism
What is the most commonly used and abused drug among the youth in the US/
Alcohol
How does alcohol get passed from mother to baby?
Through the umbilical cord, cross blood brain barrier in fetus
When should pharmacological agents be used of alcohol use disorder?
For patient that are moderate to severe subtype
Is withdrawlling from alcohol deadly?
Yes
What pharmacological are used for alcohol use disorder? (Inpatient hospitalization)
Benzodiazepine protocols
*lorazepam (ATIVAN)
*Diazepam (VALIUM)
What is the first-line medication for alcohol use disorder?
naltrexone (vivitrol)
Acamprosate (Campral)
What is the second-line medication for AUD
Disulfiram (Antabuse)
How does naltrexone work?
Treats alcohol dependence and prevents relapse of addiction to opioids
*Can be initiated while the individual is still drinking
*CANT be given to patients taking opioids
What are the different type of naltrexone medication?
Vivitrol: IM
Revia: Oral, MC used in pregnancy
What is Acamprosate? (Campral)
Anti-drinking neurochemical effect
*safe in alcohol dependent liver disease
Describe disulfiram
Aversive agent
*Doesnt influence motivation to drink
*Causes unpleasant reaction
What happens if you drink alcohol while taking disulfiram?
There will be an accumulation of acetaldehyde in the blood
Which age group has the highest prevalence of using marijuana?
Young adults 18-25
What is the psychoactive component of cannabis?
Delta-9 tetrahydrocannabinol
Does CBD cause psychoactive effects?
No
*has little or no abuse liability
What are risk factors of cannabis?
Men>Women
Cigarette smokers and alcohol drinkers are each 5-6x more likely to use
Can THC cross the placenta?
YES
*Also accumulates in the breast milk
What is the difference between cannabis when its inhaled vs ingested?
Inhaled: peak at 12-30 mins, last up to 4 hours
Ingested: Delayed onset, last up to 12 hours
*Increase in unintentional pediatric ingestions
What is the origin of opioids?
Natural: poppy
Synthetic: made in a lab
Semi-synthetic opioids: Synthesized form naturally occurring opium products
What is an opiate?
Natural opioids
*heroin, morphine, codeine
*will cause a drug screen to turn positive
What are opioids?
All natural, semisynthetic, and synthetic opioids
*Semisynthetic and synthetic will not turn a drug test +
What are some semi-synthetic opioids?
Heroin, oxycodone, hydrocodone
What are synthetic opioids?
Tramadol
Fentanyl
Methodone
What is heroin?
Illegal opioid, naturally occurring
High is minutes to hours
What is fentanyl?
Synthetic opioid pain reliever
*High is seconds
*Deaths related to illegally made fentanyl
What are the 5 drugs on a basic urine drug screen?
- Amphetamines= powerful stimulant used to treat ADHD, narcolepsy
- Benzo/ Barbiturates= depressed CNS
- Methamphetamine= strong CNS stimulant
- Cannabinoids
- Phencyclidine
What is an opioid agonist?
Suppress craving and withdrawal symptoms
*Block acute effects of other opioids
*Still physically dependent upon medication, but behavior associated with addiction are stopped
What is an opioid antagonist?
naltrexone used for maintenance
Naloxone (Narcan) used for acute overdose
*Blocks effects of opioids
When is naltrexone used? (vivitrol or revia)
Maintenance therapy
*Block opioid receptors
*must be off opioids for 2 weeks prior to starting
*lessens the high, patients will try to supersede the high
When is Naloxone used (Narcan)
Used for acute overdose
*Some thoughts are if prescribed narcotic should scribe narcan nasal spray
When is Methadone used?
Full agonist, long lasting
*Stabilizes patient by mitigating withdrawal syndrome
*indicated for pregnant women (first line)
What class is methadone?
Controlled substance II
*greater potential for lethal overdose compared to buprenorphine
When will Methadone Maintenance Therapy be prescribed?
To individuals who wish to abstain from illicit drug use but have failed to maintain abstinence from opiates
What is Suboxone?
Buprenoprhine + Naloxone
*Preferred
*schedule III
*Partial agonist, patient does not have withdrawal
What are the different forms of Suboxone?
Films or Tablet
*Film is preferred (on buccal mucosa)
*Patient education is important 90% are not taking correctly
How long should Suboxone be on the buccal mucosa?
15 minutes
*Max dose is 16mg in OH
*Most patients on 8mg daily
What are the four treatment phases?
- Induction
- Stabilization
- Maintenance
- Tapering
Describe the induction phase?
Dirty with other drugs in the system
*Takes 12-24 hours to detox
Describe the stabilization phase
7-14 days
*Finding proper dose to control withdraw
*education on proper use of medication.
Describe the Maintenance phase
2-4 weeks
*Drug testing, counseling
*Monitor withdraw symptoms
Describe tapering phase
Suboxone easier to taper
*methadone about 6-8 months but painful
