Substance Abuse and Addiction

Question 1

Categories of General Substance Use Disorder

Answer 1

Impaired Control
Social Impairment
Risky Use
Pharmacologic Dependence

Question 2

What are the different classes of severity?

Answer 2

Mild: 2-3 Criteria
Moderate: 4-5
Severe: 6 or more

Question 3

What are the different timelines for remission?

Answer 3

Early: 3-12 mo
Sustained: > 12 mo

Question 4

What is the definition of substance abuse?

Answer 4

Problematic pattern of substance use within a 12 mo period manifest by two or more symptoms that cause impairment in functioning

Question 5

Examples of symptoms in substance abuse

Answer 5

Taken in larger amounts or for longer than intended.
Persistent desire or unsuccessful efforts to cut down use.
Great deal of time spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
Important social, occupational, or recreational activities are reduced or given up because of substance use.
Craving or a strong desire or urge to use the substance.
Psychological and/or physiological dependence are not necessary for diagnosis

Question 6

What is the definition of dependence vs abuse?

Answer 6

Dependence: Abuse + Withdrawal/Tolerance/Physical Signs

Question 7

How is intoxication defined?

Answer 7

Specific criteria for each substance
Use by history
Physiological correlates of use
Clinically significant maladaptive behavior/physiological changes
No other medical condition or substance

Question 8

What is the definition of withdrawal?

Answer 8

Cessation of prolonged use
Specific physiologic correlates
Clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 9

What are other substance induced disorders?

Answer 9

Depression, Psychosis, Anxiety, Bipolar, etc.

Develop during use and not due to outside causes

Question 10

Which chemical is the traditional basis of addiction?

Answer 10

Dopamine

Question 11

What is the neurological significance of dopamine regarding substance abuse?
What characteristic do almost all addictive drugs display?
What occurs without drug-induced dopamine release?

Answer 11

Common reward pathway – Opiates, cannabis, cocaine, alcohols, amphetamines
Ventral Tegmental Area to Nucleus Accumbens

Almost all addictive drugs exhibit tolerance

Lack of dopamine due to use stoppage results in conscious dysphoria or unconscious craving

Question 12

What genetic variant plays a role in codeine?

Answer 12

CYP2D6 to convert to morphine
Inability to process is more common in African Americans

Question 13

What psychodynamic and personality factors play a role in addiction?

Answer 13

Affective dysregulation – Cannot tolerate bad moods
Impulse control deficits – More reliance on reward
Ego defects – Harder to cope with pain

Question 14

What family dynamics play a role in addiction?

Answer 14

Codependence, enabling
Multigenerational drug dependence
Parental loss through divorce, death, abandonment, incarceration

Question 15

What are the stages of treatment?

Answer 15

Detoxification (Pre-treatment)
Active Treatment
Maintenance Treatment
Relapse

Question 16

How are alcohol, opiates, and stimulants detoxed?

Answer 16

Alcohol – Benzo, Phenobarbital, Folate, Thiamine
Opiates – Clonidine, Loperamide, Analgesics
Stimulants – Sleep, food, water

Question 17

What is involved in active treatment?

Answer 17

Separation from substance
Education
Lifestyle changes
Family and relationship work
Conversion process – Give control back to patient, make patient understand that the substance will kill them

Question 18

What is the purpose of maintenace treatment?
What is the prognosis of it?
What does it involve?

Answer 18

Change is key and maintain change
Relapse rates are very high if not taken seriously
Involves medications, aftercare, personal commitment

Question 19

What are the major concerns with relapse?

Answer 19

Often as bad or worse than former use
High morbidity
Changes in tolerance, often reach worse highs because less tolerance but still use elevated dosing

Question 20

What is the realistic best prognosis for addicts?

Answer 20

Addicts seek normalcy, but often not actually possible
Recovery is a mindset patients need to reach and maintain

Question 21

What is the goal of motivational enhancement therapy?

Answer 21

Recognize the stage the patient currently is in
Create conditions that enhance patient’s efforts
Support intrinsic motivation of patient

Question 22

What are the principles of motivational enhancement therapy?

Answer 22

Express Empathy
Develop Discrepancy (between where patient is and where they want to be)
Avoid Argumentation
Roll with Resistance
Support Self-Efficacy