Substance Abuse Disorders

Question 1

what is substance use disorder?

Answer 1

• important social, occupational, recreational activities given up or reduced
• use in hazardous situations
• tolerance
• withdrawal
• use despite physical or psychological problems caused by use

Question 2

What does severity depend on?

Answer 2

-the # of symptoms that they have

Question 3

Specifiers for early remission?

Answer 3

-no criteria for > 3months but < 12

Question 4

Sustained remission

Answer 4

-no criteria for > 12 months (except craving)

Question 5

Withdrawal

Answer 5

• substance specific syndrome problematic behavioral change due to stopping or reducing prolonged use
• no withdrawal: PCP; other hallucinogens; inhalants

Question 6

What does DA get converted into?

Answer 6

• adrenaline!

- so, coke addicts will come in emaciated and complaining of being tired

Question 7

Why do Native Americans have a higher alcoholism?

Answer 7

• they can burn through alcohol faster

- more efficient Alcohol dehydrogenase

Question 8

Is AA good for treatment?

Answer 8

• no, it is a social experience

- there is no professional leading it

Question 9

What does alcohol do with NT’s in our brain?

Answer 9

• raises GABA

- so, we compensate by increasing Glutamate

Question 10

Does alcohol withdrawal sometimes require hospitalization?

Answer 10

• yes

- Delerium tremens is the really bad one that is life-threatening

Question 11

What is the score for CIWA that they need to indicate more severe withdrawal?

Answer 11

->10

Question 12

Benzodiazpines

Answer 12

• GABA agonist…. cross tolerant with alcohol

- reduce risk of SZ; provide comfort/sedation

Question 13

Anticonvuslants

Answer 13

• reduce risk of SZand may reduce kindling
• helpful for portracted withdrawal
• carbamazepine or valproic acid

Question 14

Thiamine supplementation

Answer 14

-risk thiamine deficiency (wernicke-korsakoff)

Question 15

What meds will we use for alcohol t?

Answer 15

• disulfiram
• naltrexone
• acamprosate

Question 16

what kind of prevention is disulfiram doing?

Answer 16

-tertiary prevention

Question 17

Why would someone on disulfiram have rashes?

Answer 17

-they spray perfume on their skin… it’s that powerful

Question 18

Do we ever use alprazolam for withdrawal?

Answer 18

• no!

- too short of a time of action

Question 19

Which three benzos have no metabolites associated with them?

Answer 19

-oxazepam, lorazepam, and temazopam or something like that

Question 20

Pinpoint pupils…. what do we think of ?

Answer 20

• opioid intoxitcation

- for withdrawal, their pupils go the other way

Question 21

Meds for opiate use disorder

Answer 21

• methadone: opioid sub… no ceiling…
• naltrexone
• buprenorphine: ceiling effect

Question 22

Neuroadaptation for amphetamines

Answer 22

• inhibit reuptake of DA, NE, SE…. greatest effect on DA

- all 3 of them have similar structures…. so we call them monamines sometimes

Question 23

What enzyme metabolizes tobacco?

Answer 23

-CYP1A2

Question 24

Neuroadaptation for tobacco?

Answer 24

-nAChR on DA neurons in VTA release DA in nAC

Question 25

Meds for tobacco use

Answer 25

• bupropion

- varenicline

Question 26

MDMA

Answer 26

• ectsasy
• enhanced empathy, personal insight, euphoria, increased energy
• tolerance develops really quickly

Question 27

Neuroadaptation for MDMA

Answer 27

-affects 5HT, DA, NE, but predominantly 5HT2 receptor agonists

Question 28

Psychosis from MDMA

Answer 28

• Hallucinations generally mild

- paranoia

Question 29

PCP

Answer 29

• angel dust
• severe dissociative reactions, paranoid delusions, hallucinations, can become very agitated/violent with decreased awareness of pain
• cerebellar sx: ataxia, dyarthria, nystagmus*** this one is important
• they will have superhuman strength**

Question 30

Tx for PCP

Answer 30

• antipsychotic drugs or BZD if required
• low stimulation environment
• acidify urine if severe toxicity/coma