Substance Abuse Disorders Flashcards
categories of substance use disorders: sedative, hypnotics and anxiolytics
barbiturates, non-barbiturates, benzodiazepines
categories of substance use disorders: opiates
heroin, meperidine, codeine/hydromorphone
categories of substance use disorders: other
hallucinogens, phencyclidine, cannabis, inhalants, nicotine, caffeine, anabolic steroids, spice
DSM-V
eliminated the distinction between abuse and dependence in 2013 dude to absence of physiologic withdrawal from cannabis
DSM-IV: criteria for substance abuse
a maladaptive pattern of substance leading to impairment or distress as manifested by one or more of the following:
- failure to fulfill major role obligations at work, school, home
- reoccurring situations that are physically hazardous
- recurrent legal problems
- continued use despite having persistent social/interpersonal problems
DSM-IV: criteria for substance dependence
a maladaptive pattern leading to impairment or distress as manifested by 3 or more 7 things all occurring within 1 year
DSM-IV: 7 patterns
- tolerance - a need for markedly increased amounts of the substance to achieve intoxication/desired effect + markedly diminished effect with continued use of the same substance
- withdrawal - the characteristic withdrawal syndrome for the substance/the same substance is taken to relieve or avoid withdrawal symptoms
- the substance is often taken in larger amounts or over a longer period of time than what was intended
- there is a persistent desire/unsuccessful efforts to cut down/control substance us
- a great deal of time is spent in activities necessary to obtain the substance, use it and recover from its effects
- important social, occupational or recreational activites are given up/reduced because of substance use
- substance use is continued despite knowldge of having a persisent or recurrent physicla or psychological problem (that is likely to have been caused or exacerbated by the substance)
are men more or less likely than women to have a substance abuse problem?
more
white more than black?
yes whites more than blacks
consequences of alcohol dependence: GI
esophageal bleeding, gastritis
consequences of alcohol dependence: liver diseases
fatty infiltration, alcoholic hepatitis, cirrhosis
consequences of alcohol dependence: nutritional deficiency
B12 deficiency, gastiris
consequences of alcohol dependence: neuropsychiatric
wernick-korsakoff syndrome, alcohol-induced dementia
consequences of alcohol dependence: alcohol withdrawal syndromes
uncomplicated withdrawal-shakes, withdrawal seizures, alcoholic hallucinations, alcohol withdrawal delirium
consequences of alcohol dependence: cardiovascular
cardiomyopathy
consequences of alcohol dependence: others
drug-drug interaction, FAS, pancreatitis
motivational interviewing
this is an evidence based intervention designed to enhance client motivation for change
motivational interviewing: clinical intervention modalities
brief 30 min interventions, multiple sessions, ongoing counseling, client assessment
motivational interviewing: structure
feedback - construction/nonconfrontation feedback
responsibility - clearly placed on the client
advice - recommend to reduce or stop
options - to help reduce dropout rate
empathetic - warm, respect, caring commitment
self-efficacy - optimistic, empowerment
motivational enhancement therapy
created by Miller
a systematic intervention to evoke change in problem drinkers
based on principle of motivational psychology
designed to produce rapid change, internally motivated
motivational enhancement therapy: 4 Key assumptions
- ambivalence about substance use & change is normal and constitutes an important motivational obstacle in recover
- ambivalence can be resolved by working with your clients intrinsic motivations and values
- the alliance between you and your client is a collaborative partnership to which you each bring importance expertise
- empathetic, supportive, direct counseling style provides conditions under which change can occur
motivational enhancement therapy: opening strategies
- ask open questions
- listen reflectively
- affirm with compliments/appreciation
- summarization to reinforce
- elicit self-motivating statements
motivational enhancement therapy: 5 basic principles, 1. express empathy
communication that implies superior/inferior relationships are avoided, your role is supportive companion/knowledgable consultant.
client has freedom of choice
persuasion is gentle and subtle
motivational enhancement therapy: 5 basic principles, 2. develop discrepancy
seeks to enhance and focus the clients attention on such discrepancies
motivational enhancement therapy: 5 basic principles, 3. avoid argumentation
if you don’t you could evoke resistance
don’t try and label
motivational enhancement therapy: 5 basic principles, 4. roll with resistance
new ways of thinking are invited not imposed
ambivalence is viewed as normal
solutions are evoked from client not that therapist
motivational enhancement therapy: 5 basic principles, 5. support self-efficacy
belief that one can perform a particular behavior or accomplish a task
they have to believe that they can change
optimism
screening, brief intervention, referral and treatment (SBIRT)
an evidence-based public health approach providing early intervention in treatment for individuals with substance abuse disorders and those at risk
reduces frequency and severity of alcohol and drug use, reduces risk of trauma associated with it and increased number of clients to enter substance abuse treatment
shown to reduce ER visits
major significance in young adults
screening, brief intervention, referral and treatment (SBIRT): screening
identification of client seen in medical and public health setting who require further treatment
integration substance abuse screening into regular medical and public health care
two elements: 1. attention to biomarkers/client reports 2. use of screening instruments
screening, brief intervention, referral and treatment (SBIRT): brief intervention
single session or multiple sessions implementing motivational strategies
intention is to increase motivation toward positive behavioral changes
screening, brief intervention, referral and treatment (SBIRT): brief treatment
increased intensity but over a shorter period of time
highly structured/focused
cost less, effective
screening, brief intervention, referral and treatment (SBIRT): referral to treatment
used when have a more severe substance abuse problem
intention is to appropriately address the issue
pharmacotherapy to treat alcohol: disulfiram
blocks metabolism of ethanol metabolite
stimulates severe nausea, vomiting, shortness of breath, sweating, drop in BP, heart racing
2nd line therapy
little long term affect
pharmacotherapy to treat alcohol: naltrexone (oral)
mu opioid antagonist reduces + reinforcement from alcohol and reduces craving 1st line therapy decrease in relapse to heavy drinking daily dose is kinda crappy
pharmacotherapy to treat alcohol: naltrexone (injectable)
mu opioid antagonist
reduces + reinforcement from alcohol and reduces craving
better efficacy than oral
super expensive
pharmacotherapy to treat alcohol: acamprosate
unknown mechanism
maintains abstinence
good in europe (not so much in US ~ probably bc of therapy provided
not many bad effects
treatment for opiates: agonist treatment
most effective
decreases in: illicit opioid use, other drugs, criminal activity, needle sharing
improvements in: prosocial activities, mental health
pharmacotherapy for opioid dependence: methadone
full mu opioid agonist
levels go down with concurrent use of alcohols, dilatine
levels go up with concurrent use of Tagamet, erythromycin
usually comes with psychosocial support
pharmacotherapy for opioid dependence: LAAM
a metabolite of methadone
advantages: slower onset, longer duration
disadvantages: potential for cardiac arrhythmias
not really used anymore
pharmacotherapy for opioid dependence: buprenorphine
the wonder drug!!!
partial mu agonist
desirable properties: low abuse, low physical dependence, safe if ingested at over dose quantity
poor oral bioavailability - weak opioid effect
used often with adolescents
not much psychosocial support given
pharmacotherapy for opioid dependence: naltrexone
mu antagonist
poor compliance major limiting factor
nonaddictive
treatment for: cocaine/stimulatns/sedatives
nothing really
just try to decreases use slowly
treatment for: nicotine
bupropion NRT Varenicline: the best! -partial nicotinic receptor agonist -1mg daily for 1 week then 1mg bid -decreased cotinine levels and enhanced abstinence -slight increase in psychiatric symptoms
treatment for: designer drugs/ectasy/MDMA
don’t really know whats in these guys, not really addictive but still dangerous
goal of treatment: 1. Abstinence
historically goal standard, but lots of failures
goal of treatment: 2. harm reduction
use of substitution therapies like methadone/suboxone for heroin, NRT for tobacco
goal of treatment: 3. controlled use
subset of people can still use in a controlled way
financing addiction
<1% of all healthcare goes to treatment of substance use disorders but 1/3 of healthcare goes toward treatment of complications of problems related to those disorders. 80% of function comes from public sources
