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Substance Abuse Disorders Flashcards

1
Q

categories of substance use disorders: sedative, hypnotics and anxiolytics

A

barbiturates, non-barbiturates, benzodiazepines

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2
Q

categories of substance use disorders: opiates

A

heroin, meperidine, codeine/hydromorphone

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3
Q

categories of substance use disorders: other

A

hallucinogens, phencyclidine, cannabis, inhalants, nicotine, caffeine, anabolic steroids, spice

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4
Q

DSM-V

A

eliminated the distinction between abuse and dependence in 2013 dude to absence of physiologic withdrawal from cannabis

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5
Q

DSM-IV: criteria for substance abuse

A

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
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6
Q

DSM-IV: criteria for substance dependence

A

a maladaptive pattern leading to impairment or distress as manifested by 3 or more 7 things all occurring within 1 year

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7
Q

DSM-IV: 7 patterns

A
  1. 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
  2. withdrawal - the characteristic withdrawal syndrome for the substance/the same substance is taken to relieve or avoid withdrawal symptoms
  3. the substance is often taken in larger amounts or over a longer period of time than what was intended
  4. there is a persistent desire/unsuccessful efforts to cut down/control substance us
  5. a great deal of time is spent in activities necessary to obtain the substance, use it and recover from its effects
  6. important social, occupational or recreational activites are given up/reduced because of substance use
  7. 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)
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8
Q

are men more or less likely than women to have a substance abuse problem?

A

more

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9
Q

white more than black?

A

yes whites more than blacks

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10
Q

consequences of alcohol dependence: GI

A

esophageal bleeding, gastritis

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11
Q

consequences of alcohol dependence: liver diseases

A

fatty infiltration, alcoholic hepatitis, cirrhosis

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12
Q

consequences of alcohol dependence: nutritional deficiency

A

B12 deficiency, gastiris

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13
Q

consequences of alcohol dependence: neuropsychiatric

A

wernick-korsakoff syndrome, alcohol-induced dementia

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14
Q

consequences of alcohol dependence: alcohol withdrawal syndromes

A

uncomplicated withdrawal-shakes, withdrawal seizures, alcoholic hallucinations, alcohol withdrawal delirium

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15
Q

consequences of alcohol dependence: cardiovascular

A

cardiomyopathy

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16
Q

consequences of alcohol dependence: others

A

drug-drug interaction, FAS, pancreatitis

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17
Q

motivational interviewing

A

this is an evidence based intervention designed to enhance client motivation for change

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18
Q

motivational interviewing: clinical intervention modalities

A

brief 30 min interventions, multiple sessions, ongoing counseling, client assessment

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19
Q

motivational interviewing: structure

A

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

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20
Q

motivational enhancement therapy

A

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

21
Q

motivational enhancement therapy: 4 Key assumptions

A
  1. ambivalence about substance use & change is normal and constitutes an important motivational obstacle in recover
  2. ambivalence can be resolved by working with your clients intrinsic motivations and values
  3. the alliance between you and your client is a collaborative partnership to which you each bring importance expertise
  4. empathetic, supportive, direct counseling style provides conditions under which change can occur
22
Q

motivational enhancement therapy: opening strategies

A
  • ask open questions
  • listen reflectively
  • affirm with compliments/appreciation
  • summarization to reinforce
  • elicit self-motivating statements
23
Q

motivational enhancement therapy: 5 basic principles, 1. express empathy

A

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

24
Q

motivational enhancement therapy: 5 basic principles, 2. develop discrepancy

A

seeks to enhance and focus the clients attention on such discrepancies

25
Q

motivational enhancement therapy: 5 basic principles, 3. avoid argumentation

A

if you don’t you could evoke resistance

don’t try and label

26
Q

motivational enhancement therapy: 5 basic principles, 4. roll with resistance

A

new ways of thinking are invited not imposed
ambivalence is viewed as normal
solutions are evoked from client not that therapist

27
Q

motivational enhancement therapy: 5 basic principles, 5. support self-efficacy

A

belief that one can perform a particular behavior or accomplish a task
they have to believe that they can change
optimism

28
Q

screening, brief intervention, referral and treatment (SBIRT)

A

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

29
Q

screening, brief intervention, referral and treatment (SBIRT): screening

A

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

30
Q

screening, brief intervention, referral and treatment (SBIRT): brief intervention

A

single session or multiple sessions implementing motivational strategies
intention is to increase motivation toward positive behavioral changes

31
Q

screening, brief intervention, referral and treatment (SBIRT): brief treatment

A

increased intensity but over a shorter period of time
highly structured/focused
cost less, effective

32
Q

screening, brief intervention, referral and treatment (SBIRT): referral to treatment

A

used when have a more severe substance abuse problem

intention is to appropriately address the issue

33
Q

pharmacotherapy to treat alcohol: disulfiram

A

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

34
Q

pharmacotherapy to treat alcohol: naltrexone (oral)

A 
mu opioid antagonist
reduces + reinforcement from alcohol and reduces craving
1st line therapy
decrease in relapse to heavy drinking
daily dose is kinda crappy
35
Q

pharmacotherapy to treat alcohol: naltrexone (injectable)

A

mu opioid antagonist
reduces + reinforcement from alcohol and reduces craving
better efficacy than oral
super expensive

36
Q

pharmacotherapy to treat alcohol: acamprosate

A

unknown mechanism
maintains abstinence
good in europe (not so much in US ~ probably bc of therapy provided
not many bad effects

37
Q

treatment for opiates: agonist treatment

A

most effective
decreases in: illicit opioid use, other drugs, criminal activity, needle sharing
improvements in: prosocial activities, mental health

38
Q

pharmacotherapy for opioid dependence: methadone

A

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

39
Q

pharmacotherapy for opioid dependence: LAAM

A

a metabolite of methadone
advantages: slower onset, longer duration
disadvantages: potential for cardiac arrhythmias
not really used anymore

40
Q

pharmacotherapy for opioid dependence: buprenorphine

A

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

41
Q

pharmacotherapy for opioid dependence: naltrexone

A

mu antagonist
poor compliance major limiting factor
nonaddictive

42
Q

treatment for: cocaine/stimulatns/sedatives

A

nothing really

just try to decreases use slowly

43
Q

treatment for: nicotine

A 
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
44
Q

treatment for: designer drugs/ectasy/MDMA

A

don’t really know whats in these guys, not really addictive but still dangerous

45
Q

goal of treatment: 1. Abstinence

A

historically goal standard, but lots of failures

46
Q

goal of treatment: 2. harm reduction

A

use of substitution therapies like methadone/suboxone for heroin, NRT for tobacco

47
Q

goal of treatment: 3. controlled use

A

subset of people can still use in a controlled way

48
Q

financing addiction

A

<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

Neuro (15 decks)

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