Substance Abuse I-II Flashcards
Definition of substance use disorders (SUD)
- Substance is often taken in larger amounts or over a longer period than was intended
- There is a persistent desire or unsuccessful efforts to cut down or control substance use
- A great deal of time is spent in activities necessary to obtain or use the substance or recover
from its effects - Craving, or a strong desire or urge to use the substance.
- Recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home.
- Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
- Important social, occupational, or recreational activities are given up or reduced because of substance use.
- Recurrent substance use in situations in which it is physically hazardous.
- Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance use.
- Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of substance to achieve intoxication or desired effect. (b) Markedly diminished effect with continued use of the same amount of the substance.
- Withdrawal, as manifested by experiencing the characteristic withdrawal syndrome or the substance is used to relieve or avoid withdrawal symptoms.
Mild: presence of 2-3 symptoms.
Moderate: Presence of 4-5 symptoms.
Severe: Presence of 6 or more symptoms.
SUD sx relate to…
- physical dependence (tolerance and withdrawal)
- craving
- diminished capacity to control one’s use (substance use becomes the priority over other important things in one’s life)
Preventable/actual causes of death
- tobacco
- alcohol
- illicit drugs
Brain regions implicated in SUDs
- motivational systems and reward (ventral tegmental area to nucleus accumbens), frontal regions involved in learning, cognitive control, or inhibition (prefrontal cortex), regions involved in mood and stress reactivity
- All substances of abuse increase DA release in the shell of the nucleus accumbens
Why are adolescents more vulnerable to addiction than adults?
-reward related circuitry processing matures earlier while neural processing of inhibition are not yet fully developed
Assessment and screening
MAST: michigan alcoholism screening test
CAGE questionnaire: cut down, angry, guilt, eye-opener
Substance Abuse Subtle Screening Inventory (SASSI)
TWEAK
Self Administered Alcoholism Screening Test (SAAST)
AUDIT (alcohol use disorder identification test)–no fee, score>8 needs further eval
At risk drinking (men/women)
M: >5 drinks/day or >14/wk
F: >4/d or >7/wk
increased risk for alcohol related problems
single question: how many times in past yr have you had 4/5 or more drinks in a day? (> or = 1 is positive)
Alcohol withdrawal
- autonomic hyperactivity (sweating or pulse >100 bpm)
- increased hand tremor
- nausea or vomiting
- transient visual, tactile, or auditory hallucinations or illusions
- psychomotor agitation
- anxiety
- generalized tonic-clonic sz
Opioid withdrawal
- dysphoric mood
- n/v
- muscle aches
- lacrimation or rhinorrhea
- pupillary dilation, piloerection or sweating
- diarrhea
- yawning
- fever
- insomnia
Antabuse
Antabuse (disulfiram)
-won’t allow breakdown of acetaldehyde via aldehyde dehydrogenase
Result:
=flushing, headache, nausea, dizziness, tachycardia
Dosage/admin:
- breath zero
- load 500 mg PO qd for 5 days
- 250 mg PO qd or 500 mg M-W-F
- some need higher doses to have disulfiram rxn
- supervised admin recommended
SE:
- metallic taste
- HA
- drowsy/fatigue
- optic neuritis
- peripheral neuropathy
- hepatitis
- rash
- a few cases of psychotic sx (metronidazole)
Contraindications: -risk for MI -risk for CVA -cognitive dysfunction Preg category C
Revia and Vivitrol (naltrexone)
- for alcohol tx
- pure opioid antagonist
- Blocks mew opioid receptors
Why does it work?
- mew agonists increase DA release in nucleus accumbens and increase drinking in rats
- opioid antag reduce alcohol consump in rats
- Alcohol dependent ppl may have low baseline beta-endorphin levels (stress response)
- alcohol consumption increases endorphin in those with FH of alcoholism
- naltrexone BLOCKS euphoria from alcohol
Naltrexone depot (Vivitrol) q month admin, IM, –> fewer drinking days, greater abstinence rates, time to first drink
Dosage and admin:
50mg po qd
or 280 mg IM q 4 weeks
SE: -nausea -HA -anxiety -sedation -hepatic failure (rare) Preg: C at risk for opioid withdrawal -Hypersens rxns
Interactions:
- decreased benefit from opioid analgesics
- decreased benefit from some antidiarrheal and opioid containing cough meds
Campral (Acamprosate)
- for alcohol tx
- structure resembles GABA
- Enhances GABA transmission
- Interferes with glutamate transmission
- reduces CNS hyperexcitability
?efficacy
Contraindications:
- hypersens to drug
- severe renal impairment
- Preg C
333 mg tablets, 2 tabs po TID
SE: diarrhea anxiety depression insomnia suicidality
Methadone
-opioid abuse tx
-Mew opioid agonist
-long acting
-20-40 mg to start, go to 50-150 mg/d
-specialized clinics
Don’t see complete abstinence, but do see:
-reduce use of heroin
-reduce harm
-increase employment
-reduce crime
-engage in treatment
-save lives
-cost effective
Buprenorphine
- opioid tx
- partial agonist
- subutex/suboxone
- usual dose 4-24 mg of buprenorphine per d; 16 mg ~80-95% receptor occupancy
- can precipitate withdrawal
- retention in treatment and reduction in opioid use
- office based
Naltrexone for opioid tx
- blocks effects of heroin
- poor retention
- groups with strong contingency (physicians or people on parole)
