Substance Abuse - Junig Flashcards
Characteristics of substance abuse disorders tend to break down into four categories:
- Impaired control
- Social impairment
- Risky use
- Pharmacologic dependence
Give a couple examples of each
- Impaired control
- taking more or longer than intended
- unsuccessful efforts to cut down
- craving
- spending lots of time seeking or recovering from
- Social impairment
- failure to fulfill major obligations
- continued use despite problems
- giving up important activities
- Risky use
- recurrent use in hazardous situations
- continued use despite problems or exacerbations of related problems (medical, etc)
- Pharmacologic dependence
- tolerance to effects
- withdrawal symptoms
To be considered in ‘sustained remission’, abstinence from substance abuse must last for at least how long?
>12 months
The final common pathway in most pleasureable activities tends to inlcude what neurotransmitter?
dopamine
Name a few drugs or substances that exert their effects primarily in the following areas
- Ventral tegmental area
- Nucleus accumbens
- VTA
- opioids
- ethanol
- barbiturates
- benzodiazepines
- NA
- amphetamines
- cocaine
- cannabinoids
- opioids
- phencyclidine
Is euphoria required for addiction?
No
Which neurotransmitter is most linked to addictive disorders?
Name three other neurotransmitters/receptors implicated in addiction and a drug that might be use to combat their role in addiction
dopamine
opiate receptors: naltrexone
GABA: campral
Nicotinic ACh receptor: Chantix
Describe the kind of conditioning implicated in each of the following:
- Repetitive, reinforced patterns of behavior that encourage use
- Craving or euphoric recall. Often prompted by paraphernalia
- Use of drug removes negative sensation (such as pain)
- operant conditioning
- classical conditioning
- negative reinforcement
Does addiction have a genetic component?
Yes
Examples: Twin studies and 2/3 of alcoholics have a family history.
Give some drugs used to facilitate detox of the following substances:
- Alcohol
- Opiates
- Stimulnts
- Alcohol: benzodiazepines, phenobarbital, folate, thiamine
- Opiates: clonidine, loperamide, analgesics
- Stimulants: food, sleep, water
Name (5) pertinent elements of the ‘Active Treatment’ phase
- separation from substance
- education
- ‘conversion process’
- lifestyle changes
- family and relationship work
Why is addiction ‘cure’ more or less a myth?
- Requires maintenence
- Continued anstinence requires personal commitment
- Requires sustained change in lifestyle and behavior
- Ongoing medications and aftercare help prevent relapse
- Neglect of this phase often leads to relapse
What characteristic of addiction contributes to the high rate of morbidity in relapse?
Tolerance
(patient loses tolerance in remission, then returns to old patterns of consumption - cannot handle it physically)
How is the concept of ‘recovery’ different than ‘abstinence’?
Abstinence involves removal of the substance abuse, but does not fix the underlying cause. Recovery is an ongoing process towards ‘better’ living and management of the underlying defects that led to substance abuse in the first place.
Give the (5) stages of motivation enhancement therapy and describe each
- Precontemplation
- establish rapport and support any positive changes
- Contemplation
- encourage ambivalence, educate w/ pros and cons
- Preparation
- encouragement towards goal
- Action
- continue to encourage
- family ultimatums?
- Maintenence
- relapse prevention
- maintenence
- education and continued vigilence
What tends to be the initial action of most 12-step programs?
Give some other major themes
Confrontation (to break through denial)
Themes: change, personal responsibility, boundary enforcement, limits, and consequences of actions
Alcohoics Anonymous is probably the most well-known of what type of program?
12-step program
Treatment should last how long?
As long as the patient needs (though this may be complicated by money and insurance policies)
Anything less than 30 days is usually considered ineffective
What is the key differentiator of the ‘Harm Reduction Approach’?
The Harm Reduction Approach does not demand total sobriety. Instead it focuses on ‘Moderation Management’ (eg: drink counting, etc)
Give some drugs use to maintain treatment for the following substance addictions:
- Alcohol
- Opiates
- Nicotine
- Cocaine
- Alcohol: naltrexone, disulfiram, acamprosate, topiramate, baclofen
- Opiates: Naltrexone, mehtadone, buprenorphine
- Nicotine: Nicotine replacement, chantix, buprorion
- Cocaine: Immune approach (?), stimulants (?)
What enzyme converts codeine to morphine?
Name three drugs that inhibit this enzyme.
CYP2D6
Paxil, Prozac, Quinidine
What opiate is particularily contraindicated in pts taking an MAOI?
Why?
Demerol
MAOIs prevent the breakdown of normeperidine, a metabolite of demerol.
Accumulation of normeperidine can cause convulsive seizures.
- Do opiates share cross tolerance?
- Can opiate withdrawal be fatal?
- What drug is somewhat useful in treating the symptoms of opiate withdrawal?
- Yes.
- Generally, no. But it is horrible.
- Clonidine.
What is the typical demographic of opiate abusers?
What demographic is showing increasing rates of opiate abuse?
- Typical onset is late teens or twenties
- Male:Female 1.5:1
- Decreasing prevalence with age
- White middle-class female demographic shows increasing use
What “symptoms” often concur with opiate abuse?
- Depression
- Sexual problems
- Cellulitis
- Poverty
