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Substance Abuse, Part 1 Flashcards

1
Q

Define substance.

A

Alcohol, tobacco, illicit drugs or improperly used medication

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2
Q

Define substance use.

A

Sporadic consumption with no major adverse consequences

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3
Q

Define at-risk substance use.

A

Consumption that risks major adverse consequences

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4
Q

Define codependency.

A

Condition characterized by an individual who is significantly affected by another person’s substance use or addiction

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5
Q

Define substance abuse.

A

Maladaptive use causing impairment or distress over a 12-month period where 1+ has occurred:

-Failure to fulfill major role obligations
-Use of drugs in hazardous situations
-Recurrent legal problems due to substance use
-Continued drug use despite persistent social or interpersonal problems because of use

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6
Q

What conditions help define substance abuse?

A

Failure to fulfill major role obligations
Use of drugs in hazardous situations
Recurrent legal problems due to substance use
Continued drug use despite persistent social or interpersonal 
problems because of use

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7
Q

Define dependence.

A

State of adaptation manifested by a substance class-specific withdrawal syndrome

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8
Q

How can dependence be produced by?

A

Rapid dose reduction or cessation of a substance
Administration of an antagonist
Tolerance to the substance

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9
Q

What types of dependence are there? (2)

A

Psychological dependence
Physiologic dependence

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10
Q

Define addiction.

A

Primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations

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11
Q

What behaviors define addiction?

A

Impaired control of use
Compulsive use
Continued use despite harm
Craving for substance

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12
Q

What is the difference between substance use and dependence/addiction?

A

substance use: pts retain control of their use.
-control can be affected by judgement, social factors, environment

Dependence/addiction: pts don’t have full control
Measurable brain abnormalities-often predate the initial substance use, though to be genetically predisposed

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13
Q

What often predates the initial substance use?

A

Measurable brain abnormalities
thought to be genetically predisposed

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14
Q

How does substance use affect our hormones?

A

Affect dopamine levels in mesolimbic system

Changes are often permanent

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15
Q

Define substance use disorder.

A

Maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2+ defining conditions within a 12-month period

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16
Q

What percentage of pts 12yrs and up with any illicit dug use in the past month? lifetime?

A

Over 1 in 10 - 14%
About half- 49% in lifetime

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17
Q

What percentage of pts 12 years and up with marijuana use in the past 1 month? lifetime?

A

over 1 in 10 (13%)
45% of people over their entire lifetime

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18
Q

How many people are unaware that they have a substance abuse problem?

A

95%

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19
Q

Who are the highest risk for substance abuse?

A

Late teens and early 20s

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20
Q

What increases the risk of later addiction?

A

The lower the age of first use

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21
Q

Who are likely to engage in binge drinking?

A

Males (2x likely)
3x for heavy drinking

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22
Q

What are young adults now likely to use instead of cigarettes?

A

Vaporized cigarettes (vapes)

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23
Q

What is the #1 substance for dependence and abuse?

A

Alcohol

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24
Q

What it the most expensive substance abuse cost in society?

A

Tobacco

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25
Q

What is the lifetime prevalence of ETOH for patients age 12+?

A

almost 4 out of 5 (78%)
ETOH within past 12 months-almost 2 out of 3 (62%)
ETOH within past 12 months, ages 12-20 over 1 in 10 (15%)

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26
Q

How many pts 12 and up have vaped or used cigarettes in their lifetime?
What about in the past 1 year?

A

over 1 out to 2 pts (58%)
over 1 out of 5 pts (26%)

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27
Q

What is the most leading preventable cause of death in the US?

A

Tobacco

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28
Q

What medical conditions arise from substance abuse?

A

Hepatitis
Cirrhosis
HIV/AIDS
Sexually Transmitted Infections (STIs)
Motor vehicle crashes/fatalities

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29
Q

What social conditions arise from substance abuse?

A

Teenage pregnancy
Domestic violence
Child abuse
Physical fights
Overall crime
Homicide/Suicide

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30
Q

What are some risk factors for substance use?

A

Substance factors
Societal influence
Static pt demographics
Modifiable pt demographics
Associated psychiatric disorders
Personality traits

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31
Q

What are the substance factors?

A

Early onset tobacco use
Early experimentation with substances
Type of substance tried

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32
Q

What are the societal influence factors?

A

Family
Peer groups
Religious groups
Cultural and societal norms

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33
Q

What are the static patient demographics factor?

A

Male gender
Black, AI/AN or NHOPI ethnicity
Gay or lesbian status
Genetic predisposition

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34
Q

What are the the modifiable pt demographics factors?

A

Low socioeconomic status
Single or divorced
Low educational level
Violent or high-crime neighborhood
Personal history of abuse

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35
Q

What are the patient personality traits factors?

A

Risk-takers, thrill-seekers, novelty seekers
Poor impulse control or emotional control
Difficulty relating to others

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36
Q

What are the associated psychiatric disorders?

A

Conduct disorder
MDD or Bipolar disorder
ADHD
Antisocial personality disorder

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37
Q

Why do people use substances?

A

To feel good/better (experience new feelings, and lessen anxiety)
To fit in (peer pressure)

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38
Q

How does anandamide affect the brain?

A

NT involved in regulation of pain, appetite, memory, mood

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39
Q

What is THC?

A

Active ingredient in marijuana

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40
Q

What is similar about THC and anandamide?

A

Similar structure

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41
Q

What hormones does drug abuse affect?

A

Dopamine
Serotonin
Glutamate
Endorphins
GABA

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42
Q

What is the function of Dopamine?

A

Movement, motivation, reward, addiction, well-being

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43
Q

What is the function of serotonin?

A

Mood, memory, sleep, cognition

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44
Q

What is the function of glutamate?

A

Learning, memory

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45
Q

What is the function of endorphins?

A

Lessened pain, euphoria

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46
Q

What is the function of GABA?

A

Relaxation, anxiolytic

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47
Q

What are other naturally rewarding things?

A

Food
Sex
Exercise
Excitement
Comfort

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48
Q

What do nearly all drugs of abuse have in common?

A

Increase dopamine levels
Affect serotonin and glutamate levels

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49
Q

What are common cognitive defects with addiction?

A

Short-term memory loss
Impaired abstract thinking
Impaired problem-solving strategies
Loss of impulse control

…similar to those defects seen in brain damage

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50
Q

What are the 3 C’s of addiction?

A

Control
Compulsion
Chronicity

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51
Q

What are the control factors?

A

Early social & recreational use
Eventual loss of emotional & behavioral control
Cognitive distortions (denial and minimization)
Tolerance and withdrawal

52
Q

What are compulsion factors?

A

Drug-seeking activities and craving → addiction
Continued use despite adverse consequences

53
Q

What are chronicity factors?

A

Natural history of multiple relapses preceding stable recovery
Possible relapse after years of sobriety

54
Q

How does mental illness relate to substance use?

A

Self-medication (try to alleviate symptoms of mental illness)
Casual effects (increase vulnerability to mental illness)
Correlated causes (similar risk factors for substance abuse and mental illness)

55
Q

How many substance abuse pts have a mental disorder?

A

50%

56
Q

What is the opponent-process theory?

A

Process (either pleasant or unpleasant) has a 2ndary opponent(opposite) process that sets in after

With repetition, the primary gets weaker while opponent process is strengthened

57
Q

How does drug addiction work over time?

A

Early: high pleasure, low withdrawal
Overtime: pleasure decreases, withdrawal increases

58
Q

How do we treat drug addiction?

A

block high pleasure
block withdrawal symptoms

59
Q

What other disorders are alcohol-related disorders commonly associated with?

A

Mood disorders(depression)
Anxiety disorders
Suicide
Personality disorders

60
Q

Define at-risk drinking.

A

Repetitive use of alcohol, often to alleviate emotional problems

61
Q

What is considered at-risk drinking for men?

A

15+/week
Moderate: 1-2/day
Binge: 5+/single occasion

62
Q

What is considered at-risk drinking for women?

A

8+/week
Moderate: 1/day
Binge: 4+/day

63
Q

What is considered at-risk drinking for elderly?

A

1+/day
7+/week

64
Q

What is considered 1 “drink”

A

0.5-0.6oz of alcohol

Beer: 12oz 4%
Malt liquor: 8oz 7%
Wine: 5oz 12%
Hard liquor: 1.5oz(1shot) 40%

65
Q

How much alcohol can a liver process?

A

0.5oz/hr

66
Q

What is the telescoping effect?

A

Faster timeline from 1st drink to alcohol dependence?

67
Q

Who is seen with the telescoping effect?

A

Women who use alcohol

68
Q

Why are women more likely to be seen with the telescoping effect?

A

Lower EtOH dehydrogenase
Lower total body water
Smaller volume of distribution
Drink like partner

69
Q

What specific psychiatric disorder is associated with alcohol-related disorders?

A

Depression

70
Q

Who are likely to have alcohol-related disorders?

A

Males 4:1

Women are more likely to delay seeking help

71
Q

What is the 3rd leading preventable cause of death in the US?

A

Excessive alcohol use

72
Q

What are some effects of alcohol addiction?

A

Recurrent alcohol use despite disruption of social roles
Alcohol-related legal problems
Taking safety risks

73
Q

What are risk factors for alcohol dependence?

A

Male
White, NA
Younger age (18-29)
Single
Low income
Past exposure to adverse events (military combat deployment)
Genetic disposition
Significant disability
Psych disorders(SUD, depression, BPD, personality d/o)

74
Q

What are the key questions for Cage(screening substance abuse)?

A

Cutdown
Annoyed
Guility
Eye opener

75
Q

How many “yes” do you need for the cage-aid questionnaire?

A

2+: need a more in depth assessment
1+: possible substance use

76
Q

What other screening tools can we use to determine substance abuse?

A

Alcohol Use Disorders Identification Test (AUDIT)
Drug Abuse Screening Test (DAST-10)
NIDA Quick Screening Tool

77
Q

What is the MOA of alcohol?

A

Crosses BBB
Acts as a sedative-hypotonic substance
Affects CNS receptors (GABA, NMDA(glutamate), 5HT-3(serotonin)
Facilitates dopamine release
Suppression of inhibitory control systems

78
Q

What drug also affects GABA receptors?

A

Benzodiazepines

79
Q

What are effects of alcohol?

A

Psychomotor dysfunction (disinhibition, dysarthria, ataxia, nystagmus, memory lapses)
N/V
Drowsiness; fragmented sleep
Respiratory depression
Hypoglycemia
Severe: stupor, coma, death

80
Q

What are symptoms of 0.05% BAC?

A

Thought, judgement, and restraint are loosened

81
Q

What are symptoms of 0.1% BAC?

A

Voluntary motor actions become clumsy

82
Q

What are symptoms of 0.2% BAC?

A

Depression of motor control and emotional control areas of brain

83
Q

What are symptoms of 0.3% BAC?

A

Confusion, stupor

84
Q

What are symptoms of 0.4-0.5% BAC?

A

Coma; respiratory depression

85
Q

What are effects of alcohol withdrawal?

A

Decreased cognitive function
Tremulousness
Anxiety, irritability, and hyperreactivity
N/V
Delirium Tremens

86
Q

What are symptoms of delirium tremens?

A

Prolonged ETOH consumption → fewer GABA receptors
Unopposed sympathetic nervous system activity
Neuro: confusion, tremor, seizures, sensory hyperacuity, hallucinations, hyperreflexia
Psych: anxiety, agitation, panic attacks, paranoia
Diaphoresis, dehydration, electrolyte abnormalities

87
Q

What are the affects of chronic use of alcohol?

A

Wernicke encephalopathy
Korsakoff psychosis
GI symptoms
Cardiac
Cancer
Endocrine

88
Q

What are the effects of chronic use of alcohol?

A

Wernicke encephalopathy
Korsakoff psychosis
GI symptoms
Cardiac
Cancer
Endocrine

89
Q

How does wernicke encephalopathy present as?

A

Confusion, ataxia, opthalmoplegia
Impaired vision/hearing, psychological dysfunction, memory deficit, hypothermia, hypotension

90
Q

How do we treat wernicke encephalopathy?

A

Thiamine other B vitamins
Can be completely reversible with treatment

91
Q

What are symptoms of Korsakoff psychosis?

A

Amnesia: anterograde and retrograde
Aphasia, apraxia, agnosia
20% are reversible

92
Q

How is the liver affected with chronic alcohol use?

A

Fatty liver
Alcoholic hepatitis
Cirrhosis

93
Q

How is the vascular system affected with chronic alcohol use?

A

Portal HTN, varices

94
Q

How is the pancreas affected with chronic alcohol use?

A

Pancreatitis
Pancreatic insufficiency
Cancer

95
Q

How is the GI affected with chronic alcohol use?

A

Esophagitis
Gastritis
Gastric ulcers
Cancers

96
Q

How would labs be affected with chronic alcohol use?

A

Increased GGT, AST/ALT (ratio >2:1) *assesses liver damage

97
Q

How is the CV system affected with chronic alcohol use?

A

HTN
Increase HR
Increased myocardial O2 consumption

98
Q

Where are the cancers formed from chronic alcohol use?

A

Head/neck
Esophageal
Liver
Breast
Colorectal
Pancreas

99
Q

How are the endocrine systemic affected from chronic alcohol use?

A

Dysregulation of lipoproteins and triglycerides

100
Q

What are the stages of liver damage?

A

Fatty liver (deposits of fat cause liver enlargement)
Liver fibrosis(scar tissue forms)
Cirrhosis(connective tissue destroys liver cells0

101
Q

When does alcohol withdrawal occur, when are the peak intensity of symptoms?

A

8-12hours
48-72hours

102
Q

What is the main treatment for alcohol withdrawals? Examples?

A

Benzodiazepines(BZDs)
Diazepam(valium), lorazepam(altivan), chlordiazepoxide (Librium), Gabapentin or carbamazepine (Tegretol)

103
Q

What are anti-hypertensives we give to alcohol withdrawal pts?

A

Clonidine
Atenolol

104
Q

What nutritional supplements can we give to alcohol withdrawal supplements?

A

B vitamins, vitamin C
DONT give IV glucose before giving thiamine supplementation
Fluid replacement PRN

105
Q

How do we assess withdrawal severity?

A

CIWA scoring
Facilities own standardized protocol

106
Q

What are the stages of security for withdrawals?

A

Mild
Moderate
Severe

107
Q

What type of consolation does a withdrawal pt may need?

A

Social work
Psychology

108
Q

What can be given to treat chronic use?

A

Thiamine
Naltrexone
Acamprostae(Campral) (first-line)
Disulfiram(Antabuse) (2nd-line)

109
Q

What are SE of thiamine use?

A

Low BP
Affect glucose metabolisms
(rare) anaphylaxis, bronchospasm

110
Q

What is the MOA of naltrexone?

A

Blocks release of dopamine in the brain
Antagonist at Mu receptors in brain (decrease craving and reward)

111
Q

What is naltrexone usually given together with?

A

Behaviorally therapy
Acamprosate
SSRI

112
Q

What is the BBW for naltrexone?

A

Hepatocellular injury
Heptotoxicity

113
Q

What are the SE of naltrexone?

A

N/V/D/C
Abd pain
Dizziness
HA
Anxiety
Fatigue

114
Q

What is CI in naltrexone?

A

Hx if hypersensitivity
Opioid dependence on current use

115
Q

What does naltrexone have drug interactions with?

A

Opiates

116
Q

What do you have to monitor when taking neltrexone?

A

Liver function tests

117
Q

What is the MOA of acamprosate?

A

Restore normal glutamate action
Interferes with glutamate release stopping excitation that happens with withdrawal
Affects GABA NT

Same rates of return to drinking/return to heavy drinking as naltrexone

118
Q

What is the SE of acamprosate?

A

N/D
Abd pain
Fatigue
HA
Amnesia

119
Q

What do you have to monitor while on acamprosate?

A

Anxiety
Depression
Suicidality

120
Q

What is CI in acamprosate?

A

Renal impairment

121
Q

What is the MOA of disulfiram?

A

Inhibits enzyme aldehyde dehydrogenase
Causes acetaldehyde to accumulate → sweating, headache, dyspnea, lowered BP, flushing, palpitations, N/V
Does not influence motivation/withdrawal directly
No proven long-term efficacy in alcohol abuse

122
Q

What is the SE of disulfiram?

A

Metalic taste
Sweating
HA
Dyspnea
Lowered BP
Flushing
Palpitations
NV

123
Q

What is CI when taking disulfiram?

A

Heart disease/CAD
acute intoxication

124
Q

What are the DI of disulfiram?

A

Metronidazole
Warfarin
Amitriptyline

125
Q

What are the DI of disulfiram?

A

Metronidazole
Warfarin
Amitriptyline

126
Q

What are other 2nd line therapy drugs for chronic alcohol withdrawal?

A

Anticonvulsants
Muscle relaxants
Antidepressants
Antinausea

127
Q

What are some non-medicine treatments for alcohol withdrawal?

A

Motivational interviewing
Cognitive Behaviorally therapy
Peer support groups

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