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Behavioral Health--> Module One > Substance Disorders > Flashcards

Substance Disorders Flashcards

1
Q

Drug addition occurs in what age range of individuals?

A

16-25 y.o

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2
Q

Are males or females more likely to be drug addicts?

A

Males 2:1

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3
Q

what is the etiology of drug addiction?

A

Addiction as a brain disease

1) Initiation –> initial drug use is a conscious decision not a disease
2) Maintenance and Relapse –> continued drug use is due to 5 drug induced effects on brain function

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4
Q

There are five drug induced effects on brain function. The first effect of drugs on the brain is what?

A

1) Drugs stimulate the brains reward circuitry therefore signaling the person to repeat the behavior

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5
Q

What pathway is involved in the reward circuitry of the brain?

A

Dopaminergic (DA) pathway (aka mesolimbic pathway)

ventral tegmental area to the the nucleus accumbens

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6
Q

The second effect of drugs on the brain is what?

A

Stimulation of the reward pathway affects functioning of the prefrontal cortex, altering self control

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7
Q

The third effect of drugs on the brain is what?

A

drug use may cause brain changes that result in physical withdrawal symptoms upon drug cessation (therefore relapse occurs)

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8
Q

The fourth effect of drugs on the brain is known as the protracted abstinence syndrome, describe

A

repeated drug use decreases the availability of dopamine. This is associated with prolonged feelings of anhedonia (therefore relapse)

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9
Q

The fifth and final effect of drugs on the brain is..?

A

drug use has been paired with environmental cues and these cues cause physiological changes that trigger drug seeking behavior

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10
Q

Does everyone who tries drugs become addicted?

A

Of course not

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11
Q

What percent do genes account for in vulnerability to addiction?

A

40-60%

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12
Q

What are some various psychosocial factors of addiction?

A

age of first use
method of drug administration (IV)
occupation biases (docs)
other mental illness

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13
Q

At what level of care does drug screening happen?

A

primary care level due to profound health and economic effects

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14
Q

How would a physician perform a drug screening?

A

Good history taking

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15
Q

What are key questions to ask in a drug screening assessment?

A 
CAGE QUESTIONS (alcohol) 
1) C: do you feel like you need to CUT back
2) A: do you get ANNOYED when others criticize your drinking 
3) G: do you feel GUILTY about drinking 
4) E: do you need an EYE opener (aka morning drink) 
yes to >2 then suspicion of addiction
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16
Q

Describe the FOY questions

A

Has your drinking behavior been expressed by Family, Others, or Yourself

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17
Q

What test does both CAGE and FOY questions come from?

A

Michigan Alcoholism Screening Test (MAST)

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18
Q

For a man what is the drink per day limit? and drink per week limit?

A

4 per day

14 per week

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19
Q

For a women what is the drink per day limit? and drink per week limit?

A

3 per day

7 per week

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20
Q

The first phase of treatment is the acute phase, there are 3 areas of focus, what are they?

A

1) Detox –> aka getting person off drugs
2) Medical conditions –> STDs, lesions
3) Psychiatric co-morbidity –> depression, anxiety

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21
Q

The second phase of treatment is the recovery phase, this phase focuses on what?

A

Preventing Relapse

difficult to reverse engrained habits

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22
Q

Rehabilitation involves a multi-modal approach, what does this mean?

A

individual, group and family therapy
self help groups
medication

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23
Q

What is the “magic” number of days for treatment?

A

first 90 days are critical

recovery does continue for a life time

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24
Q

In regards to therapy cognitive behavioral therapy (CBT), how does this work?

A

helps patients learn to recognize, avoid or cope with high risk relapse situations

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25
Q

Describe the cognitive component of CBT

A

emphasize importance of abstinence
learn to identify and correct self defeating thoughts to leading to relapse
have action plan ready to implement for high risk situations

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26
Q

Describe the behavioral component of CBT

A

Stimulus control (remove cues that trigger behavior)
Contingency mangement programs: voucher system or reward system
Letter to licensing board or employer
Aversion Therapy: put in room with drugs or alcohol cues and then given drugs that causes vomiting (emetic) or faradic aka shock therapy during experience

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27
Q

Therapy also involves family members, why is this a tough therapy?

A

lost relationships due to drugs

try to rebuild support system this is critical for when patient gets out

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28
Q

Patients need a coping skills training, what does this involve?

A

patients learn to cope with stress to help prevent relapse

29
Q

Self help groups are run by whom?

A

Usually addicts not professionals this leads to inspiration and support from others

30
Q

What frame work does self help groups use?

A

typically uses 12 step framework
1st step = admitting there is a problem
12th step=helping others with their addictions

31
Q

Self help groups are also aimed at family and friends, what does this involve?

A

share experiences of challenges and successes regarding loved ones with addiction
avoid enabling!!

32
Q

In regards to drugs when is pharmacotherapy used?

A

As an adjunct treatment

33
Q

For short term management of withdrawal symptoms pharmacotherapy is used, what drug is used for alcohol?

A

benzodiazepine for alcohol withdrawal

34
Q

What effects does pharmacotherapy have on treatment of drugs and alcohol?

A

To act as substitute for a more harmful drug
to decrease craving or to block the effect of a drug of abuse
for aversion therapy

35
Q

What is the theory behind using vaccination for substance abuse?

A

following vaccination when a substance of abuse is used antibodies bind to the drug, making it too large to cross the CNS.

36
Q

For each major class of drugs, the diagnoses generally include what?

A

substance intoxication
substance withdrawal
substance use disorder

37
Q

In general terms what is substance intoxication?

A

the development of a reversible substance specific syndrome due to recent ingestion of a drug

38
Q

What effects do drugs have on the body during substance intoxication?

A

the syndrome is due to drug effects on the CNS and causes significant maladaptive behavioral or psychological changes

39
Q

Within substance intoxication, define alcohol intoxication

A

a significant maladaptive psychological/behavioral change (impaired judgement)

40
Q

Within substance intoxication, define substance withdrawal

A

development of a substance-specific syndrome following cessation of a substance after heavy/prolonged substance use

syndrome causes significant distress or impairment in functioning

41
Q

During substance withdrawal are the symptoms the same or opposite of intoxication?

A

opposite

42
Q

During substance withdrawal, when do symptoms usually appear?

A

within 72 hours after reduction of drug use

may last several weeks

43
Q

The last diagnosis is substance use disorder, define this.

A

a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues to use a substance despite significant substance-related problems

44
Q

Severity of the substance use disorder is based on what?

A

number of symptoms

45
Q

Define dependence or addiction

A

a pattern of drug use involving compulsive drug seeking behavior

46
Q

Define abuse in terms of drug use

A

a pattern of drug use with recurrent adverse consequences (role failures, use in risky situations, run ins with law)

47
Q

Both dependence and abuse have been merged to what diagnosis?

A

substance USE disorder

48
Q

Most psychoactive drugs are controlled substances, which are regulated under what?

A

Controlled Substances Act (CSA)

49
Q

What is a controlled substance?

A

controlled drugs are placed on schedules by the DEA based on whether the drug has an accepted medical use and its harm risk

50
Q

For a controlled substance what is the schedule range?

A

I to V

I -most harmful; V= least harmful

51
Q

Can doctors prescribe drugs in schedule I?

A

NO

52
Q

Drugs with a high harm risk and NO safe, accepted medical use, describe which schedule drugs?

A

Schedule I (heroin, marijuana, LSD, ecstasy)

53
Q

Drugs with a high harm risk but with safe and accepted medical use. Drugs are highly addictive. What schedule is this

A

Schedule II (most opioids and stimulants and some barbiturates)

54
Q

Drugs with a harm risk less than schedule II drugs with safe and accepted medical uses in the U.S. what schedule is that?

A

Schedule III ,IV, V

55
Q

What are the specific substances according to DSM-5?

A

Sedatives
Stimulants
Hallucinogens and Related Substances
Opioids

56
Q

What are the sedative drugs?

A

Alcohol
Benzodiazepines (diazepam)
Barbiturates (phenobarbital) (low safety margin and high abuse potential)

57
Q

what are some key symptoms of sedative intoxication?

A 
sedation, sleepiness, decreased anxiety, 
disinhibition, impaired judgement, 
slurred speech, incoordination, 
stupor or coma, 
respiratory depression
58
Q

what are some key symptoms in sedative withdrawal?

A 
agitation, insomnia, and anxiety 
ANS hyperactivity (can be fatal) 
nausea and vomiting 
hand tremor 
transient hallucinations 
seizures
59
Q

In regards to hallucinations and sedative withdrawal what does formication refer to?

A

sensation of bugs crawling under the skin

60
Q

In regards to hallucinations and sedative withdrawal what is alcohol hallucinations?

A

Withdrawal without physical symptoms

61
Q

In regards to sedative withdrawal what are delirium tremens (DTs)?

A

A delirium (a confusional state) may also occur as part of sedative withdrawal:
severe and uncommon
hallucinations
seen after chronic heavy use of a sedative
associated with high mortality rate

62
Q

One pharmacological treatment for alcohol abuse is Disulfiram (Antabuse), describe its mechanism of action

A

Inhibits the enzyme that breaks down acetaldehyde

63
Q

Describe the effects of disulfiram if alcohol is consumed during use

A

acetaldehyde accumulation causes a toxic reaction lasting 30-60 minutes

64
Q

In regards to disulfiram use when is it given to patients?

A

due to poor compliance disulfiram is typically given short term if person is going into a know high risk situation

65
Q

The next pharmacological treatment for alcohol use is Naltrexone (Revia), describe its mechanism of action

A

opioid receptor block that reduces the pleasurable effects of alcohol

66
Q

How does Naltrexone (Revia) work?

A

helps a person stop drinking after a few drinks when a slip occurs

67
Q

The last pharmacological treatment for alcohol is acamprosate (Campral), describe the mechanism of action

A

an NMDA receptor blocker that reduces craving for alcohol by decreasing the uncomfortable feelings associated with protracted abstinence

68
Q

How does acamprosate (campral) work?

A

helps to prevent the slip from happening in the first place

69
Q

Define 1 drink equivalents in terms of beer, wine and liquor?

A

12 ounce beer
5 ounce wine
1.5 ounce liquor

Behavioral Health--> Module One (21 decks)

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