Substance Disorders Flashcards
Drug addition occurs in what age range of individuals?
16-25 y.o
Are males or females more likely to be drug addicts?
Males 2:1
what is the etiology of drug addiction?
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
There are five drug induced effects on brain function. The first effect of drugs on the brain is what?
1) Drugs stimulate the brains reward circuitry therefore signaling the person to repeat the behavior
What pathway is involved in the reward circuitry of the brain?
Dopaminergic (DA) pathway (aka mesolimbic pathway)
ventral tegmental area to the the nucleus accumbens
The second effect of drugs on the brain is what?
Stimulation of the reward pathway affects functioning of the prefrontal cortex, altering self control
The third effect of drugs on the brain is what?
drug use may cause brain changes that result in physical withdrawal symptoms upon drug cessation (therefore relapse occurs)
The fourth effect of drugs on the brain is known as the protracted abstinence syndrome, describe
repeated drug use decreases the availability of dopamine. This is associated with prolonged feelings of anhedonia (therefore relapse)
The fifth and final effect of drugs on the brain is..?
drug use has been paired with environmental cues and these cues cause physiological changes that trigger drug seeking behavior
Does everyone who tries drugs become addicted?
Of course not
What percent do genes account for in vulnerability to addiction?
40-60%
What are some various psychosocial factors of addiction?
age of first use
method of drug administration (IV)
occupation biases (docs)
other mental illness
At what level of care does drug screening happen?
primary care level due to profound health and economic effects
How would a physician perform a drug screening?
Good history taking
What are key questions to ask in a drug screening assessment?
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
Describe the FOY questions
Has your drinking behavior been expressed by Family, Others, or Yourself
What test does both CAGE and FOY questions come from?
Michigan Alcoholism Screening Test (MAST)
For a man what is the drink per day limit? and drink per week limit?
4 per day
14 per week
For a women what is the drink per day limit? and drink per week limit?
3 per day
7 per week
The first phase of treatment is the acute phase, there are 3 areas of focus, what are they?
1) Detox –> aka getting person off drugs
2) Medical conditions –> STDs, lesions
3) Psychiatric co-morbidity –> depression, anxiety
The second phase of treatment is the recovery phase, this phase focuses on what?
Preventing Relapse
difficult to reverse engrained habits
Rehabilitation involves a multi-modal approach, what does this mean?
individual, group and family therapy
self help groups
medication
What is the “magic” number of days for treatment?
first 90 days are critical
recovery does continue for a life time
In regards to therapy cognitive behavioral therapy (CBT), how does this work?
helps patients learn to recognize, avoid or cope with high risk relapse situations
Describe the cognitive component of CBT
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
Describe the behavioral component of CBT
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
Therapy also involves family members, why is this a tough therapy?
lost relationships due to drugs
try to rebuild support system this is critical for when patient gets out
Patients need a coping skills training, what does this involve?
patients learn to cope with stress to help prevent relapse
Self help groups are run by whom?
Usually addicts not professionals this leads to inspiration and support from others
What frame work does self help groups use?
typically uses 12 step framework
1st step = admitting there is a problem
12th step=helping others with their addictions
Self help groups are also aimed at family and friends, what does this involve?
share experiences of challenges and successes regarding loved ones with addiction
avoid enabling!!
In regards to drugs when is pharmacotherapy used?
As an adjunct treatment
For short term management of withdrawal symptoms pharmacotherapy is used, what drug is used for alcohol?
benzodiazepine for alcohol withdrawal
What effects does pharmacotherapy have on treatment of drugs and alcohol?
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
What is the theory behind using vaccination for substance abuse?
following vaccination when a substance of abuse is used antibodies bind to the drug, making it too large to cross the CNS.
For each major class of drugs, the diagnoses generally include what?
substance intoxication
substance withdrawal
substance use disorder
In general terms what is substance intoxication?
the development of a reversible substance specific syndrome due to recent ingestion of a drug
What effects do drugs have on the body during substance intoxication?
the syndrome is due to drug effects on the CNS and causes significant maladaptive behavioral or psychological changes
Within substance intoxication, define alcohol intoxication
a significant maladaptive psychological/behavioral change (impaired judgement)
Within substance intoxication, define substance withdrawal
development of a substance-specific syndrome following cessation of a substance after heavy/prolonged substance use
syndrome causes significant distress or impairment in functioning
During substance withdrawal are the symptoms the same or opposite of intoxication?
opposite
During substance withdrawal, when do symptoms usually appear?
within 72 hours after reduction of drug use
may last several weeks
The last diagnosis is substance use disorder, define this.
a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues to use a substance despite significant substance-related problems
Severity of the substance use disorder is based on what?
number of symptoms
Define dependence or addiction
a pattern of drug use involving compulsive drug seeking behavior
Define abuse in terms of drug use
a pattern of drug use with recurrent adverse consequences (role failures, use in risky situations, run ins with law)
Both dependence and abuse have been merged to what diagnosis?
substance USE disorder
Most psychoactive drugs are controlled substances, which are regulated under what?
Controlled Substances Act (CSA)
What is a controlled substance?
controlled drugs are placed on schedules by the DEA based on whether the drug has an accepted medical use and its harm risk
For a controlled substance what is the schedule range?
I to V
I -most harmful; V= least harmful
Can doctors prescribe drugs in schedule I?
NO
Drugs with a high harm risk and NO safe, accepted medical use, describe which schedule drugs?
Schedule I (heroin, marijuana, LSD, ecstasy)
Drugs with a high harm risk but with safe and accepted medical use. Drugs are highly addictive. What schedule is this
Schedule II (most opioids and stimulants and some barbiturates)
Drugs with a harm risk less than schedule II drugs with safe and accepted medical uses in the U.S. what schedule is that?
Schedule III ,IV, V
What are the specific substances according to DSM-5?
Sedatives
Stimulants
Hallucinogens and Related Substances
Opioids
What are the sedative drugs?
Alcohol
Benzodiazepines (diazepam)
Barbiturates (phenobarbital) (low safety margin and high abuse potential)
what are some key symptoms of sedative intoxication?
sedation, sleepiness, decreased anxiety, disinhibition, impaired judgement, slurred speech, incoordination, stupor or coma, respiratory depression
what are some key symptoms in sedative withdrawal?
agitation, insomnia, and anxiety ANS hyperactivity (can be fatal) nausea and vomiting hand tremor transient hallucinations seizures
In regards to hallucinations and sedative withdrawal what does formication refer to?
sensation of bugs crawling under the skin
In regards to hallucinations and sedative withdrawal what is alcohol hallucinations?
Withdrawal without physical symptoms
In regards to sedative withdrawal what are delirium tremens (DTs)?
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
One pharmacological treatment for alcohol abuse is Disulfiram (Antabuse), describe its mechanism of action
Inhibits the enzyme that breaks down acetaldehyde
Describe the effects of disulfiram if alcohol is consumed during use
acetaldehyde accumulation causes a toxic reaction lasting 30-60 minutes
In regards to disulfiram use when is it given to patients?
due to poor compliance disulfiram is typically given short term if person is going into a know high risk situation
The next pharmacological treatment for alcohol use is Naltrexone (Revia), describe its mechanism of action
opioid receptor block that reduces the pleasurable effects of alcohol
How does Naltrexone (Revia) work?
helps a person stop drinking after a few drinks when a slip occurs
The last pharmacological treatment for alcohol is acamprosate (Campral), describe the mechanism of action
an NMDA receptor blocker that reduces craving for alcohol by decreasing the uncomfortable feelings associated with protracted abstinence
How does acamprosate (campral) work?
helps to prevent the slip from happening in the first place
Define 1 drink equivalents in terms of beer, wine and liquor?
12 ounce beer
5 ounce wine
1.5 ounce liquor
