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Psychosocial Conditions > Substance-Related and Addictive Disorders > Flashcards

Substance-Related and Addictive Disorders Flashcards

1
Q

Does the term “abuse” appear in the DSM5?

A

no

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2
Q

How are substance use problems identified?

A
  • Immediate use
  • Intoxication (for those substances that can cause what is typically considered intoxication)
  • Withdrawal
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3
Q

What are the levels of severity in substance use problems?

A

mild

moderate

severe

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4
Q

What specifiers allow for detail about individual circumstances for substance abuse issues?

A
  • Severity
  • Use of more than one substance
  • Presence of other mental disorders
  • Combinations of use, intoxication
  • Withdrawal features
  • Presence or absence of perceptual disturbance in those substances likely to cause them.
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5
Q

What does substance use result in?

A

cognitive, behavioral, and physiological symptoms, with apparent changes in brain circuits that last beyond immediate intake

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6
Q

When is substance use diagnosed?

A

when there is a pathological pattern of behavior associated with ingesting the substance

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7
Q

What is the difference between substance use and intoxication?

A

Substance use is a long term behavior

Intoxication describes the immediate effects of the substance

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8
Q

What is the substance use diagnostic criteria?

A
  • Need and craving for use of the substance
  • Increased frequency or amount of the substance used
  • Substantial investment of time and effort in obtaining the substance
  • Unsuccessful efforts to cut down
  • Dysfunction
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9
Q

What is tolerance?

A

a need to increase the dose as the body accommodates to the substance

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10
Q

What is withdrawal?

A

the physiological symptoms that can accompany reduced use of the substance or the gradual decrease in the substance in the body as it is eliminated

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11
Q

Do tolerance and withdrawal symptoms need to be present for the substance use disorder to be labeled an addiction?

A

yes

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12
Q

What is Substance/Medication-Induced Mental Disorder?

A
  • Significant symptoms with accompanying history, examination, or laboratory findings that support the relationship between those symptoms and the use of the substance
  • May be associated with any of the classes of drugs including alcohol, cannabis, inhalants, opioid, gambling
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13
Q

What is the diagnostic criteria for intoxication disorders?

A
  • Recent intake of the substance with associated problematic behavioral or psychological changes
  • A short-term condition associated with current intake of the substance
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14
Q

What is the diagnostic criteria for withdrawal disorders?

A
  • Physical or psychological symptoms caused by cessation of a substance that has been used heavily for a prolonged period
  • symptoms cause distress or dysfunction
  • Typically a short-term condition for hours, days, or a few weeks after cessation of a substance
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15
Q

What are the implications for function for Substance Use Disorders?

A
  • Potential negative consequences for all performance areas.
  • Work and self-care often ignored.
  • Social and leisure performance center on substance use
  • Skills impacted include cognitive and emotional regulation skills. May affect perceptual motor skills
  • Patterns, habits, roles center on securing and using substance
  • Physical illness
  • High potential for legal consequences, suicide
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16
Q

What are the effects of alcohol?

A
  • Alcohol is central nervous system (CNS) depressant

- May cause a brief sense of excitement, but ultimately slows responses of CNS and autonomic function

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17
Q

What physiological changes may occur as a result of an overdose?

A
  • Death may occur as a result of respiratory or cardiac slowing
  • Death can occur as a result of a single episode
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18
Q

What is the diagnostic criteria for Alcohol Use Disorder?

A
  • Alcohol taken in larger amounts of over a longer period than the person had intended, and efforts to control its use are unsuccessful
  • Time spent obtaining, using, and recovering from alcohol use
  • Experiencing cravings and difficulty with work, home, or school function
  • Other important activities (e.g. leisure) are given up and use is continued in hazardous situations (e.g. driving)
  • Continued use even when the person knows she or he has a problem
  • Tolerance
  • Withdrawal
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19
Q

What behavioral and psychological changes are seen in Alcohol Intoxication?

A
  • Slurred speech
  • Incoordination
  • Unsteady gait
  • Nystagmus
  • Impairment of attention or memory
  • In very high intake situations- coma or death
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20
Q

What is the diagnostic criteria for Alcohol Withdrawal?

A
  • Autonomic hyperactivity
  • Hand tremor
  • Insomnia
  • Nausea or vomiting
  • Hallucinations
  • Psychomotor agitation, anxiety
  • Seizures and sometimes death
  • Long-term users may also experience delirium tremens
    • Seizures, hallucinations, severe tremors
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21
Q

What is the prognosis for Alcohol Use Disorders?

A
  • One of the more treatable of substance-related disorders
  • Better when no dual diagnosis
  • Long-term use is associated with significant health issues (liver disease, heart disease, and others)
  • Long-term use also associated with social, work, and legal difficulties
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22
Q

What treatments are available for Alcohol Use Disorders?

A
  • No one treatment works best for everyone, but there is an array of choices that can be effective
  • Cognitive behavioral therapy
  • Group therapy
  • 12-step programs like Alcoholics Anonymous (AA)
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23
Q

What is the reputation of Cannabis?

A

Reputation as a “gateway drug” that begins a path toward use of more damaging substances

24
Q

What is the most widely used illicit substance?

A

cannabis

25
Q

What is the diagnostic criteria for Cannabis Use Disorder?

A

-A problematic pattern of use w/ significant impairment or distress, with at least 2 of the following in a 12 month period
-Taken in larger amounts or over a longer time than
intended
-Desire or unsuccessful efforts to control use
-Significant time spent obtaining, using, or
recovering from use
-Craving or urge to use cannabis
-Failure to fulfill major obligations as a result of use
-Continued use in spite of these problems
-Important activities given up because of use
-Continuation in spite of awareness of having a
problem
-Tolerance
-Withdrawal

26
Q

What is the implication for function for Cannabis Use Disorder?

A
  • Potential negative consequences for all performance areas
  • Work and self-care often ignored
  • Social and leisure performance center on substance use
  • Skills impacted include cognitive and social skills
  • Lethargy is a typical consequence
  • Patterns, habits, roles center on securing and using cannabis
  • But less impairment than with some other substances
27
Q

What treatments are available for Cannabis Use Disorder?

A

Minimal evidence

28
Q

What is the diagnostic criteria for Inhalant Use Disorder?

A

-Problematic pattern of use with significant impairment or distress, with at least two of the following:
-Taken in larger amounts or over a longer time than
intended
-Desire or unsuccessful efforts to control use
-Significant time spent obtaining, using, or recovering
from use
-Craving or urge to use
-Recurrent use interferes with major role obligations
-Recurrent use leads to social or personal problems
-Important activities given up because of use
-Recurrent use in physically hazardous situations
-Use continues despite awareness of the problem
-Tolerance

29
Q

What is the prognosis for Inhalant Use Disorder?

A
  • Toxic substances can cause significant physical damage, even on first use, with damage cumulative over time
  • Substantial potential for long-term consequences, including persistent, disabling neurological defects
  • Strong probability of other substance abuse or comorbid conduct disorder, depression, and other mental disorders
  • Use in adolescence is associated with suicide and with criminal behavior
30
Q

What are the prescription names of opioids?

A

-analgesics, anesthetics, or cough suppressants

31
Q

Name some types of opioids?

A
  • Codeine
  • Hydromorphone (e.g., Dilaudid)
  • Methadone
  • Hydrocodone (e.g., Vicodin)
  • Oxycodone (e.g. Percocet)
32
Q

How has the misuse of prescription opioids changed?

A

Prescription misuse has tripled since 1990

33
Q

Alcohol abuse, and use of marijuana, hallucinogens, cocaine, sedatives, and tranquilizers are associated with what?

A

prior non-medical use of prescription opioids

34
Q

A rapid increase has been seen in abuse of what?

A

OxyContin and Vicodin

35
Q

What is the diagnostic criteria for Opioid Use Disorder?

A

Problematic pattern of use with significant impairment or distress, with at least two of the following:

  • Taken in larger amounts or over a longer time than intended
  • Desire/unsuccessful efforts to control use
  • Significant time spent obtaining, using, or recovering from use
  • Craving or urge to use
  • Recurrent use interferes with major role obligations
  • Recurrent use leads to social or personal problems
  • Important activities given up because of use
  • Use in situations that are physically hazardous (e.g. driving)
  • Use continues despite knowledge of problem
  • Tolerance
  • Withdrawal: hallucinations, anorexia, depression, insomnia, vomiting
36
Q

What is the etiology of Opioid Use Disorder?

A
  • May begin with legitimate use for pain control
  • Only a very small proportion of individuals who use opioids transition to non-medical prescription use
  • risk factors: depression and anxiety
37
Q

What is the prognosis of Opioid Use Disorder?

A
  • Poor outcomes as long as 20 years after initial diagnosis.
  • Significant tolerance effects fairly rapidly, and withdrawal symptoms are severe and unpleasant, leading to continued drug seeking
  • Respiratory suppression with overdose, interaction with other medications, transmission of infectious diseases (specifically with intravenous administration)
  • Worst with other psychosis
38
Q

Why is gambling disorder included in the cluster of other substance abuse disorders?

A

because of impulse control similarities, similar urges/craving

39
Q

What is the diagnostic criteria for Gambling disorder?

A

Persistent and recurrent gambling causing distress or dysfunction, including at least 4 of:

  • Need to gamble with increasing amounts of money
  • Restlessness/ irritation when attempting to control behavior
  • Repeated efforts to control behavior
  • Preoccupied with gambling
  • Gambles to reduce feelings of distress
  • After losing, returns to recoup losses
  • Lies to conceal extent of problem
  • Jeopardizes relationships to gamble
  • Relies on others for money when in debt
40
Q

What are the implications for function for Gambling Disorder?

A
  • Work and social relationships significantly affected
  • Self-care may be compromised if finances severely damaged
  • Leisure performance severely affected
  • Interpersonal skills affected
  • Patterns and roles affected as gambling becomes major activity
41
Q

What treatment methods are used for Substance-Related Disorders?

A
  • Specific strategies may vary depending on substance
  • Behavior therapy
  • Drugs to assist with withdrawal (e.g. nicotine patch, methadone)
  • 12-step programs
  • Strategies for managing social influences (coping with peer pressure)
  • Careful attention to prescribing patterns
  • Careful attention to associated medical problems
42
Q

What are the implications for OT in Substance Related Disorders?

A
  • Need to refocus patterns/habits to more functional occupations
  • Address time use, support alternative leisure patterns
  • Address work-related issues that may arise due to substance use
  • Stress management
  • Social skills training
  • Family therapy
  • Incorporate CBT concept in treatment
  • Encourage physical activity
  • Encourage spiritually-focused activities
  • Enhance skills to provide sense of hope and accomplishment, in disadvantaged populations (i.e. job skills, appropriate social behavior)
43
Q

What is the screening tool for Substance Related Disorders?

A

CAGE which reflects the four questions that are included in this assessment

44
Q

What are the questions included in the CAGE assessment?

A

C: Has anyone ever felt you should Cut down on your drinking?

A: Have people Annoyed you by criticizing your drinking?

G: Have you ever felt Guilty about your drinking?

E: Have you ever had a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

45
Q

What does a positive response to any of the CAGE screening indicate?

A

A positive response to one of these questions suggests a problem

46
Q

What is included in a brief intervention for substance use disorder?

A

Have a discussion about whether there is a problem

Encouraging realistic self-appraisal about substance use

Clinicians can be very effective in reducing the impact on individuals in the early stages or making sure that those who are having serious problems receive help

47
Q

What other diagnoses often coexists with substance abuse?

A
  • conduct disorder
  • depression
  • developmental disabilities
  • schizophrenia
  • manic depressive disorder
  • personality disorders
48
Q

What kind of disorders can substance abuse lead to?

A

mood, anxiety, and psychotic disorders

49
Q

What is found to be common among adolescents who are substance abusers?

A

various forms of violence are common, both with the adolescent as a victim of abuse and as a perpetrator of violent acts

50
Q

What treatments are used for dual diagnosis with substance use disorder?

A
  • Recovery oriented intervention, focused on skill-building and behavioral management effective for some individuals
  • Recommendations for care emphasize the need for careful assessment to ensure that the approach is tailored to the individual
  • A combination of psychosocial and pharmacological interventions is the most common
51
Q

How does substance abuse in adolescents impact the lifespan?

A
  • Increased risk for significant additional problems throughout life, including health consequences, disruptions in developmental tasks, and disordered interpersonal relationships
  • Adolescents typically don’t recognize the risk
52
Q

What solutions are currently used for substance abuse in relation to adolescents?

A

Health promotion/prevention programs that help alter normative expectations can be helpful but are challenging to implement effectively.

53
Q

What age group are rates of substance abuse lower and why?

A

among older adults

may be due to differential rates of early death

54
Q

What do older adults more commonly abuse?

A

Older adults who use substances often abuse prescription or over-the-counter medications

55
Q

Why may older adults be more at risk?

A

At risk because of slower rates of metabolism and excretion

Frequently, cognitive symptoms occur

Psychosocial Conditions (9 decks)

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