Substance‐Related and Addictive Disorders Flashcards
1
Q
Substance Abuse
Issues
A
-
Illicit drug use in America has been increasing
- Mostly marijuana, the most commonly used illicit drug
- 51% of America’s teenagers have tried an illicit drug by the time they finish high school
- Marijuana use has increased since 2007
- Use of most drugs other than marijuana has not changed appreciably over the past decade or has declined
- More than half of new illicit drug users begin with marijuana, then prescription pain relievers, followed by inhalants
2
Q
DSM IV
Changes
A
- We now use the term Substance Use Disorder
- Used to distinguish between abuse and dependence
- Dependence: neurobehavioral syndrome in which pt has not only signs of w/d but behavioral changes associated with the drugs
- Abuse was considered to be a mild or early phase of dependence
- Craving for a drug is added
- Legal consequences as a criterion removed
- Gambling Disorder /“Pathological gambling” added
3
Q
Substance Related and Addictive Disorders
DSM 5
A
- Substance Use Disorders
- Substance Induced Disorders
- Intoxication
- Withdrawal
- Neurocognitive disorders
- Psychotic disorder
- Mood disorder
- Anxiety disorder
- Sexual dysfunction
- Sleep disorder
4
Q
DSM 5:
Substance Use Disorder
A
NEED AT LEAST TWO:
- Taken in larger amounts or over a longer period of time then intended
- Unsuccessful attempts at cutting down
- Great deal of time spent on substance use
- Craving
- Failure to fulfill major role obligations at work/home/school
- Persistent social or interpersonal problems
- Important activities given up for substance use
- Use in hazardous situations
- Use in spite of physical and psychological problems
- Tolerance
- Withdrawal
5
Q
Substance Abuse
Classification
A
- Alcohol
- Opioids
- Stimulants
- Dissociative Anesthetics
- Hallucinogens
- Depressants
- Cannabinoids
- Others: Inhalants, Anabolic steroids
- 9. Tobacco
- 10. Caffeine
- And Gambling Disorder
6
Q
Alcohol
Prevalence of Drinking
A
- 86.4% of people ages 18 or older reported that they drank alcohol at some point in their lifetime
- 70.1% reported that they drank in the past year
- 56.0% reported that they drank in the past month
7
Q
Prevalence of Binge Drinking and Heavy Alcohol Use
A
- 26.9% of people ages 18 or older reported that they engaged in binge drinking in the past month
- 7.0% reported that they engaged in heavy alcohol use in the past month
8
Q
Alcohol
Epidemiology
A
- Caucasians have the highest rates of alcohol use
- Heavy drinking is the same across all races in US
- Gender: M>F
- Region: Rates highest in North Central US
- Higher in metropolitan areas compared to rural areas
- Education: Drinkers are likely to have had higher education compared to illicit drug use
- Socioeconomic status: No correlation
9
Q
Excess Alcohol Use
Definitions
A
-
Bing Drinking
- Pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL
- ♂ 5 drinks in 2 hours
- ♀ 4 drinks in 2 hours
- Pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL
-
At risk for alcohol‐related problems
- ♂ > 14 standard drinks per week or 4 drinks per day
- ♀ > 7 standard drinks per week or 3 drinks per day
- (Standard drink defined as one 12‐ounce bottle of beer, one 5‐ounce glass of wine, or 1.5 ounces of distilled spirits)
- Heavy Alcohol Use: Binge drinking on 5 or more days in the past month
10
Q
Alcohol
CAGE Questions
A
-
Cut
- Ever felt you ought to cut down on your drinking?
-
Annoyed
- Have people annoyed you by criticizing your drinking?
-
Guilt
- Ever felt bad or guilty about your drinking?
-
Eye Opener
- Ever had an eye‐opener to steady nerves in the AM?
11
Q
Cloninger
Alcoholism Classification
A
Type I and Type II Alcoholism
12
Q
Babor
Alcoholism Classification
A
13
Q
Alcohol and Women
A
- Drink alone
- Binge less
- Drink less
- Higher ethanol levels than men (less gastric alcohol dehydrogenase, less volume of distribution, less total body water)
- Faster progression from first drink to problems
- Reach criteria for dependence quicker
- Progress to liver disease with less ETOH and more quickly
- Higher mortality rate from Alcohol related liver disease
14
Q
Fetal Alcohol Syndrome
A
- Leading cause of Mental retardation
- Microcephaly
- Craniofacial malformations
- Short stature
- Maladaptive behavior
15
Q
Alcohol Related
Psychiatric Disorders
A
- Alcohol intoxication
- Alcohol withdrawal delirium
- Alcohol withdrawal seizures
- Alcohol‐Induced Amnestic disorder (Wernicke‐Korsakoff Syndrome)
- Neurocognitive Disorder associated w/ ETOH
- Alcohol induced psychotic disorder
- Alcohol induced mood disorder
16
Q
Alcohol Withdrawal
A
- Can be serious even without delirium
- Includes seizures and autonomic hyperactivity (BP, HR, temp)
- Begins 8‐24 hours after cessation or reduction in drinking
- Tremors (“shakes”; “jitters”)
- Other Sx: nausea/vomiting, anxiety, irritability, sweating, flushing
- Can progress on to develop delirium
17
Q
Delirium Tremens
“DTs”
A
- Delirium occurring during ETOH withdrawal
- Medical emergency
- Usually develops within 72 hrs
- Watch out for DTs for up to a week following cessation of ETOH
- High mortality – up to 20% in untreated cases
- Confusion and disorientation
- Autonomic instability
- Perceptual disturbances: Visual, tactile, auditory hallucinations, illusions
18
Q
Alcohol Treatment
A
- Intervention: Inpatient v Outpatient
- Detoxification: Benzodiazepines (Lorazepam, Oxazepam and Temazepam)
- Pharmacotherapy: (Dr. J. Horwitz)
- Rehabilitation
19
Q
Opioids & Morphine
Derivatives
A
- Heroin
- Morphine
- Codeine
- Oxycodone
- Hydrocodone
- Hydromorphone (DilaudidTM)
- Fentanyl