Substance-related d/os Flashcards
Pathways and neurotransmitters involved in substance abuse
Opioid
Catecholamine
GABA
DSM-5 criteria for substance use d/o
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by two or more of the following, occurring during a 12-mo period:
Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
Recurrent substance use in situations in which it is physically hazardous
Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
Tolerance, as defined by either of the following:
-A need for markedly increased amounts of the substance to achieve intoxication or desired effect
-Markedly diminished effect with continued use of the same amount of the substance
Withdrawal, as manifested by either of the following:
-The characteristic withdrawal syndrome for the substance
-The same (or a closely related) substance is taken to relieve or avoid withdrawal sx
The substance is often taken in larger amounts or over a longer period than was intended
There is a persistent desire or unsuccessful efforts to cut down or control substance use
A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
Important social, occupational, or recreational activities are given up or reduced because of substance use
The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
Craving or a strong desire or urge to use a specific substance
Effects of alcohol on biochemistry
Nicotinic acetylcholine, serotonin 5-HT3, and GABA type A receptors are enhanced by alcohol
Ion channel activities associated with glutamate receptors and voltage-gated calcium channels are inhibited
Effects of alcohol on behavior
- 05%: Thought, judgement, and restraint are loosened and sometimes disrupted
- 1%: Voluntary motor actions usually become perceptibly clumsy
- 2%: the function of the entire motor area of the brain is measurably depressed, and the parts of the brain that control emotional behavior are also affected
- 3%: A person is commonly confused or may become stuporous
- 4-0.5%: the person falls into a coma
Effects of alcohol on sleep
Increases the ease of falling asleep but has adverse effects on sleep architecture
Decrease in REM and deep sleep and more sleep fragmentation
Effects of alcohol on theliver
Accumulation of fats and proteins
Associated with the development of alcoholic hepatitis and hepatic cirrhosis
Effects of alcohol on the GI system
Long-term heavy drinking is associated with developing esophagitis, gastritis, achlorhydria, and gastric ulcers
Particularly heavy EtOH abuse can lead to esophageal varices
Pancreatitis, pancreatic insufficiency, and pancreatic CA
Can interfere with normal processes of food digestion and absorption
-Can lead to vitamin deficiencies
Effects of alcohol on other body systems
Increased BP
Dysregulation of lipoprotein and triglyceride metabolism
Increased risk for MI and CVD
Can increase the incidence of head, neck, esophageal, stomach, hepatic, colonic, and lung CAs
Acute intoxication may also be associated with hypoglycemia
Labs that are affected by alcohol-related d/os
High gamma-glutamyl transpeptidase levels
High MCV
High uric acid, triglycerides, AST, ALT
What patterns can strongly suggest alcohol dependence and alcohol abuse?
A need for daily use of large amounts of alcohol for adequate functioning
A regular pattern of heavy drinking limited to weekends
Long periods of sobriety interspersed with binges of heavy alcohol intake lasting for weeks or months
Behaviors associated with alcohol abuse
Inability to cut down or stop drinking
Repeated efforts to control or reduce excessive drinking by periods of temporary abstinence or by restricting drinking to certain times of the day
Binges (remaining intoxicated throughout the day for at least 2 days)
Occasional consumption of a fifth of spirits (or its equivalent in wine or beer)
Amnestic periods for events occurring while intoxicated
The continuation of drinking despite a serious physical d/o that the person knows is exacerbated by alcohol use
Drinking non-beverage alcohol
DSM-5 criteria for alcohol intoxication
Recent ingestion of alcohol Clinically significant problematic behavioral or psychological changes that developed during, or shortly after, alcohol ingestion One, or more, of the following signs or symptoms developing during or shortly after alcohol use: -Slurred speech -Incoordination -Unsteady gait -Nystagmus -Impairment in attention or memory -Stupor or coma
DSM-5 criteria for alcohol withdrawal
Cessation of (or reduction in) alcohol use that has been heavy and prolonged
Two or more of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use:
-Autonomic hypersensitivity (e.g., sweating or pulse rate >100 bpm)
-Increased hand tremor
-Insomnia
-Nausea or vomiting
-Transient visual, tactile, or auditory hallucinations or illusions
-Psychomotor agitation
-Anxiety
-Generalized tonic-clonic seizures
Tx of alcohol withdrawal sx
BZDs, PO or IV
Studies have shown that carbamazepine in daily doses of 800 mg is as effective and has less abuse potential
Beta-adrenergic receptor antagonists and clonidine
Alcohol-induced delirium- timeline
Delirium occurring within 1 wk after a person stops drinking or reduces the intake of alcohol
Features of alcohol intoxication delirium
Autonomic hyperactivity, such as tachycardia, diaphoresis, fever, anxiety, insomnia, and HTN
Perceptual distortions
Fluctuating levels of psychomotor activity
Essential feature of alcohol-induced persistent amnestic d/o
disturbance in short-term memory caused by prolonged heavy use of EtOH