Substance-Related Disorders Flashcards
Definition of Addiction
- Biopsychosocial disorder manifested by compulsively seeking a desired effect (intoxication) despite harmful consequences
- Addiction= severe substance use disorder
Dopaminergic Brain Reward pathway
- Addictive substances tend to activate endogenous dopaminergic brain reward pathways
- Ventral Tegmental Area to Nucleus Accumbens (“pleasure center”)
First use of a substance is often voluntary
What does an alteration in the prefrontal lobe cause?
From addiction
- Impaired inhibition
- Reduced capacity for delayed gratification
- Impaired working memory
- Impaired decision-making and reasoning
- Impaired long-term planning
Can lead to physical withdrawal symptoms and discomfort
What is methadone used for and why?
- Opioid Addiction
- Replacement therapy-less addictive
Addiction Risk Factors
- Genetics (50%)
- Environment-peer pressure, availibility of substance
- Dual Diagnosis-mental/physical illness that requires pain meds leading to addiction
- Age of first use-prefrontal lobes still developiung
- Substance of choice
- Method of use-injecting vs swallowing
Substance Intoxication Definition and Symptoms (6)
Definition: reversible substance-specific syndrome-recent ingestion-maladaptive changes d/t CNS effects
Diagnosis: Significant maladaptive psychological/behavior change (impaired judgement) PLUS 1
1. Slurred speech
2. Incoordination
3. Unsteady gait
4. Nystagmus
5. Impaired attention/memory
6. Stupor or coma
Substance Withdrawal Definition and Diagnosis (8)
Definition: substance-specific syndrome occurring following cessation of a substance after heavy/prolonged use
Diagnosis: 2 of the following symptoms
1. ANS hyperactivity
2. Hand Tremor
3. Insomnia
4. Nausea/Vomiting
5. Hallucinations/Illusions
6. Psychomotor agitation
7. Anxiety
8. Generalized Seizures
Usually results 2-3 days after last use
Substance Use Disorder Definition and Diagnosis
Definition: maladaptive pattern of substance use-
Diagnosis: 12 months of 2+ symptoms
Substance Abuse Disorder Symptoms (4 Categories-11 Symptoms)
Symptoms:
A) Impaired control
1. Taken in a larger amt than intended
2. Persistent unsucessful attempts to cut back
3. Time consuming (obtaining, using, recovering)
4. Cravings or strong desire for the substance
B) Social Impairment:
5. Failure to fulfill major role obligations (work)
6. Social/interpersonal problems
7. Reduction of important activities
C) Risky use:
8. Use in physically hazardous situations
9. Use despite having a physical/psychological problem related to the substance
D) Pharmacological criteria (physical dependence)
10. Tolerance
11. Withdrawal syndrome unpon cessation
Severity of Substance Use Disorder
Number of symptoms
2-3=mild
4-5=moderate
6+=severe
Sedative Intoxication Symptoms
Alcohol, Benzodiazepines, Barbiturates (CNS depressants)
- Sedation
- Impaired judgement
- Slurred speech
- Stupor
- Respiratory depression
- Overdose potentially lethal
Sedative Intoxication Withdrawal Symptoms
- Anxiety, insomnia
- Hand tremor
- Extreme tachycardia/HTN
- Delirium
- Hallucinations (Formication-bugs on skin)
- Seizures
Bolded=potentially lethal
Major Stimulant Intoxication Symptoms: Psychological (3) /Physical (6)
Amphetamines, Cocaine (CNS activators)
Pyshological
1.Euphoria and grandiosity
2. Psychomotor acceleration & sterotypies
3. Paranoia & hallucations
Physical
1. Mydriasis (pupil dilation)
2. Elevated HR & BP
3. Appetite loss
4. Insomnia
5. Increased energy
6. Seizures
Bolded=similar to manic
Major Stimulant Withdrawal Symptoms (4)
- Dysphoric mood
- Hypersomnia
- Increased Appetite
Not usually life threatening
Symptoms like: MDD w/ atypical features
Minor Stimulant Intoxication Symptoms (7)
Caffeine, Nicotine (minor CNS activators)
- Increased Energy
- Restlessness
- Nervousness
- Racing thoughts
- Tachycardia
- Increased alertness
- Decreased appetite
All the symptoms=hypomania
Minor Stimulant Withdrawal Symptoms (7)
Caffeine, Nicotine (minor CNS activators)
Suppression of function
1. Dysphoria
2. Fatigue
3. Decreased attention
4. Headache
5. Irritability
6. Insomnia
7. Increased Appetite
Nicotine Treatment: (1) replacement therapy-nicotine gum (2) medications- buproprion & varenicline
Hallucinogen Intoxication & Withdrawal
LSD, Mescaline, Psilocybin
Intoxication:
1. Heightened/altered sensory perceptions
2. Dissociation
3. Hallucinations
4. Sense of well-being and sedation
5. Paranoia and anxiety (“bad trip”)
Withdrawal: NONE
Cannabis Intoxication & Withdrawal
Intoxication:
1. Perceptual intensification
2. Conjuntiva reddening
3. Increased appetite
4. Dry mouth
Withdrawal
1. Irritability, nervousness, dysphoria
2. Insomnia, reduced appetite
3. Headaches, night sweats, stomach cramps
PCP Intoxication & Withdrawal
Intoxication:
1. Agitated, unpredicatable, potentially violent behavior
2. Nystagmus
3. Hyperacusis, unresponsive to pain
4. Rigidity, seizures
5. Acute intoxication is a medical emergency: Calm the patient-benzodiazepines
Withdrawal Symptoms: NONE
Opioid Intoxication Symptoms
Heroin, Morphine
- Analgesia
- Euphoria
- Drowsiness
- Miosis-pupilary restriction “pinpoint”
- Unconsciousness
- Respiratory depression
If overdose (potentially lethal)=NALOXONE
Opioid Withdrawal Symptoms
Heroin, Morphine
Withdrawal (flu-like symptoms)
1. Nausea/Vomiting
2. Muscle Aches
3. Fever
4. Shivering
5. Yawning, lacrimation, rhinorrhea
Not life-threatening-but very uncomfortable
Treatment of Opioid Addiction
- Abstinence: Naltrexone-blocks opioid receptors. This reduces euphoria.
- Replacement Therapy: Methadone-still causes euphoria but not as extreme. Allows pt to start CBT. Helps with withdrawal symptoms
- Replacement Therapy 2.0 Buprenorphine-addresses dysphoria and withdrawal symptoms-higher success rate and less addictive then methadone
Addiction Treatment General
- Inpatient hospitalization
- Psychotherapy: Cognitive/Behavioral/Family
- Addiction Support Groups
- Pharmacotherapy
Addiction Treatment: Alcohol (3 meds)
1.Disulfiram: aversion therapy-nausea, hypotension, SOB
2. Naltrexone: reduces pleasurable effects of alcohol
3. Acamprosate: reduces cravings
