Substance Related Disorders Flashcards
Substance use that has not met criteria for dependence but has
resulted in impairment
Substance Abuse
development of a reversible change with use of a substance
Intoxication
Substance Abuse Diagnosis Criteria
Maladaptive pattern of substance use leading to impairment or
distress, characterized by 1 or more of the following symptoms in a
12 month period:
Recurrent substance use leads to failure of major obligations (home, school, work)
Repeated substance use in situations in which it is physically hazardous
Recurrent substance-related legal problems
Continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance
Substance Dependence Diagnosis Criteria
Maladaptive pattern of substance use leading to impairment or distress, characterized by 3 or more of the following symptoms in a 12 month period:
Tolerance (need for more or diminished effect)
Withdrawal (characteristic syndrome or avoidance of symptoms)
Substance taken in larger amounts or over a longer period than intended
Persistent desire or unsuccessful efforts to cut down or control substance use
Great deal of time spent obtaining, using, or recovering from effects of the substance
Important social, occupational, or recreational activities are given up or reduced because of substance use
Substance use continued despite knowledge of having a persistent or recurrent physical or psychological problem that was likely caused or exacerbated by the substance
Withdrawal Diagnosis Criteria
Withdrawal, as manifested by either of the following:
2 or more of the following, developing within several hours to a few days of reduction in heavy or prolonged substance use:
Sweating or rapid pulse
Increased hand tremor
Nausea or vomiting
Insomnia
Physical agitation
Anxiety
Transient visual, tactile, or auditory hallucinations or illusions
Grand mal seizures
List some risk factors for prescription drug abuse
Past or present addictions to other substances, including alcohol
Younger age (Specifically the teens or early 20s)
Exposure to peer pressure or a social environment where there’s drug
use
Easy access to prescription drugs (such as working in a healthcare
setting)
Lack of knowledge about prescription drugs, or thinking that taking
someone else’s prescription drug is safe because it was prescribed by
a doctor
What is the most commonly abused substance in the US?
alcohol
What is the most common non-hereditary cause of mental
retardation?
Alcohol use in pregnancy
Guidelines - men and women
Moderate Drinking
No more than 1 drink per day for women
No more than 2 drinks per day for men
Guidelines - men and women
Binge Drinking
≥ 4 drinks for women
≥ 5 drinks for men
What are some differentials to consider for intoxication?
Hypoglycemia
Hypoxia
Drug overdose
Ethylene glycol or methanol poisoning
Hepatic encephalopathy
Psychosis
Psychomotor seizures
Describe the alcohol withdrawal timeline
Onset in 12-24 hours after last drink with peak intensity at 24-48 hours
How long does alcohol withdrawal tend to last?
Typically lasts 4-7 days
When does alcohol withdrawal peak?
Peak in 2nd day of absence,
What is the most severe form of alcohol withdrawal?
Delirium tremens
What is the best predictor for delirium tremens?
a seizure
What is the usual time frame to see delirium tremens post withdrawal?
shows up about 72 hours after last drink
What is the DOC for delirium tremens?
BZs
What is the mortality rate for untreated delirium tremens?
15-20%
What is the mortality rate for treated delirium tremens?
~5%
What is the definition of delirium tremens?
acute organic psychosis that usually manifests within 24-72 hours after the last drink
List some signs/symptoms of delirium tremens
Delirium
Tremors
Seizures
Visual hallucinations
Mental confusion
Sensory hyperactivity
Autonomic hyperactivity
Dehydration
CV abnormalities
Electrolyte disturbances (hypokalemia, hypomagnesiumeia)
What symptoms are seen in Wernicke-Korsakoff syndrome?
Impaired recent memory
Anterograde amnesia
Confabulation
What is a good screening tool for alcohol abuse?
CAGE Questionnaire
What are the questions in the CAGE Questionnaire?
C – cut down
Have you felt the need to cut down?
A – annoyed
Have you felt annoyed by criticism of drinking?
G – guilty
Have you felt guilty about your drinking?
E – eye opener
Have you had a morning eye opener?
What should be given to patients to prevent Wernicke’s
encephalopathy, especially before giving glucose?
Thiamine
What are the essential vitamin and mineral supplementation needed in chronic alcohol abuse?
Thiamine
Folate
B6
Magnesium
Why is magnesium important to supplement in alcoholics?
Alcoholics chronically deficient
Also an essential cofactor in thiamine metabolism
Describe the opium withdrawal timeline
Begins in 8 hours and lasts up to 3 days (within one week)
Describe the cocaine withdrawal timeline
Symptoms last 1-2 weeks and are predominately psychosocial
What factors are unique to marijuana that are different from other drugs?
no overdose
no toxic effect
No true withdrawal syndrome or dependence
What is the estimated percentage of people in the US have used prescription drugs for non medical reasons?
20%
What are four classes of medication that can lead to addition?
Opioids
Anxielytics (BZs)
Stimulants
Sedatives-hypnotics
In a BZ overdose use, what should you give a patient?
Flumazenil
What is the primary addicting substance in cigarettes?
nicotine
Describe the cigarette withdrawal timeline
Onset of symptoms 2-3 hours after last tobacco use with peak in 2-3
days, resolution in 1 month of quitting
Assess dependence level and suggest dosing using what tool?
Fagerstrom questionairre
In intervention, describe the FRAMES method components
Offer FEEDBACK
Emphasize personal RESPONSIBILITY
Give ADVICE
Provide a MENU of options
Use EMPATHY
Support SELF-efficacy
What are some effective medications for the treatment of opiate addiction?
Methadone
buprenorphine
naltrexone
What are the two prescription medications FDA approved for tobacco addiction?
Bupropion
Varenicline (Chantix) – most effective drug available
