Substance Use Flashcards
What is the difference between how the DSM IV and how the DSM V describes SUD
Dependence, abuse, addiction are not separated, rather under an umbrella. Addictive behavior has been added under this umbrella
What is the current diagnostic criteria for substance use disorders?
11 equally weighted symptoms, generally related to ”loss of behavioral control” which is the cardinal feature of addiction
What 3 basic neurotransmitters are related to SUD and what is the main function of each.
Dopamine (reward), GABA (chief inhibitory), Serotonin (feelings and emotion)
Describe the reward pathway
At the nucleus accumbens, dopamine triggers a surge of pleasurable feelings. At another location, dopamine is released into the amygdala and relieves anxiety and stress.
What causes the enhancement of dopamine?
Opiates inhibit GABA —> no inhibitory stimulus —> larger dopamine release
What happens when the opiates are taken away?
Unpleasurable effects and seeking begins due to the loss of GABA (causes withdrawals)
SUDs fall into what 4 main types
- Impaired control
- Social impairment
- Risky use
- Pharmacological indicators (tolerance and withdrawal).
Diagnostic criterial for SUD
Must be present for 12 months
2-3 criteria met- mild
4-5 criteria met- moderate
6 or more criteria met- severe
What 9 types of substance related disorders are established in the DSM-5?
Alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics or anxiolytics, stimulants, tobacco, NOT CAFFEINE
T or F: incarceration is a diagnostic criteria for SUD
False
What level of treatment is prevention and early intervention according to AMSA?
0.5
What level of treatment is outpatient services according to AMSA? What does this entail?
Level 1. Treatment facilities providing counseling, meds, and referral services
Commonly referred to as Medication Assisted Treatment
Most hospitalization and inpatient treatment revolves around the need for ___________
Detox and withdrawal
What is the first step of treatment for SUD?
Screening (CAGE)
What are the approaches to treatment?
Abstinence programs, needle exchange programs, medication assisted programs, holistic herbal and non-certified programs
What is medication assisted treatment?
The use of FDA-approved medications in combination with counseling and behavioral therapies to provide a “whole patient” approach to the treatment of SUD
What is a common misconception that providers, family members and patients need to understand?
MAT does not just substituting one drug for another. They provide a safe and controlled level of medication to relieve withdrawal symptoms and physiological cravings that cause chemical imbalances in the body. No adverse effects
MAT contributes to lowering a person’s risk of contracting __________
HIV or Hep C
MAT increases ________ in treatment and helps prevent __________
Retention
Relapse
The ultimate goal of MAT is _________
Patient recovery
What medications are used in MAT
- Methadone
- Buprenorphine
- Disulfiram
- Acamprostate (GABA analogue)
- Naltrexone
Also barbiturates, antihistamines, clonidine, lofexidine for withdrawal symptoms
What medication is a pure Mu agonist, processed in the liver, long half life, and has extensive historical data
Methadone
What medication is a partial Mu and Delta Agonist, kappa antagonist, short half life, and has data 2000 restrictions
Buprenorphine
What is the difference between naltrexone and naloxone
Naltrexone is for treatment, naloxone is for overdose
Neonatal abstinence syndrome
Caused by long term opiate/opioid use regardless if it’s illicit or from treatment- can happen to mothers on methadone and Buprenorphine.
T or F: outcomes are better for neonates born to mothers treated with Buprenorphine than those treated with methadone
True
One must accept that treatment is/is not drug use
Is not
