Substance use d/o Flashcards
Dependence definition
Can be behavioral dependence (substance seeking activities) and/or physical dependence
Substance use disorder and essential feature includes…
The prolonged use and abuse of a substance causing functional impairment
Essential feature is a cluster of cognitive, behavioral and physiological sx causing the individual to continue using substance despite significant substance-related problems.
Substance intoxication
syndrome of specific s/sx resulting from recent ingestion/exposure to a substance
Substance withdrawal
Substance specific syndrome that results from abrupt cessation of heavy/prolonged use of a substance
What are the 10 separate classes of drugs?
- ETOH
- Caffeine (only substance w/o d/o dx)
- cannabis
- hallucinogens (separate category for PCP)
- inhalants
- opioids
- sedatives
- hypnotics
- stimulants
- tobacco
When does the use of a drug become a disorder?
When taken in excess the ‘reward’ to brain comes in such a manner as to cause significant reinforcement of use behaviors leading to neglect of normal activities.
What are the 2 groups of substance-related d/o’s?
Substance use d/o
Substance-induced d/o
What are addictive activities?
gambling, sex, exercise, shopping, phonography etc. these activate reward systems in similar manner to substances.
What is an important characteristic of SUD in relation to brain?
There’s an underlying change in brain circuitry that may persist beyond detox, particularly with severe d/o. This can lead to intense cravings and frequent relapse. Long-term tx needed.
What are 4 criteria for first grouping/dx SUD?
- Impaired control
- Desire to cut down/stop
- Spend most of their ADL time in pursuit of substance
- Cravings
What is the second criteria for dx of SUD?
Social impairment: failure to meet major role obligations and continued use despite severe social/interpersonal problems. Abandoning important activities because of SU. Withdrawal from social groups, family, activities, hobbies etc
What is the 3rd criteria for dx of SUD?
Physical hazard: use leads to hazardous situations with continued use, even though they know there are persistent physical/psychologial problems w/ongoing use. Unable to abstain despite this knowledge.
What is the pharmacological criteria for SUD?
Tolerance: need increasing amounts to acheive desire effect or reduced effect from usual dose.
Withdrawal: symptoms caused when blood or tissue concentrations of substance fall.
What method of substance administration results in most rapid/efficient absorption?
IV, smoking, intranasal: these can also result in a more intense intoxication and increase likelihood of escalating pattern of substance use leading to withdrawal.
What age group has highest prevalence rates?
18-24 y/o
Sedating substances
ETOH, sedatives, hypnotics, anxiolytics: these tend to cause more depressive d/o during intoxication and anxiety during withdrawal
Stimulating substances
amphetamines, cocaine: tend to cause more substance induced psychotic d/o or anxiety during intoxication and depressive sx during withdrawal
How long do substance induce disorders persist after cessation?
SID tend to disappear w/in 1 moth of cessation or acute withdrawal, severe intoxication or use of medication
Medications to help in opioid withdrawal.
Alpha blockers, especially clonidine. They do not reduce cravings but help with anxiety, agitation and discomfort (muscle aches, cramping, diaphoresis, rhinorrhea).
Buprenorphine or methodone help with cravings and maintenance tx to prevent relapse
What are Substance Abuse and Mental Health Services (SAMHSA)?
Program for opioid use d/o, provides methadone for maintence. These programs must meet certain criteria and provide counseling to participants in addition to other services and other med-assisted tx for OUD including buprenorphine and naltrexone.
Clinical Opiate Withdrawal Scale (COWS)
used to measure a client’s level of response. It is used for buprenorphine/naloxone induction.
You enter score at time 0, then 1-2 hrs after 1st dose, and at additional times when bup/nalax is given over induction period.
