Substance use d/o

Question 1

Dependence definition

Answer 1

Can be behavioral dependence (substance seeking activities) and/or physical dependence

Question 2

Substance use disorder and essential feature includes…

Answer 2

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.

Question 3

Substance intoxication

Answer 3

syndrome of specific s/sx resulting from recent ingestion/exposure to a substance

Question 4

Substance withdrawal

Answer 4

Substance specific syndrome that results from abrupt cessation of heavy/prolonged use of a substance

Question 5

What are the 10 separate classes of drugs?

Answer 5

1. ETOH
2. Caffeine (only substance w/o d/o dx)
3. cannabis
4. hallucinogens (separate category for PCP)
5. inhalants
6. opioids
7. sedatives
8. hypnotics
9. stimulants
10. tobacco

Question 6

When does the use of a drug become a disorder?

Answer 6

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.

Question 7

What are the 2 groups of substance-related d/o’s?

Answer 7

Substance use d/o
Substance-induced d/o

Question 8

What are addictive activities?

Answer 8

gambling, sex, exercise, shopping, phonography etc. these activate reward systems in similar manner to substances.

Question 9

What is an important characteristic of SUD in relation to brain?

Answer 9

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.

Question 10

What are 4 criteria for first grouping/dx SUD?

Answer 10

1. Impaired control
2. Desire to cut down/stop
3. Spend most of their ADL time in pursuit of substance
4. Cravings

Question 11

What is the second criteria for dx of SUD?

Answer 11

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

Question 12

What is the 3rd criteria for dx of SUD?

Answer 12

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.

Question 13

What is the pharmacological criteria for SUD?

Answer 13

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.

Question 14

What method of substance administration results in most rapid/efficient absorption?

Answer 14

IV, smoking, intranasal: these can also result in a more intense intoxication and increase likelihood of escalating pattern of substance use leading to withdrawal.

Question 15

What age group has highest prevalence rates?

Answer 15

18-24 y/o

Question 16

Sedating substances

Answer 16

ETOH, sedatives, hypnotics, anxiolytics: these tend to cause more depressive d/o during intoxication and anxiety during withdrawal

Question 17

Stimulating substances

Answer 17

amphetamines, cocaine: tend to cause more substance induced psychotic d/o or anxiety during intoxication and depressive sx during withdrawal

Question 18

How long do substance induce disorders persist after cessation?

Answer 18

SID tend to disappear w/in 1 moth of cessation or acute withdrawal, severe intoxication or use of medication

Question 19

Medications to help in opioid withdrawal.

Answer 19

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

Question 20

What are Substance Abuse and Mental Health Services (SAMHSA)?

Answer 20

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.

Question 21

Clinical Opiate Withdrawal Scale (COWS)

Answer 21

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.