SUBSTANCE USE DISORDER Flashcards
substance abuse triad
(1) Psychological dependence or craving
(2) Physiologic dependence
(3) Tolerance
Commonly encounter abused substances
(1) Alcohol
(2) Tobacco
(3) Prescription medication
(a) Opioids
(b) Benzodiazepines
(4) Other illegal substances
(a) More than 85,000 deaths per year directly attributable to alcohol use
(b) Annual economic cost of $250 billion
(c) 1 in 10 deaths in working age adults results from excessive drinking
(d) 3rd leading preventable cause of death in the United States
Alcohol Use Disorder
alcohol use refers to consumption of alcohol that puts patient at risk for health consequences
1) Use is not so severe as to meet criteria for alcohol use disorder
2) May go on to develop alcohol use disorder
Risky Alcohol Use
Nation Institute of Alcohol Abuse and Alcoholism (NIAAA) has estimated
consumption amounts of alcohol that increase health risks:
1) Men under age of 65
a) More than 14 standard drinks per week on average
(1 Standard drink: 5 oz of wine, 12 oz beer
b) More than 4 drinks on any day
2) Women and adults 65 years and older
a) More than 7 standard drinks per week on average
b) More than 3 drinks on any day
Alcohol Use Disorder is diagnosed as mild, moderate, or severe on the basis of the
number of the following present (at least 2-3 required for mild):
1) Recurrent drinking resulting in failure to fulfill role obligations
2) Recurrent drinking in hazardous situations
3) Continued drinking despite alcohol-related social or interpersonal problems
4) Evidence of tolerance
5) Evidence of alcohol withdrawal or use of alcohol for relief or avoidance of
withdrawal
6) Drinking in larger amounts for longer periods than intended
7) Persistent desire or unsuccessful attempts to stop or reduce drinking
8) Great deal of time spent obtaining, using, or recovering from alcohol
9) Important activities given up or reduced because of drinking
10) Continued drinking despite knowledge of problems caused
11) Alcohol cravin
Medical Complications of alcohol use
1) HTN
2) Cardiovascular disease
3) Liver disease
4) Pancreatitis
5) Gastritis
6) Esophagitis
7) Neuropathy
Strong association between alcoholism and psychiatric disorders:
1) Depression
2) Anxiety
3) PTSD
4) Eating disorders
5) Other substance use disorders
6) Sleep disturbances
7) Suicidal ideation and attempt
a) Meta-analysis of 31 studies pooling data from 400,000 participants found
strong association with SI and SA
b) Estimated lifetime rate suicide attempts was 7%
c) US average of adult population much lower at 1%
Assessment
1) Physical exam ranges in severity
a) May be normal
b) May be signs of withdrawal
(1 Tremor, agitation
c) Peripheral neuropathy
(1 Problems with sensation, diminished DTRs, parasthesias, etc
d) Features of liver disease
(1 Hepatic/splenic enlargement
(2 Icterus/jaundice
(3 Spider angiomata
(4 Palmar erythema
“CAGE questions”
1) Four quick questions, not a valid screening tool
2) Not intended to detect full spectrum of unhealthy alcohol use
a) Have you ever felt you should Cut down on your drinking?
b) Have people Annoyed you by criticizing your drinking?
c) Have you ever felt bad or Guilty about your drinking?
d) Have you ever taken a drink first thing in the morning (Eye opener) to steady
your nerves or get rid of a hangover?
3) 2 affirmative questions:
a) 77% sensitive, 79% specific for alcohol abuse and dependence
b) 53% sensitive, 70% specific for unhealthy alcohol use
deficiency of Thiamine (Vitamin B1)
Wernicke Korsakoff syndrome
acute syndrome (1 Direct damage to the brain caused by thiamine deficiency (a Demyelination, atrophy, hemorrhages, vascular congestion (2 Triad (a Encephalopathy (b Disorientation, inattentiveness (c Oculomotor dysfunction (d Nystagmus most common finding (3 Gait ataxia (4 Wide based gait (5 Slow, short spaced steps (6 Most will not have triad (7 Most common symptom: Confusion
Wernicke encephalopathy (WE)
Chronic neuro condition
(1 Usually a consequence of WE
(2 It is a late neurophsychiatric manifestation of Wernickes
(3 Causes anterograde and retrograde amnesia
(a Long term memory and cognitive skill impairment is less common
) Korsakoff syndrome
1) This is a potentially life threatening problem
a) Approximately half of patients experience some form of withdrawal
b) Usually mild but estimated 20% experience severe symptoms
Alcohol Withdrawal
Mild Withdrawal symptoms
a) Symptoms generally begin within 6 to 24 hours of last drink (1 Anxiety (2 Minor agitation (3 Restlessness (4 Insomnia (5 Tremor (6 Diaphoresis (7 Palpitations (8 Headache (9 Alcohol craving
