Substance Use Disorder Flashcards
neurobiology of addiction/tolerance
- exposure ➔ pleasurable feeling ➔ hippocampus
- Ventral tegmental area ➔ dopamine ➔ nucleus accumbens ➔ pleasurable feeling
- dopamine ➔ prefrontal cortex ➔ learnt behaviour and addiction that this was a pleasurable experience
- overtime ➔ build tolerance ➔ body downregulates dopamine receptors to maintain homeostasis
- need more of the substance to induce same feelings of pleasure
s/s of alcohol intoxication (depressants)
- euphoria
- behavioural disinhibition
- resp depression
- poor coordination
s/s of alcohol withdrawal (depressants)
- anxiety
- poor appetite
- N/V
- tremor
- seizures
- insomnia
- psychosis
- delirium tremens
- death (CAN BE FATAL)
time line for alcohol withdrawal symtpoms
6-8 h from last drink
peaks on 2nd day of abstinence
improves by day 4-5d
timeline for seizure risk for alcohol withdrawal
6-48h post reduction/discontinuation
s/s of delirium tremens
severe, get them hospitalized
- arrythmias
- high fever
- severe confusion/disorientation
- seizures
- extreme agitation
- heavy sweating
- hallucinations and delusions
timeline for delirium tremens
can present anytime within teh withdrawal period (5d) even after they clear the 48h seizure risk timeline
specific s/s of opioid withdrawal
profound diarrhea
piloerection (goosebumps)
yawning
not deadly though
examples of depressants
alcohol
benzodiazepines
opioids
barbiturates
examples of stimulants
amphetamine
cocaine
methylanediate
caffeine
MDMA (ecstasy/molly)
examples of hallucinogens
LSD (acid)
shrooms - psilocybin
PCP
ketamine
cannabis
s/s of stimulant intoxication
- euphoria
- mania
- psychomotor agitation
- psychosis (esp paranoia)
- insomnia
- cardiovascular complications ➔ stroke, MI, arrhythmias)
- seizures
s/s of stimulant withdrawal
- “crash”
- cravings
- dysphoria
- suicidality
s/s of hallucinogen intoxication
- distortion of sensory stimuli
- enhancement of feelings
- psychosis ➔ esp visual hallucinations
- poor coordinations
- delirium
- anxiety
s/s of hallucinogen withdrawal
not usually any
RF for substance use
- genetics: fhx, predisposition, personality (impulsive personality)
- early exposure to substances
- childhood adverse events
- access to substances
- psychiatric comorbidities
- social factors: unemployment, housing instability, poor social support
- chronic medical conditions
Top 3 addicting drugs
- heroin
- methadone
- nicotine
stages of motivational interviewing
- precontemplation
- contemplation
- preparation
- action
- maintenance
- is relapse but hopefully theres no relapse
tell me about addiction potential?
inhaled or IV ROA have increased addiction potnetial bc of the immediate feelings of euphoria
how long the drug lasts in the body also impacts the level of addiction ➔ fast clearance ➔ immediate withdrawal ➔ looking for next dose ➔ addiction
what does CAGE questionnaire stand for and function?
alcohol use disorder screening questionnaire
C - felt the need to CUT down on drinking
A - felt ANNOYED by critics of the drinking?
G - felt GUILTY about drinking
E - ever had an EYE opening experience about the drinking
what does the AUDIT (-C) tell us?
alcohol screening
what is PAWSS and COWS
prediction scores for alcohol and opioid withdrawal severity
how to investigate substance use disorders?
- tox screen ➔ blood alcohol levels + urine
- vitamins ➔ thiamine, B12, folate
- CBC ➔ macrocytic anemia
- LFTs, Cr, Urea
- blood borne infection and STI ➔ HIV, syphillus, hepatitis, gon/chalmydia
pharmacological tx for alcohol dependance
- naltrexone - opioid antagonist, to reduce cravings
- acamprosate - GABA agonist
- disulfiram - inhibits alcohol metabolism
other support for those that want to quit alcohol
support groups - AA
consider residential centres
nutritional support - thiamine and B12 replacement and folic acid
can consider CBT or family therapy
pharmacological tx for those wanting to quit opiods
- suboxone - opiod agonist
- methadone - opioid agonist
- kadian - opiod agonist
tx for alcohol withdrawal
CIWA protocol
- thiamine and fluids
- benzodiazepines ➔ basically giving them depressant again to remove the stimulant like withdrawal s/s
- give anticonvulsants for seizure risk (valprioc acid)
tx for opioid withdrawal
- opioid agonists – suboxone, methadone, kadian
tx for alcohol overdose
pump the stomach
tx for opioid overdose
naloxone
pt education for substance use disorders
safe supply and safe supplies
harm reduction
don’t use alone ➔ hotline
