Substance Use Disorders

Question 1

Risky Alcohol Use

Answer 1

• Alcohol Use Categories:
  
  • Current Use: 51%
  • Binge (risky) Use: 24%
  • Alcohol Use Disorder: 6%
• Risky Drinking:
  
  • Men: 4+ drinks in one sitting, 14+ drinks weekly
  • Women: 3+ drinks in one sitting, 7+ drinks weekly
  • Age > 65 = 1+ drink/day
• Tx:
  
  • Brief Intervention: 15 minutes, FRAMES (feedback, responsibility, advise decreased use, menu of options, empathy, self-efficacy)

Question 2

Alcohol Use Disorder: Definition, Risks, Pathophys, PE

Answer 2

• Definition:
  
  • problematic pattern of alcohol use → clinically significant impairment or distress
• Risks:
  
  • genetics, psychiatric disorders, physical disorders (chronic pain), environment (culture, stress exposure)
• Pathophys:
  
  • Decreased executive control over use, increased organization around substance use, physiological changes
  • Affects prefrontal cortex (executive function), hippocampus, nucleus accumbens, amygdala, ventral tegmental area (VTA)
  • Neurocircuitry becomes dysfunctional as someone moves from acute → chronic → substance use disorder
• PE:
  
  • Brain damage: loss of memory, hallucinations, dementia, fits
  • hepatitis, cirrhosis
  • numbness, trembling hands
  • risk of chest infection
  • Loss of muscle
  • CV: enlarged heart, HTN
  • GI: ulcers, gastritis, hematemesis, pancreatitis
  • GU: impotence, infertility
  • Poor DM control

Question 3

Alcohol Use Disorder: DSM-V, Screening, Tx

Answer 3

• DSM-V Criteria:
  
  • *2+significant sxs in past12 months:
    
    • Impaired control: use more or longer than planned, unsuccessful attempts to cut down/stop, lots of time spect to get/use/recover, recurrent use when dangerous, continues despite knowledge of problems caused, craving
    • Social Impairment: activities given up, role failure at work/school/home, social or interpersonal problems
    • Pharmacological: tolerance, withdrawal
  • Types:
    
    • Mild (abuse): 2-3 criteria met
    • Moderate (dependence): 4-5 criteria met
    • Severe (dependence): 6+ criteria met
• Screening Tools:
  
  • CAGE Alcohol Screening
    
    • Cutdown
    • Annoyed
    • Guilt
    • Eye Opener
  • Epic Screening:
    
    • CRAFFT: better for adolescents
    • AUDIT
• Tx:
  
  • Mild Disorders:
    
    • brief intervention, tx not well studied
  • Moderate-Severe:
    
    • Psychotherapies
    • -Peer support & self-help groups
    • -Disulfiram: affects dopamine pathways
    • -Amethystic agents: Naltrexone, acamprosate, gabapentin, topiramate
• GOALS:
  
  • abstinence, relapse prevention (learning coping skills, stabilization of other problems
• Remission:
  
  • Early: 3-12 months without sxs
  • Sustained: > 1 year without sxs

Question 4

Alcohol Withdrawal

Answer 4

• Definition:
  
  • cessation (or reduction) of alcohol use that has been heavy prolonged
• S/sxs:
  
  • Autonomic hyperactivity → Delirium Tremens : sweating, tachycardia
  • -increased hand tremor
  • -Insomnia
  • -N/V
  • -Hallucinations
  • -agitation, anxiety
  • -Generalized tonic-clonic seizure
• Tx:
  
  • IV benzos
  • -IV fluids, IV thiamine, magnesium, multivitamins, & electrolyte repletion
  • Alcohol withdrawal can be fatal

Question 5

Tobacco Use Disorder: Withdrawal and Tx

Answer 5

• Withdrawal:
  
  • Restlessness, anxiety
  • -Irritability, sleep abnormalities
  • -Depression
  • -Increased Appetite, weight gain
  • -Chest tightness
• Tx:
  
  • Nicotine tapering therapy: gum, spray, patches
  • -Bupropion: antidepressant drug, lowers seizure threshold
  • -Varenicline (Chantix)

Question 6

Opioid Use Disorder

Answer 6

• Definition:
  
  • problematic pattern of opioid use → significant impairment or distress
• Drugs:
  
  • heroin, oxycodone, hydrocodone, codeine, morphine, dextromethorphan, meperidine, methadone
• Intoxication Sxs:
  
  • -Euphoria, sedation
  • -Pupillary constriction
  • -Respiratory Depression
  • -Altered Mental Status
  • -Bradycardia
  • -Hypotension
  • -Constipation
• Withdrawal Sxs:
  
  • -Piloerections (goosebumps)
  • -Pupil dilation
  • -Flu-like sxs
  • -Lacrimation
  • -Tachycardia
  • -HTN
• Tx:
  
  • Agonist therapy: methadone, buprenorphine +/- naloxone
  • -Antagonist therapy: naltrexone

Question 7

Cocaine Use Disorder

Answer 7

• Intoxication Sxs:
  
  • elevated or euphoric mood
  • -Sympathetic hyperactivity: tremor, flushing, hyperthermia
• Withdrawal Sxs:
  
  • -Post-intoxication depression
  • -anhedonia
  • -hypersomnia
  • -suicide ideation
• Tx:
  
  • Managing intoxication = benzos