Substance use disorders

Question 1

Disease - noun

Answer 1

A disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or
symptoms or that affects a specific
location and is not simply a direct
result of physical injury

Question 2

10 classes of substance use disorders

Answer 2

○ Alcohol
○ Caffeine
○ Cannabis
○ Hallucinogens
○ Inhalants
○ Opioids
○ Sedatives, hypnotics, anxiolytics
○ Stimulants
○ Tobacco
○ Other

Question 3

Reward center process

Answer 3

• ↑ dopamine into nucleus accumbens
  promotes pleasure and reinforcing
  behavior
• Nucleus accumbens (post-dopamine
  infusion), signals cerebral cortex, codes the experience, create memories, and guides future behavior

Question 4

Dopaminergic neurons

Answer 4

• Located in the midbrain structures
• Substantia Nigra (SNc)
• Ventral Tegmental Area (VTA)

Question 5

Dopaminergic neurons project their axons to:

Answer 5

• Striatum
• Dorsal prefrontal cortex
• Ventral prefrontal cortex

Question 6

Substance-Induced Disorders

Answer 6

Substance-Induced Disorders:
Intoxication
Withdrawal
Other Substance Induced
Mental Disorders

Question 7

What is NSDUH and what do they do?

Answer 7

The National Survey on Drug Use and Health (NSDUH): a nationwide
survey interviewing around 70,000 random individuals aged 12 and older
* Provide national/state-level estimates on the use of tobacco, alcohol, illicit
drugs (including non-medical use of prescription drugs), and mental health
* Assess and monitor the consequences of drug and alcohol use

Question 8

Most common substance use disorder

Answer 8

Alcohol use disorder

Question 9

Substance-Use Disorder:

Answer 9

Defines as a pathological pattern of
symptoms (cognitive, behavioral, physiologic) indicating that the
individual continues to use the substance despite significant
consequences

Question 10

DSM Criteria for Substance use disorders

Answer 10

11 criteria under 4 headings
* Impaired control
* Social impairment
* Risky use
* Pharmacological criteria

Question 11

Subtance use disorders DSM - Impaired control:

Answer 11

taking a larger amount of a substance or over a longer period of time than originally intended:
1. A need for markedly ↑ amounts of the substance to achieve intoxication or desired effect
2. Having a persistent desire or unsuccessful efforts to cut down or
control substance-use
3. The individual may spend a great deal of time obtaining, using, or recovering from the effects of the substance
4. Craving – an intense desire or urge for the drug that may occur at any time, and more likely in certain circumstances
Ex: driving by the bar on the way home from work

Question 12

Substance use disorders DSM - Social Impairment criteria:

Answer 12

5. Recurrent substance-use may result in a failure to fulfill major role obligations at work, school, or home
6. Substance use may continue despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
7. Important social, occupational, or recreational activities may be given up or ↓ because of substance-use
   Ex: Withdrawn from family activities and hobbies, to use

Question 13

Substance-Use Disorders – risky use:

Answer 13

8. Recurrent substance-use in situations in which it is physically
   hazardous
9. May continue using despite knowledge of having a persistent or
   recurrent physical or psychological problem likely caused by or
   exacerbated by the substance

Question 14

Substance-Use Disorders – Pharmacological criteria:

Answer 14

10. Tolerance – needing ↑ dosing of the substance to achieve the desired effect or a markedly ↓ effect when the usual dose is consumed
    * Lab tests may be helpful (ie ↑ blood levels of substance and little
    intoxication)
11. Withdrawal* – a syndrome occurring when blood or tissue
    concentrations of a substance decline after prolonged use
    * Specific symptoms are dependent upon the substance

Question 15

DSM-5 Criterion for Substance use disorders: Severity and Specifiers

Answer 15

Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6+ symptoms

Question 16

Substance-Induced Disorders

Answer 16

Potentially severe, usually temporary, but sometimes persistent,
syndromes that develop in the context of the effects of substances
of abuse, meds, or toxins. Includes:
● Intoxication
● Withdrawal
● Induced Mental Disorders

Question 17

T/F Substance-Induced Disorders are not factors that contribute to the continued use of a substance

Answer 17

T

Question 18

Substance Intoxication Criterion (DSM)

Answer 18

A. Development of a reversible substance-specific syndrome due to
the recent ingestion (within 1 month) of a substance (Essential)
B. Clinically significant problematic behavioral or psychological
changes, are attributable to the physiologic effects of the substance
C. Symptoms are not attributable to another medical condition

Question 19

Substance Withdrawal Criterion (DSM-5)

Answer 19

A. Development of a substance-specific problematic behavioral
change, with physiological and cognitive problems due to cessation
or reduction in heavy and prolonged substance-use Essential
B. Clinically significant distress or impairment in social occupational or
other areas of functioning
C. Symptoms are not attributable to another medical condition

Question 20

Patients often re-administer the substance to _____

Answer 20

reduce symptoms

Question 21

Codependence

Answer 21

Misguided attempts by a loved one, to protect a patient with
substance-use disorder from the consequences of substance use
Enabling – The instinct to shelter a loved one from harm, allowing
the substance use to continue and progress in severity

Question 22

The ____ of codependents usually focus on helping patients with substance-use disorder manage short-term crises
rather than focusing on long-term solutions

Answer 22

enabling behaviors

Question 23

Etiology of Substance Abuse - Biological factors

Answer 23

susceptibility to acute
psychopharmacologic effects of a given drug
● Metabolism of the drug
● Cellular adaptation within the CNS to chronic exposure to the drug
● Predisposing personality characteristics
● Susceptibility to medical and neuropsychiatric complications of
chronic drug self-administration.

Question 24

Etiology of Substance Abuse - Psychological factors

Answer 24

● Presence of co-occurring psychopathology
● Medical illnesses
○ Chronic pain, essential tremor
● Past or present severe stress
○ Resulting from crime, battle exposure, sexual trauma, or economic difficulties
● Potential causes of “self-medication”

Question 25

Etiology of Substance Abuse - environmental stressors

Answer 25

● The same Environmental stressors that predispose to depression
following a major loss can also contribute to developing a substance-use disorder.
● Similarly, prefrontal cortical dysfunction manifested by impulsiveness or
poor decision making is observed in individuals diagnosed with either
pathological gambling or cocaine dependence

Question 26

Etiology of Substance Abuse - social factors

Answer 26

Often contribute to the initiation of drug use
and progression of substance-use disorders.
● Peer group attitudes toward drug use
● Availability of competing reinforcers in the form of educational, recreational, and occupational alternatives to substance use
● Availability of drugs during particular
developmental stages

Question 27

Drug Seeking Behaviors
Behavior and characteristics

Answer 27

● Exaggerated medical conditions or simulate medical symptoms (malingering)
● Unusual knowledge of controlled substances (names, dosing)
● Requests certain drugs by name
● Cutaneous signs of drug-use such as “track marks”
● Often hops around to different providers, or sees multiple providers at once
● Has “allergy” to non-narcotic medications or state that they don’t work

Question 28

Behaviors that a patient exhibits in the attempt to be prescribed a
medication for a reason other than the prescribed use

Answer 28

Drug Seeking Behaviors