Substance Use Disorders

Question 1

Continued substance use despite _________ caused or exacerbated by the effects of the substance.

Answer 1

having persistent or recurrent social or interpersonal problems

Question 2

Withdrawal, as manifested by experiencing the characteristic withdrawal syndrome or the substance is used to relieve or avoid ________________

Answer 2

withdrawal symptoms.

Question 3

Tolerance, as defined by either of the following:

Answer 3

(a) A need for markedly increased amounts of substance to achieve intoxication or desired effect. (b) Markedly diminished effect with continued use of the same amount of the substance.

Question 4

Substance use is continued despite____________ that is likely to have been caused or exacerbated by substance use.

Answer 4

knowledge of having a persistent or recurrent physical or psychological problem

Question 5

8. Recurrent substance use in situations in which it is

Answer 5

physically hazardous.

Question 6

Substance is often taken in larger amounts or over a longer period than was ________

Answer 6

intended

Question 7

There is a ___________ to cut down or control substance use

Answer 7

persistent desire or unsuccessful efforts

Question 8

A great deal of time is spent in activities necessary to?

Answer 8

obtain or use the substance or recover from its effects

Definition of substance use disorders (SUD).

Question 9

_________ to use the substance.

Answer 9

Definition of substance use disorders (SUD).

Craving, or a strong desire or urge

Question 10

Recurrent substance use resulting in a failure to fulfill : __________

Answer 10

major role obligations at work, school or home.

Question 11

_________________ are given up or reduced because of substance use.

Answer 11

Important social, occupational, or recreational activities

Question 12

Important to substance abuse disorders

Answer 12

Cortically regulated cognitive and emotional processes, which result in the overvaluing of drug reinforcers, the undervaluing of alternative reinforcers, and decifits in inhibitory control

Question 13

AUDIT

Answer 13

screening for substance abuse

Question 14

At-risk drinking

Answer 14

Men ≥ 5 standard drinks in a day or > 14 per week

Women ≥ 4 in a day or > 7 per week

This level of drinking are asc. with bad health outcomes

Question 15

Alcohol withdrawal

Answer 15

Autonomic hyperactivity (e.g., sweating or pulse >100 bpm)
Increased hand tremor

Nausea or vomitting

Transient visual, tactile, or auditory hallucinations or illusions

Psychomotor agitation
Anxiety

Generalized tonic-clonic seizures.

• generally opposite of etoh use
  rx: benzo

Question 16

Opioid withdrawal

Answer 16

Dysphoric mood

Nausea/vomiting

Muscle aches

Lacrimation or rhinorrhea

Pupillary dilation, piloerection or sweating

Diarrhea

Yawning

Fever

Insomnia

Question 17

Alcohol meds

Answer 17

Antabuse (disulfiram)

Question 18

Going cold turkey

Answer 18

term comes from opioid withdrawal- goose bumps

Question 19

Antabuse/disulfiram reaction

Answer 19

Flushing
Headache
Nausea
Dizziness
Tachycardia

Question 20

meds can only help w/ 3 classes

Answer 20

etoh
opioids
nicotine

Question 21

Antabuse Side effects/complications

Answer 21

Metallic taste
Headaches
Drowsiness or fatigue
Optic neuritis
Peripheral neuropathy
Hepatitis
Rash
A few cases of psychotic symptoms (i.e. metronidazole)

Question 22

You should maybe do what test for antabuse?

Answer 22

Liver enzyme

Question 23

Reasons to not do anabuse

Answer 23

Some Contraindications
Risk for MI
Risk for CVA
Cognitive dysfunction (can’t understand or remember what will happen if drinks)

Pregnancy category C/breast feeding safety unknown

Question 24

Revia and Vivitrol (naltrexone)

Answer 24

Pure opioid antagonist

Blocks μ opioid receptors

Question 25

Naltrexone Why might it work

Answer 25

μ agonists ↑ dopamine release in Nucleus Accumbens
μ agonists ↑drinking in rats

Opioid antagonists reduce alcohol consumption in rats

Alcohol dependent people may have low baseline beta-endorphin levels (stress response)

Alcohol consumption ↑endorphin in those with family history of alcoholism

Naltrexone blocks euphoria from alcohol

beware opiot or herion comorbid

Question 26

Naltrexone

Answer 26

moderate effect size on etoh quitting

can be a depot injection aka vivatrol

Question 27

Naltrexone Some side effects/complications:

Answer 27

Nausea (10%)
Headaches (7%)
Anxiety (2%)
Sedation (2%)
Hepatic failure (rare)

Question 28

Naltrexone Interactions

Answer 28

↓Benefit from opioid analgesics
↓Benefit from some antidiarrheal
↓Benefit from opioid containing cough medicines

Question 29

Campral (acamprosate)

Answer 29

Structurally resembles GABA
Enhances GABA transmission
Interferes with Glutamate transmission
Reduces CNS hyperexcitability

Question 30

Some side effects/complications:

Campral (acamprosate)

Answer 30

Diarrhea (10-17%)
Anxiety (5-8%)
Depression (4-8%)
Insomnia (6-9%)
Suicidality (1.4% vs. 0.5%)