Substance Use DIsorders

Question 1

Substance abuse - DSM 4

Answer 1

Maladaptive pattern of use leading to clinically significant impairment or distress for a 12 month period

Question 2

Substance dependence - DSM 4

Answer 2

Maladaptive pattern of use leading to clinically significant impairment or distress, with at least 3 episodes

Question 3

Substance use and addictive disorders - DSM 5

Answer 3

Defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual

Question 4

4 major groupings to diagnose a substance use disorder (SUD)

Answer 4

Impaired control, social impairment, risky use, pharmacological criteria (tolerance and withdrawal)

Question 5

Diagnostic criteria

Answer 5

2 of the following must occur with a 12 month period: 1. The substance is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance. 3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. 4. Craving, or a strong desire or urge to use the substance. 5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.

Question 6

Tolerance

Answer 6

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

Question 7

Withdrawal

Answer 7

The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance).

Question 8

Prevalence

Answer 8

20.2 million adults (8.4%) had a substance use disorder when asked about past year’s use. Of these, 7.9 million people had co-occurring mental and substance use disorder

Question 9

Prevalence - gender difference

Answer 9

When asked about use in the past year - Men aged 12 or older are more likely than women to report illegal drug use (12.8% vs. 7.3%). However, women are more impacted by substance use than their male counterparts

Question 10

Adolescence and SUDs

Answer 10

9 out of 10 people with SUDs started smoking, drinking, or using others drugs before age 18

Question 11

Alcohol and adolescence

Answer 11

If adolescence started drinking before age 14, 47% are alcohol dependent. If adolescence started drinking before age 21, 9% are alcohol dependent

Question 12

Risk factors for SUDs

Answer 12

Biological (genetics, neuroanatomy), psychological (trauma, learned behavior), and environmental

Question 13

Psychological Risk Factors

Answer 13

Mental illness: self-medication; ADHD, low self-esteem, self-worth, or trauma

Question 14

Trauma - Psychological Risk Factors

Answer 14

Rhesus monkeys who were stressed more after birth had higher rates of accepting alcohol offered to them (higher levels of cortisol found in the heaviest drinkers); Hx of child abuse and neglect are 1.5x more likely to use illicit drugs, especially marijuana, in middle adulthood; Hx of sexual assault is associated with a 3x greater risk for alcoholism, 4x for drug addiction

Question 15

Biological Risk Factors

Answer 15

• Addiction is very heritable. Ex: 4x more likely to have alcohol use disorder if parent does.
• Twin studies: 40-60% concurrence of alcoholism
• Adoption studies: adopted to separate homes – both 3-4x’s more likely to have disordered drinking

Question 16

Stockholm Adoption Study

Answer 16

Alcoholism in at least one birth parent increased the son’s risk of disordered drinking vs. alcoholism in the adoptive parents did not

Question 17

The Reward Pathway

Answer 17

Reward pathway tries to make sure you repeat the behavior so it connects to regions of the brain that control memory and behavior to signal the brain’s motor center to strengthen the wiring for behaviors that help achieve the reward

Question 18

Environmental Risk Factors

Answer 18

• Familial, socially, culturally normalized
• Peer pressure
• Interpersonal violence
• Directed advertisement

Question 19

Alcohol’s impact on health

Answer 19

• Heart health: alcoholic cardiomyopathy, arrhythmia, strokes, hypertension
• Pancreas: pancreatitis
• Cancer: mouth, esophagus, throat, liver, breast
• Immune system: pneumonia & TB, slowed ability to ward off infection
• Head injuries from falls sustained when inebriated
• Cerebrovascular disease

Question 20

Drugs and alcohol

Answer 20

• Tylenol and alcohol: liver failure, liver damage, yellow skin tone, cirrhosis, immune system breakdown
• Alcohol and sedatives: multiples sedative effect of both

Question 21

Korsakoff syndrome

Answer 21

Peripheral neuropathy related to lack of vitamin B1

Question 22

Heroin and opiates impact on health

Answer 22

Physical complications due to neglect, infection (injection, picking)

Question 23

Cocaine’s impact on health

Answer 23

Cardiovascular disease, destruction of nasal tissue if sniffed

Question 24

Methamphetamine’s impact on health

Answer 24

Loss of appetite, increased heart rate, blood pressure, body temperature, disturbed sleep patterns, nausea, bizarre, erratic, sometimes violent behavior, hallucinations, hyperexcitability, irritability

Question 25

Inhalant’s impact on health

Answer 25

Varied effects, increase/decrease HR, headaches, dizziness, loss of sense/smell, lung collapse, and confusion

Question 26

Nicotine’s impact on health

Answer 26

• Cancer: lung, larynx, oral cavity, esophagus, bladder, kidney and pancreas
• Cardiovascular disease
• Pulmonary disease (COPD)
• Cerebrovascular disease (strokes and dementia)
• Peptic ulcers, osteoporosis in postmenopausal women, and macular degeneration

Question 27

Alcohol and smoking

Answer 27

• 80-95% of those with alcohol use disorder smoke
• Reduces alcohol effects
• Smokers 10x more likely to develop alcohol use disorder

Question 28

Ecstasy: long term effects

Answer 28

Liver damage, anxiety disorders, irregular heartbeats, brain damage, depression confusion, paranoia

Question 29

Impact on health: gender differences

Answer 29

For alcohol, opiates, cocaine, and other drugs, sexual dysfunction differs by gender. For prescription meds, elderly women are more likely to misuse prescribed medications (10% of women misuse)

Question 30

SUDs impact on others

Answer 30

Prenatal drug exposure on infants and children (neonatal abstinence syndrome), secondhand smoke, spread of infectious disease

Question 31

Fetal Alcohol Syndrome

Answer 31

CNS problems like mental retardation, hyperactivity, delayed development, problems with learning, and seizures

Question 32

Advantages of doing assessment

Answer 32

Getting information, matching to counselor, getting insurance reimbursement for diagnosis

Question 33

Disadvantages of doing assessment

Answer 33

May set up false expectations for specialized treatment, delays actual treatment, may be inappropriate for many minority groups.

Question 34

Screening instruments

Answer 34

Consists of a few questions to determine nature of the help needed; informal questions like “do you sometimes drink”

Question 35

Assessment tools

Answer 35

Process for defining the nature of the problem and developing specific treatment recommendations for addressing the problem; CAGE, TWEAK, AUDIT, MAST, SASSI, DriInC

Question 36

Assessing levels of care

Answer 36

Early intervention, outpatient treatment, intensive outpatient/partial hospitalization treatment, residential treatment

Question 37

Assessment of someone with co-occurring disorders

Answer 37

• A basic program provides treatment for one disorder but screens for the other.
• An intermediate program focuses primarily on one disorder but addresses some needs of the other.
• Advanced program provide services for both disorders

Question 38

Assessment of younger clients

Answer 38

• Risk at every life transition (college transition)

- First sexual encounter for girls is usually accompanied by alcohol or drugs

Question 39

Assessment of older clients

Answer 39

At higher risk for disordered use of prescription drugs

Question 40

Best treatment practices

Answer 40

Medications and behavioral therapy

Question 41

Behavioral and cognitive treatments

Answer 41

Types: motivational interviewing, cognitive therapy, contingency management, relapse prevention.
Goals: modify attitudes and behavior, strategies to plan for triggers/relapse, increase life skills/coping techniques

Question 42

Interactional group - psychotherapy

Answer 42

Alcoholics Anonymous

Question 43

Medication

Answer 43

Odansteron (zofran) decreases cravings. ZYban (bupropion) reduces cravings and other withdrawal effects. Chantix helps pt produce more dopamine. Naltrexone blocks receptors for getting high. Disulfiram (antabuse) - for alcohol abuse disorder

Question 44

Holistic treatments

Answer 44

Herbal remedies, hypnosis, acupunture, massage therapy, physical exercise

Question 45

CAGE

Answer 45

Cut down, annoyed, guilty, eye opener

Question 46

TWEAK

Answer 46

Tolerance, Worried, Eye Openers, Amnesia, Kut down

Question 47

AUDIT

Answer 47

Alcohol use disorders identification test, 10 question survery

Question 48

MAST

Answer 48

The MAST Test is a simple, self-scoring test that helps assess if one has a drinking
problem

Question 49

DriInC

Answer 49

Drinker inventory of consequences quesionnaire

Question 50

SASSI

Answer 50

Substance Abuse Screening Inventory