Substance use Disorders

Question 1

what are the 3 broad categories of Symptoms of Substance use disorder (SUD)

Answer 1

(1) physical dependence (tolerance and withdrawal),
(2) craving
(3) diminished capacity to control one’s use (substance use becomes the priority over other important things in one’s life)

Question 2

All substances of abuse increase dopamine release in the ________

Answer 2

nucleus accumbens

Question 3

why are adolescents more vulnerable to addiction than adults?

Answer 3

reward-related circuitry processing matures earlier while neural processing of inhibition are not yet fully developed.

Question 4

“At-risk drinking” for Men is _______

Answer 4

≥ 5 standard drinks in a day

or > 14 per week

Question 5

“At risk drinking” for women is ____

Answer 5

Women ≥ 4 in a day

or > 7 per week

Question 6

describe what is seen in an Anabuse reaction

Answer 6

Flushing
Headache
Nausea
Dizziness
Tachycardia

Question 7

what are the Contraindications for anabuse use

Answer 7

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

Question 8

what are some side effects/complications of naltrexone

Answer 8

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

Question 9

what are contraindications for Naltrexone use

Answer 9

Pregnancy category C
Lactation safety unknown
Hepatic failure/acute hepatitis
At risk for opioid withdrawal
Hypersensitivity to naltrexone

Question 10

what is the MOA of Acamprosate

Answer 10

Enhances GABA transmission

Interferes with Glutamate transmission

Question 11

what is the contraindications of Acamprosate

Answer 11

Hypersensitivity to Acamprosate

Severe renal impairment (creatinine clearance ≤ 30mL/min)

Question 12

What are the side effects of Acamprosate

Answer 12

Some side effects/complications:
Diarrhea (10-17%)
Anxiety (5-8%)
Depression (4-8%)
Insomnia (6-9%)
Suicidality (1.4% vs. 0.5%)

Question 13

name the 3 drugs used in opioid addiction

Answer 13

Methadone
Buprenorphine
Naltrexone

Question 14

______ is used in nicotine dependence Tx

Answer 14

Bupropion

Question 15

what are the contraindications for Bupropion

Answer 15

hx seizure disorder,
MAO inhibitor,
eating disorder

Question 16

what are the side effects of Bupropion

Answer 16

Insomnia/agitation

Question 17

Avoid nicotine gum if ________

Answer 17

1 month post MI,
serious arrhythmias,
gastric ulcers

Question 18

What are the downsides of the nicotine patch

Answer 18

Skin irritation (avoid if systemic eczema),
slow delivery,
wearing at night may cause sleep problems
Same cardiovascular warnings as gum

Question 19

Varenicline is a ________- and is used for Smoking cessation

Answer 19

Partial agonist α4β2 nicotinic acetylcholine receptor

Question 20

what is Motivational interviewing

Answer 20

Aims to facilitate and enhance a person’s intrinsic motivation to change addictive behavior

Question 21

OARS is technique used in MI to increase intrinsic motivation for change. what does it stand for

Answer 21

Open ended questions,
Affirmations,
Reflections,
Summary

Question 22

what are examples of affirmations made in MI

Answer 22

Recognize effort
Appreciation of strengths
Use of positive reframes

Question 23

Describe contingency management

Answer 23

Detection
Reinforcers provided with behavior
Reinforcers are withheld when behavior not occur

Question 24

In MI the physician asks strategic questions, which may elicit ___________ statements

Answer 24

“self motivating”

Question 25

what are 4 good strategies in MI besides OARS

Answer 25

Express empathy
Roll with resistance
Develop discrepancies
Support self-efficacy