Substance Use Disorders

Question 1

Substance use disorder

Answer 1

Maladaptive pattern of substance use leading to significant impairment and/or distress during 12 month period, includes two or more:

• Failure to fulfill major role obligations
• Use in situations when it is physically hazardous
• Despite persistent social/interpersonal problems caused by or exaggerated by effects of substance
• Tolerance
• Withdrawal symptoms
• substance taken in larger amounts than intended
• desire or unsuccessful efforts to cut down/control use
• significant time spent acquiring, using, or recovering
• social, occupational, recreational activities sacrificed

Question 2

Methods of use

Answer 2

• inhale- rapid absorption: fastest way to the brain 5-8 seconds
• snorting- effects in minutes
• injection- fast route- 15-20 seconds to brain
• oral ingestion- gradual onset. Can take 5-30 minutes 75% absorbed within 1-3 hours

Question 3

Depressants

Answer 3

slow the activity of the central nervous system: alcohol, benzodiazepines, barbiturates

Question 4

Stimulants

Answer 4

cocaine, meth, nicotine, caffeine

Question 5

Opioids

Answer 5

opium, heroin, oxycontin, percocet, painkillers

Question 6

Hallucinogens

Answer 6

LCD, peyote, PCP, ketamine

Question 7

Brain circuit associated with drug abuse

Answer 7

• pleasure pathway (affects learning, reward, motivation)

* stimulated by ETOH, nicotine, cocaine, amphetamines, opiates, caffeine

Question 8

GABA system

Answer 8

associated with alcohol use. Reduces fear/inhibition

* increased GABA-> increased DA in pleasure pathway

Question 9

Reinforcement/conditioning and substance use

Answer 9

• positive reinforcement
  
  • direct from substance
  • perceived social benefit
• negative reinforcement
  
  • removal of negative state
  • removal of withdrawal symptoms
• cues for cravings

Question 10

Social implications of drug use

Answer 10

• social activities become focused around use
• social network formed around use
  
  • loss of connection with previous groups
  • standard of comparisons changes
  • quitting=loss of support network

Question 11

Stages of change

Answer 11

• precontemplation
• contemplation
• preparation
• action
• maintenance
• relapse

Question 12

Motivational Interviewing

Answer 12

• Idea is to enhance intrinsic motivation for change in behavior
• Focus on ambivalence
• Central tenets
  
  • subtly directive
  • acknowledge benefits of use “devils advocate”
  • non-confrontational
• Evidence suggest very effective, occasionally with single session.

Question 13

AA and NA

Answer 13

• Alcoholism as disease that could not be overcome through will power alone- reliance upon “higher power”
• Based on 12 step program
• daily meetings held almost anywhere
  
  • Central tenets
    
    • abstinence based
    • no professional oversight of political affiliations
    • anonymity
    • sponsorship
• effective when followed, but high drop out rate

Question 14

Cognitive treatments for substance use disorder

Answer 14

• objective evaluations of benefits of use vs. abstinence
• identifying and challenging thoughts associated with use
• slowing down “rush to recovery”

Question 15

Behavioral interventions

Answer 15

• Avoidance of “high risk” situations and relationships
• encourage activities incompatible with use
• rewarding abstinence
• develop refusal skills via role-playing
• typically, AA involvement

Question 16

Antabuse

Answer 16

disrupts metabolism of ETOH- produces flushing, throbbing headaches, nausea

Question 17

Acamprosate

Answer 17

reduces glutamate hyperactivity- reduces pleasure associated with ETOH, prevents relapse

Question 18

Naltrexone

Answer 18

opioid receptor antagonist- reduces pleasure associated with ETOH, prevents relapse

Question 19

Methadone maintenance

Answer 19

long acting opioid receptor agonist. Avoids withdrawal, reduces cravings, allows for social functioning. Taken daily.

Question 20

Buprenorphine

Answer 20

partial opioid agonist, dose-independent response

Question 21

Naloxone

Answer 21

treats opioid overdose; over the counter injection and nasal spray formulas

Question 22

delirium tremens

Answer 22

a dramatic withdrawal reaction that some people dependent on alcohol have. It consists of confusion, clouded consciousness, and terrifying visual hallucinations.

Question 23

Korsakoff’s syndrome

Answer 23

an alcohol-related disorder marked by extreme confusion, memory impairment, and other neurological symptoms.

Question 24

Fetal alcohol syndrome

Answer 24

a cluster of problems in a child, including low birth weight, irregularities in head and face, intellectual deficits, cause bye excessive alcohol intake during pregnancy.

Question 25

Sedative hypnotic

Answer 25

types of depressants used in low doses to reduce anxiety and in higher doses to help people sleep. (anxiolytic)

• barbiturates
• benzodiazepines (Xanax, Ativan, Valium)- bind to receptors on the neurons that receive GABA and increase GABA’s activity to reduce anxiety

Question 26

synergistic effect

Answer 26

in pharmacology, an increase of effects that occurs when more than one substance is acting on the body at the same time.

Question 27

relapse-prevention training

Answer 27

for alcohol use disorder, clients are taught to keep track of their drinking behavior, apply coping strategies in situations that typically trigger excessive drinking, and plan ahead for risky situations and reactions.