Substances of Abuse: Flashcards
Methadone
μ Opioid agonist Long acting Usual starting dose 20-40 mg Usual dose 50-150 mg per day Specialized clinics
Methadone yes/no
Complete abstinence- no
yes: Reduce use of heroin Reduce harm Increase employment Reduce crime Engage in treatment Save lives Be cost effective
problem: only in special clinic
Buprenorphine
Partial agonist- good since it will max out
Subutex/suboxone- (combo w/ antag to prevent IV use)
Usual dose 4-24 mg of buprenorphine per day; 16 mg ~80-95% receptor occupancy
Can precipitate withdrawal
Retention in treatment and reduction in opioid use
Office-based
Naltrexone
Blocks effects of heroin
Poor retention
Groups with strong contingency (physicians or people on parole)
Depot preparation approved for opioid dependence in 2010
Nicotine Dependence
Medications
Bupropion
Nicotine replacement
Varenicline
Bupropion
(Wellbutrin- antidep/Zyban- smoking):
↑ risk of sz w/ higher dose
Doubles quit rates
Better outcomes when combined with psychosocial treatments
Contraindicated: hx seizure disorder, MAO inhibitor, eating disorder
Insomnia/agitation common side effects
Bupropion
Wellbutrin/Zyban
Nicotine replacement
Nicotine content per cigarette varies (by brand, behavior of smoker and physiology)
General approximation is 1mg nicotine per cigarette
General approximate for 1 pack per day is about 20mg of nicotine
Nicotine Dependence Gum
Gum 1 piece 2 mg
No food or drink 15 min before
Problem include TMJ, hiccups, dyspepsia, difficult with dentures
Avoid if 1 month post MI, serious arrhythmias, gastric ulcers
Nicotine Dependence Patch
High dose (21 mg) 6-8 weeks, medium dose (14 mg) 2-4 weeks, low dose (7 mg) 2-4 weeks
Skin irritation (avoid if systemic eczema), slow delivery, wearing at night may cause sleep problems Same cardiovascular warnings
Varenicline (Chantix):
Partial agonist α4β2 nicotinic acetylcholine receptor
Smoking cessation
Worries about mood changes, suicidality, small increase in cardiovascular events
Nicotine Vaccine
Future
vax- stops nicotine from crossing BBB
AB vs nicotine
-But will it attach body?
CB1- blockers may stop wt gain when quitting
Psychosocial treatments techniques
Motivational interviewing
Contingency management/motivational incentives
Motivational Interviewing
Open ended questions
Affirmations- recognize
Reflective listening
Summarizing
Direct confrontation is not?
Motivational Intview
Education may not work if?
Substance abuse is the driving factor
Motivational Interviewing
The issue is not …to confront or not to confront
The issue is…
The issue is not …to confront or not to confront
The issue is…how to confront effectively
Motivational Interviewing strategy
Express empathy- genuine
Roll with resistance- tug of war- let it go
Develop discrepancies
Support self-efficacy
Other psychosocial treatments
CBT
12-step facilitation
MST
BSFT
Motivational Interviewing
Eliciting self-motivating statements
“In what ways has this been a problem for you?”
“How much does this concern you?”
“What things make you think that you need to make a change at this point?”
“What makes you think that if you decided to change, you could do it now?”
Motivational Interviewing:
Eliciting self-motivating statements
“On a scale of 1 to 10 how ready are you to stop?”
“I’m not ready. Maybe I’m a 2.”
Explain Responses
A) “Look at all your problems. I can’t believe it’s not a 10.”
B) “Good. How can we make you a 3?”
C) “Good. Why aren’t you a 1?”
a- confrontation
b- cheerleader
c- MOTIV INT
Contingency management
ex: cocaine contract
Detection- UA (wont work with etoh)
Reinforcers provided with behavior - needs close temporal
Reinforcers are withheld when behavior not occur
reward points- retained rx 12 wks off crack
