Substances of Abuse: Flashcards

1
Q

Methadone

A
μ Opioid agonist
Long acting
Usual starting dose 20-40 mg
Usual dose 50-150 mg per day 
Specialized clinics
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2
Q

Methadone yes/no

A

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

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3
Q

Buprenorphine

A

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

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4
Q

Naltrexone

A

Blocks effects of heroin
Poor retention

Groups with strong contingency (physicians or people on parole)

Depot preparation approved for opioid dependence in 2010

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5
Q

Nicotine Dependence

Medications

A

Bupropion
Nicotine replacement
Varenicline

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6
Q

Bupropion

A

(Wellbutrin- antidep/Zyban- smoking):

↑ risk of sz w/ higher dose

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7
Q

Doubles quit rates
Better outcomes when combined with psychosocial treatments
Contraindicated: hx seizure disorder, MAO inhibitor, eating disorder
Insomnia/agitation common side effects

A

Bupropion

Wellbutrin/Zyban

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8
Q

Nicotine replacement

A

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

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9
Q

Nicotine Dependence Gum

A

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

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10
Q

Nicotine Dependence Patch

A

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
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11
Q

Varenicline (Chantix):

A

Partial agonist α4β2 nicotinic acetylcholine receptor

Smoking cessation

Worries about mood changes, suicidality, small increase in cardiovascular events

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12
Q

Nicotine Vaccine

A

Future

vax- stops nicotine from crossing BBB

AB vs nicotine
-But will it attach body?

CB1- blockers may stop wt gain when quitting

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13
Q

Psychosocial treatments techniques

A

Motivational interviewing

Contingency management/motivational incentives

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14
Q

Motivational Interviewing

A

Open ended questions
Affirmations- recognize
Reflective listening
Summarizing

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15
Q

Direct confrontation is not?

A

Motivational Intview

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16
Q

Education may not work if?

A

Substance abuse is the driving factor

17
Q

Motivational Interviewing

The issue is not …to confront or not to confront

The issue is…

A

The issue is not …to confront or not to confront

The issue is…how to confront effectively

18
Q

Motivational Interviewing strategy

A

Express empathy- genuine
Roll with resistance- tug of war- let it go
Develop discrepancies
Support self-efficacy

19
Q

Other psychosocial treatments

A

CBT
12-step facilitation
MST
BSFT

20
Q

Motivational Interviewing

Eliciting self-motivating statements

A

“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?”

21
Q

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

a- confrontation

b- cheerleader

c- MOTIV INT

22
Q

Contingency management

A

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