Treating Substance Abuse Flashcards
What are the estimated costs per year of alcohol and drug abuse in Canada?
$40 billion
Pharmacological interventions are typically used in which two phases of the dependence cycle?
detoxification and maintenance
An example of a pharmacological agent to prevent relapse and that fits the ‘punishment’ maintenance strategy would be:
disulfiram (Antabuse).
The most common medication used to treat heroin addiction is:
methadone.
Many early theories of substance dependence were based on studying people with dependence on which substance?
alcohol
Which of the following is NOT true of contingency management therapy?
It is focused on rewarding good behaviour and does not include counselling.
Which of the following is an example of harm reduction?
syringe exchanges
methadone maintenance programs
supervised injection facilities
heroin assisted treatment (HAT)
Motivational enhancement therapy is aimed at:
preparing the user to want to change his behaviour
In the view of Alcoholics Anonymous (AA), alcoholics:
are helped through support and total abstinence.
In the Recommendations for a National Treatment Strategy, AA would be an example of a______ support or service.
Tier 1
what does the word “treatment” conjure up?
hospitals, nurses, and physicians
how many Canadians meet the diagnostic criteria for alcohol abuse and substance dependence?
2 million
how much does it cost Nova Scotia a year?
1.244 billion
what is the initial and immediate phase of treatment?
detoxification
what is detoxification?
medication administered to alleviate unpleasant and or dangerous withdrawal symptoms that may appear following abrupt cessation of drug use
what is a longer-term strategy used to help a dependent individual avoid relapse?
maintenance
what are three general categories of pharmacotherapy for maintenance
- agonist/substitution therapy (block feeling)
- antagonist therapy (block positive feeling)
- aversion therapy (negative)
what is agonist/substitution therapy used for?
to induce cross-tolerance to abused drug
what are some examples of agonist therapy?
methadone - heroin dependence
nicotine - tobacco dependence
why are agonists used?
because they have safer routes of administration and or diminished psychoactive effects compared to the original drug
subtituting a longer-acting pharmacologically equivalent drug allows user to be stabilized on the agonist and then slowly tapered off it, avoid withdrawal
what is antagonist therapy used for?
to prevent user from experiencing reinforced effect of abused drug
what are some examples or antagonist therapy?
naltrexone, blocks opioid effect
what is aversion therapy used for?
to produce aversion reaction following ingestion of abused drug
what are some examples of aversion therapy?
disulfiram for alcohol dependence
what is disulfiram used for?
punishment therapy for alcohol use
-inhibits alcohol dehydrogenase, a major enzyme in alcohol metabolism which, in the presence of alcohol can produce symptoms such as headache, vomiting, and breathing difficulties
alcohol detox phase
benzodiazepines typically used:
- to reduce autonomic hyperactivity and prevent seizures
- slow onset of action
- potentiate the inhibitory actions of GABA on the CNS
alcohol maintenance therapy
three approved medication
- disulfiram (Antabuse)
- Naltrexone
- acamprosate
what does disulfiram do?
for alcohol
- causes unpleasant symptoms if alcohol consumed
- inhibits aldehyde dehydrogenase, increasing acetaldehyde
why is disulfiram not very effective
because most people don’t take medication
what does naltrexone do?
reduces alcohol craving (but not large impact on overall treatment)
may block opioid receptors and reinforcing effects of alcohol
what does acamprosate do?
normalizes basal GABA concentrations
blocks glutamate increases with alcohol withdrawal
recently approved, effectiveness not determined
what is the primary component responsible for maintenance treatment for tobacco?
nicotine
nicotine withdrawal symptoms?
anxiety
depression
insomnia
nicotine replacement products
transdermal nicotine patch nicotine gum nicotine nasal spray nicotine vapor inhaler nicotine lozenge
bupropion (zyban) is used for what?
as a non-nicotine pharmocotherapy for smoking
- also used for depression (Wellbutrin)
- may inhibit reuptake of dopamine and norepinephrine and may block acetylcholine receptors
what is varenicline (champix)
a partial nicotinic-receptor agonist - meaning that even at larger doses, it does not produce the full response of nicotine
-found to be more effective than placebo or bupropion and is a viable option for smoking therapy
what is the premise for nicotine vaccines-basic
neutralize the drug peripherally before ever reaching the brain
- currently all are conjugates
- nicotine linked to a carrier protein
opioid withdrawal symptoms:
not life threatening
- nausea
- vomiting
- diarrhea
- aches and pains
what was traditionally used to treat opioid dependence?
anticholinergic drugs like belladonna
what was the goal of belladonna in opioid treatment
to produce delirium for several days so that the dependent person would avoid experiencing withdrawal
what is rapid opioid detox?
anesthetized and given an antagonist that causes immediate withdrawal
-released after 24hr and enters counseling while continuing to take antagonist
criticism of rapid opioid detox?
medical risks
behavioral aftercare is deemphasized
what are some drugs used for opioid detox
methadone buprenorphine (partial agonist with long duration of action)
what are some drugs used for opioid treatment maintenance?
methadone - most common
buprenorphine
what is used for opioid overdose
short-acting antagonist naloxone greater affinity for brain opioid receptors than do most apoioid agonists, including heroin often used for treating opioid overdose
naloxlone displaced opioid agonist from receptors and thereby rapidly reverses overdose
opioid dependence treatment medication:
naltrexone
when was methadone developed?
1937
what was methadone found to be able to treat after WW2?
heroin withdrawal and serve as maintenance treatment
who, when, where set up the world’s first methadone maintenance treatment program?
Dr Robert Halliday
1963
BC
when did Canada set guidelines for methadone maintenance?
1972
who can prescribe methadone?
physicians who have received an exemption under the Controlled Drugs and Substances Act
how does methadone maintenance treatment work
supports withdrawal from opioids by alleviating symptoms
methadone decreases chronic craving for opioids
reduces euphoric effects through cross-tolerance
tolerance to methadone maintenance is slow
what is suboxone used for?
substitution treatment in opioid dependence for adults
what does buprenorphine help manage?
the cravings associated with opioid withdrawal while nalozone reduces the potential for misuse by causing unpleasant withdrawal symptoms if product misued by IV injection
cocaine withdrawal symptoms:
depression nervousness anhedonia (lack of emotional response) fatigue irritability sleep disturbances
modafinil use?
to treat cocaine dependence
-however, not approved by Health Canada
how does modafinil work?
increase activity of dopamine, norepinephrine, glutamate
decrease release of GABA
relapse prevention
encouraging substance abuse treatment
developing supportive network
what started the behavioral and psychosocial treatment approach?
alcohol dependence treatment
how do people view alcohol dependence
as a biological disease that someone either has or does not have and that the only acceptable treatment goal is complete abstinence
goal of opioid treatment
changed from eliminating opioid use to eliminating heroin use
what does motivational enhancement therapy attempt to do
attempts to shift focus away from denial to motivation to change
-nonconfrontational process of determining abusers current stage of change and then helping the individual move forward
what is used to effectively manage alcohol withdrawal
benzodiazepine diazepam
-rapid onset
what is the first non nicotine pharmacotherapy for smoking?
bupropion (Zyban) 1998
-inhibit dopamine and norepinephrine
what is used to alleviate symptoms of opioid withdrawal?
methadone
- orally active and has long half-life
- tolerance develops slowly
what is buprenorphine
opioid agonist/antagonist or partial agonist at the mu receptor
-cause unpleasant withdrawal if product misued by IV injection
which drug was approved by Health Canada in 2007 and it available for substitution treatement in opioid drug dependence in adults
suboxone (combinatino of buprenorphine and naloxone)
what is the transtheoretical model
defines intentional change as a process that does not occur at a specific moment but is sensitive to the dynamic changes that an individual presents over time in terms of a motivational stage
what are the stages of TTM
precontemplation (no intention to change)
contemplation (change under consideration)
preparation (commit to action)
action (first step)
maintenance
relapse (cycling back through stages)
individuals who have both a mental health and a substance use problem
concurrent disorder
