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Psychiatry > Treatment of Addiction > Flashcards

Treatment of Addiction Flashcards

1
Q

What is the criteria for having substance use disorder?

What classifies no, mild, moderate, and severe substance abuse?

A

12 month period of atleast 2 of the following:

  1. taken in increased amount over a longer period of time than intended
  2. inability to control/modify substance use
  3. time spent obtaining, using, recovering from use of substance
  4. craving for the substance
  5. impacts ability to function at work, school, home
  6. continued abuse despite social or interpersonal problems
  7. social, occupational, recreational activities are stopped
  8. use of substance in physically dangerous situations
  9. continued used despite knowledge of physical harm, or psychological problem
  10. tolerance
  11. withdrawal

0-1 symptoms = none
2-3 = mild
4-5 = moderate
6 or more = severe

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2
Q

What are the 4 “impaired control” criteria of substance abuse?

A
  1. having more than intended or for longer time than expected
  2. craving or strongly desiring
  3. inability to control or modify substance use
  4. great deal of time is spent trying to get the drug, use or recover
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3
Q

What are the 3 social impairment criteria of substance abuse?

A
  1. impacts function at work, school, home
  2. continue use despite social or interpersonal problems around the abuse
  3. social, occupational or recreational activities are stopped b/c of substance
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4
Q

What are the 2 “risky use” criteria for substance abuse?

A
  1. use in hazardous situations

2. use despite knowledge of physical or psychological harm

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5
Q

What are the 2 pharmacological criteria for substance abuse?

A
  1. tolerance
    - alcohol if it takes more that 2 drinks to feel a buzz, 6 to be drunk
  2. withdrawal
    - “minor withdrawal syndrome” 4-6 hours with elevated pulse, increased resp. rate, elevated blood pressure
    - “major withdrawal syndrome”
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6
Q

When do alcohol withdrawal symptoms present?
What are the minor withdrawal symptoms?
Major withdraw symptoms?

A

Symptoms present 4-6 hours after the last drink and are characterized by increased ANS effects.

Minor withdrawal symptoms:

  • elevated pulse, RR, BP
  • sweating, tremors, anxiety, sleep disturbance
  • seizures

Major alcohol withdrawal symptoms:

  • delerium tremens 24-48 hours after the last drink
  • gross tremors, sweating
  • hallucinations, diorientation, agitation
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7
Q

What are some of the long term effects of alcohol abuse?

A
  1. cirrhosis
  2. Korsakoff’s psychosis - alcohol amnestic disorder- thiamine def.
  3. wernicke’s encephalopathy -thiamine def. with 6th nerve palsy and nystagmus and ataxia
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8
Q

What is the continuum of drug abuse?

A
  1. use
  2. abuse
  3. dependence
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9
Q

What are the 3 main reasons for drug use in the culture?

A
  1. hedonistic- individual is seeking pleasure and wanting to get high
  2. instrumental - use to enhance performance [adderall, steroids]
  3. self-medication - treat anxiety, depression and other forms of dysphoria
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10
Q

What does “incentivize to use” mean?

A

it refers to the sensitivity of the dopamine mediated reward system to cue connection to prior alcohol and drug

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10
Q

What does “incentivize to use” mean?

A

it refers to the sensitivity of the dopamine mediated reward system to cue connection to prior alcohol and drug

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11
Q

What are the 6 main reasons for alcohol use?

A
  1. hedonistic - pleasure seeking
  2. instrumental - improve performance
  3. self-medicating - pain, anxiety, depression
  4. positive reinforcement - get high
  5. negative reinforcement - relief dysphoria
  6. incentivize to use - mesolimbic system gets changed and they use so they don’t go through withdraw and because they are driven by people, places, things associated with the drugs
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11
Q

What are the 6 main reasons for alcohol use?

A
  1. hedonistic - pleasure seeking
  2. instrumental - improve performance
  3. self-medicating - pain, anxiety, depression
  4. positive reinforcement - get high
  5. negative reinforcement - relief dysphoria
  6. incentivize to use - mesolimbic system gets changed and they use so they don’t go through withdraw and because they are driven by people, places, things associated with the drugs
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12
Q

What percent of the population has alcohol abuse/dependence?

Drug abuse/dependence?

A

Alcohol - 5%

Drugs - 1.7%

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12
Q

What percent of the population has alcohol abuse/dependence?

Drug abuse/dependence?

A

Alcohol - 5%

Drugs - 1.7%

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13
Q

What is “dual diagnosis” for substance abuse?

A

it is the recognition of co-morbidities
There can be overlap between substance use disorders and other psychiatric disorders

Bipolar- 28%
MDD- 19%
Dysthymia -18%
Anxiety- 15%

13
Q

What is “dual diagnosis” for substance abuse?

A

it is the recognition of co-morbidities
There can be overlap between substance use disorders and other psychiatric disorders

Bipolar- 28%
MDD- 19%
Dysthymia -18%
Anxiety- 15%

14
Q

What 4 factors contribute to the onset of alcohol/drug abuse?

A
  1. genetics- roughly 50%
  2. temperament/personality
  3. stress- drive self-medication theory
  4. availability- cocaine used to be rich drug until crack
14
Q

What 4 factors contribute to the onset of alcohol/drug abuse?

A
  1. genetics- roughly 50%
  2. temperament/personality
  3. stress- drive self-medication theory
  4. availability- cocaine used to be rich drug until crack
15
Q

Describe a type 1 alcoholic in terms of:

  1. age of onset
  2. genetic loading
  3. alcohol use for anxiolytic effects with tolerance/dependence
  4. spontaneous alcohol-seeking for euphoria
  5. fighting/arrests when drinking
  6. drug abuse
  7. depression
  8. novelty seeking
  9. harm/avoidance/reward dependence
A
  1. older than 20-25
  2. moderate
  3. frequent
  4. infrequent
  5. infrequent
  6. infrequent
  7. frequent
  8. low
  9. high

timid, anxious, and looking for approval. Avoid risky situations

15
Q

Describe a type 1 alcoholic in terms of:

  1. age of onset
  2. genetic loading
  3. alcohol use for anxiolytic effects with tolerance/dependence
  4. spontaneous alcohol-seeking for euphoria
  5. fighting/arrests when drinking
  6. drug abuse
  7. depression
  8. novelty seeking
  9. harm/avoidance/reward dependence
A
  1. older than 20-25
  2. moderate
  3. frequent
  4. infrequent
  5. infrequent
  6. infrequent
  7. frequent
  8. low
  9. high

timid, anxious, and looking for approval. Avoid risky situations

16
Q

Describe a type 2 alcoholic in terms of:

  1. age of onset
  2. genetic loading
  3. alcohol use for anxiolytic effects with tolerance/dependence
  4. spontaneous alcohol-seeking for euphoria
  5. fighting/arrests when drinking
  6. drug abuse
  7. depression
  8. novelty seeking
  9. harm/avoidance/reward dependence
A
  1. before 20-25
  2. heavy
  3. infrequent
  4. frequent
  5. frequent
  6. frequent
  7. frequent
  8. high
  9. low [don’t care what ppl think]
16
Q

Describe a type 2 alcoholic in terms of:

  1. age of onset
  2. genetic loading
  3. alcohol use for anxiolytic effects with tolerance/dependence
  4. spontaneous alcohol-seeking for euphoria
  5. fighting/arrests when drinking
  6. drug abuse
  7. depression
  8. novelty seeking
  9. harm/avoidance/reward dependence
A
  1. before 20-25
  2. heavy
  3. infrequent
  4. frequent
  5. frequent
  6. frequent
  7. frequent
  8. high
  9. low [don’t care what ppl think]
17
Q

What is operant conditioning?

What is classical conditioning of drug abuse?

A

Operant conditioning = A drug effect is reinforcing and this likely to be repeated, “action-outcome”
ancedent–> response–> consequence

Classical conditioning= people, places and things associated with the drug are likely to trigger the desire for the drug

As reinforcement diminishes, the appetite for the drug returns and use behavior is stimulated.

17
Q

What is operant conditioning?

What is classical conditioning of drug abuse?

A

Operant conditioning = A drug effect is reinforcing and this likely to be repeated, “action-outcome”
ancedent–> response–> consequence

Classical conditioning= people, places and things associated with the drug are likely to trigger the desire for the drug

As reinforcement diminishes, the appetite for the drug returns and use behavior is stimulated.

18
Q

What is the key neurological pathway for mediating addictive behaviors?

A

Dopamine-rich mesolimbic system

Limbic–> prefrontal cortex are stimulated by each substance known to have addictive properties

18
Q

What is the key neurological pathway for mediating addictive behaviors?

A

Dopamine-rich mesolimbic system

Limbic–> prefrontal cortex are stimulated by each substance known to have addictive properties

19
Q

Based on the capacity to stimulate dopamine production, what can dependence/addiction be characterized as?

A

“impaired response inhibition and impaired salience attribution”

capacity to control impulses is impaired by stimulation of the system

19
Q

Based on the capacity to stimulate dopamine production, what can dependence/addiction be characterized as?

A

“impaired response inhibition and impaired salience attribution”

  1. capacity to control impulses is impaired by stimulation of the system
  2. seeking pleasurable aspects of substances gains priority [salience] as substance use continues
20
Q

What are the 2 most prominent explanations for denial and the other immature defenses associated with alcoholism and drug addiction?

A 
1. Alcoholism/drug addiction is viewed as a psychological trauma with:
loss of control
low self-esteem
stigma
loss
damaged health
blackouts

This leads to regression and regression–> immature defenses like denial, projection, acting out, externalization, rationalization

  1. Pharmacological effects of alcohol/drugs are rapid, predictable and pleasurable and they are NOT “natural rewards” because the person doesn’t have to work for them. This leads to regressed ego state with:
    impatience, impulsivity, decreased frustration tolerance, passivity [want big reward for little effort], self-centered, omnipotence
21
Q

How does the subjective experience of alcohol or drug dependent patients foster pathological defenses that impede self-awareness and treatment acceptable?

A
  1. repeated exposure to the drug rewires the reward system to think use of the drug is “normal”
  2. behaviors that result from alcohol/drugs make the person feel guilt, shame, worthlessness
  3. the defenses emerge to “protect” the patient from the negative recollections
22
Q

What are the 4 specific cognitive changes associated with pathological use of drugs and alcohol use characterized as?

A
  1. Psychological primacy- drugs become increasingly important in the individuals life [aka salience]
    - patient spends time obtaining, using recovering
    - patient gives up activities, work, etc for substance
  2. self-doubt
    - patient doesn’t think he/she can function w/o drug
  3. sense of loss
    - patient believes he can function w/o the drug but it seems unfair to do so
  4. cannot abstain
    - tried to quit and has not been successful so feels increasingly hopeless
    - the psychological threat makes defense mechanisms come out–> “its not that bad” and “ill quit tomorrow”
23
Q

What is the antidote to the pathological cognitive states of psychological primacy, self-doubt, sense of loss, and failed abstinence?

A
  1. help the chemically dependent person appreciate that they can function w/o the drug one day at a time.
  2. counter defenses by directing the individuals attention to the consequences of their troubling behavior NOT to induce more guilt, but to bring reality to the forefront
24
Q

As time goes on in substance abuse treatment, what change is made in turns of focus of treatment?

A

Early treatment focuses on the dynamics of the disease [like how it affects the brain systems and how the behavioral/cognitive/emotional changes develop

  • achieving abstinence
  • strengthening the ego

Later treatment focuses more on the psychodynamics of the patient

  • insight
  • spiritual development [gratitude, release from compulsion, humility, tolerance of ones limitations, renunciation of “things”]
25
Q

What are the 4 main steps in alcohol treatment?

A
  1. recognition/admittance
  2. compliance- motivated by guilt/shame
  3. acceptance - facilitated by shame and sense of limitations
  4. integration - understands their pathway to addiction
26
Q

How do patients achieve abstinence?

A 
Understand:
1. impact of alcohol on the brain
2. manifestations of dependence
3. defenses that emerge
4. risks of cross-addiction
Emergence of hope
27
Q

How does the patient go through ego-strengthening in the early phases of psychotherapy for addiction?

A
  1. recognize, regulate, and tolerate affect
  2. improve self-care
  3. take initiative [decrease passivity]
  4. improve observing capacity [mindfulness]
28
Q

What are the “stages of change” that a patient’s motivation can move through?

A
  1. pre-contemplation = not thinking about quitting
  2. contemplation
  3. determination = plan for change
  4. action
  5. maintenance phase [3 months after action]
  6. relapse [hopefully not]
29
Q

What are the 5 pharmacotherapies for treatment of addiction?

A
  1. maintenance with cross-tolerance
    - methadone for opioids
    - buprenorphine/natrolone for alcohol
  2. block the drug high
    - natrexone for opioids
  3. aversive
    - disulfiram for alcohol
  4. suppress craving
    - natrexone/acomprosate for alcohol
  5. block withdrawals
    - clonidine

Psychiatry (18 decks)

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