W5: Diagnosis, assessment and treatment

Question 1

Across the DSM-4 spectrum, they always intermixed across

Answer 1

abuse and dependence

Question 2

Criteria that should be added

Answer 2

craving

consumption (quantity and frequency)

Question 3

Set diagnostics for DSM 5 at threshold of

Answer 3

3 criteria or more

Question 4

Severity scales

Answer 4

criteria count
2-3 mild
4-5 mod
>6 severe

Question 5

Could biomarkers be used in DSM

Answer 5

no

Question 6

Which addictions should also be added to the DSM

Answer 6

• cannabis = no in 4, but now there is evidence
• inhalants/hallucingens no evidence
• caffeine yes evidence
• in DSM 5 nicotine is aligned with other SUD
• prenatal yes
• gambling and internet gaming yes

Question 7

Components of assessment Fong

Answer 7

• current and past patterns of use
• diagnose what SUD is present now
• what effect it has on mental and physical state
• understand readiness to change
• co-occuring psychiatric disorders
• medical history
• lab tests
• family SUD
• social factors

Question 8

Assessment of consequences Saitz

Answer 8

CAGE_AID
cut down, annoyed, guilty, eye-opener drug

CRAFFT
car, relax, alone, forget, friends, trouble

more than two yes = likely disorder

Question 9

Effects of brief interventions is to decrease

Answer 9

drinking by 10-12% at 1 year and 3 drinks per week

Question 10

CB Approach for Alcohol use disorders Rohnsenow

Answer 10

cognitive behavioural coping skills training

cue exposue

Question 11

Cocaine dependence CB

Answer 11

contigency management

coping skills training

community reinforcement

Question 12

Marijuana CB

Answer 12

conticency management and coping skills training

Question 13

Opiate CB

Answer 13

contigency management -> decreased use of other drugs while on methadone

Question 14

Smoking

Answer 14

aversive conditioning

and coping skill training

Question 15

Coping skills training

Answer 15

handling emotions or high risk situations for relapse or interpersonal situations more effectively

• alcohol and cocaine
• marijuana

Question 16

RPT

Answer 16

relapse prevention training

Question 17

ACT

Answer 17

acceptance and commitment therapy => decreasing escape from key symptoms

• how to reduce negative thoughts
• mindfulness and behavioural change of via CT
• further research needed

Question 18

Aversive conditioning works for

Answer 18

abstinence initiation
relapse prevention

-BUT avoid positive reinforcement through drug experiences

Question 19

CET Cue exposue treatment good for

Answer 19

relapse prevention

• reduce respondent conditioning to stimuli associated with drugs
• show cues while patient in safe environment
• long sessions
• no for opiate and cocaine
• no evidence after treatment for smokers
• yes for alcohol

Question 20

Contigency management good for

Answer 20

abstinence and relapse

Question 21

Aversive conditioning

Answer 21

-induce nausea via ingestion of agent like apomorphine
=> mod success for drinking

• electrical aversion = less encouraged success
• covert sensitisation: imagining aversive scenes while drinking small amounts = less encouraged success

Question 22

Basic cognitive model of high risk situation for drug use

Answer 22

• activating stimuli
• automatic thoughts
• urges and cravings
• facilitating beliefs

Question 23

Cognitive management

Answer 23

• operant conditioning
• requires measure (urine)
• receive reinforcement for positive behaviour
• cocaine, opiate and marijuana
• most useful with CST
• might undermine intrinsic motivation to change

Question 24

CBT approaches

Answer 24

• relaxation training
• drug refusal skills (social)
• assertive skills (express)
• problem solving skills
• cognitive restructuring (replace thoughts)
• relapse prevention training

Question 25

Primary prevention strategies

Answer 25

primary - before SUD

secondary - early stage

tertiary - minimise the likelihood of serious consequences

Question 26

Types of primary prevention

Answer 26

• information dissemination (educate about harms)
• personal growth
• alternative (reduce boredom)
• skills for resisting
• personal and social skills training
• public health (all population)

Question 27

VR immersion techniques offer

Answer 27

good alternative to conventional cue-provoked treatment

integrate stimulated social interactions

its beneficial effect in assessment and management still needs validation

Question 28

Opioid

Answer 28

agonists= methadone (analgesia)

antagonist = naltrexone, naloxone

partial agonist = buprenorphine (substitute but without reaching dangerous levels)